Signs Of Dry Drowning

A 2017 article states that during the drowning process, fewer than 2 milliliters per kilogram of body weight typically enters the lungs.

What is dry drowning and what are the symptoms?

Dry drowning is an outdated term for a complication following a drowning incident. A person who has inhaled water or another liquid may experience airway spasms and difficulty breathing. It is a medical emergency.

Healthcare professionals often use the term “post-immersion syndrome” instead. However, some people continue to use dry drowning to describe cases in which a person survives drowning but later develops breathing problems as the muscles around the larynx spasm and block the airways.

This article will define what dry drowning is and the symptoms to watch out for. It will also look at treatment and prevention tips.

According to a 2017 article, dry drowning once referred to cases in which no water was present in the lungs of those who had drowned. However, it is not a medically accepted term.

In the past, doctors used the terms wet drowning and dry drowning before the medical community had the necessary diagnostic tools to examine breathing.

Once they learned that drowning results from a lack of oxygen and not the volume of water in the lungs, the term “drowning” replaced both wet and dry drowning.

Despite not being a medically accurate term, some researchers and doctors may still occasionally say dry drowning to refer to cases in which water, or another liquid, causes the voice box and vocal folds to spasm. This is called laryngospasm and can occur in at least 20% of people who have drowned.

When the voice box spasms, the vocal folds close, and breathing becomes difficult. Liquids may end up in places they should not go, such as the sinuses, and it can be difficult to get air into the lungs.

A severe spasm can reduce the airflow enough to be life threatening.

Typically, this happens after a person has come out of the water. They may start coughing and have difficulty taking in a breath in the hours following the drowning incident.

The World Health Organization (WHO) describes drowning as a process of experiencing breathing difficulties or other respiratory problems after being submerged or immersed in liquid. They list the possible outcomes as:

death
drowning with ongoing health problems
drowning with no ongoing health problems

Drowning occurs when someone cannot breathe after going below the surface of water or another liquid.

When someone is drowning, lung damage and exposure to liquid can cause the major lung passageways to spasm, stopping airflow.

Ultimately, people who die from drowning do so because of a lack of oxygen. They may go into cardiac arrest or have too little oxygen in their blood to maintain brain function.

However, the WHO points out that many people survive drowning. They can either recover completely, shortly after the incident, or recover with ongoing medical problems.

People who have experienced nonfatal drowning should seek immediate medical care if they start coughing excessively and the feeling is worse than something going down the wrong pipe.

Other signs to look out for include:

uncontrollable or continuous coughing
wheezing
lightheadedness or dizziness
sleepiness
confusion
fast or hard breathing
abnormal breathing patterns
trouble breathing
foam in the nose or mouth

In children

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The Centers for Disease Control and Prevention (CDC) say that children between the ages of 1–4 years are most at risk of drowning.

According to the American Red Cross, a person should seek immediate medical help if a child develops the following symptoms after being rescued:

a cough
confusion
difficulty breathing
excessive or prolonged coughing
hard or fast breathing

Parents or caregivers should watch closely for symptoms if a child sputters and coughs after being rescued and returns to their typical self quickly. They should contact a doctor if a child experiences the following within 2–3 hours:

coughing
sleepiness
confusion
breathing difficulties

If a child develops any symptoms after 8 hours, the parent or caregiver should contact a doctor.

If a person seems to lack oxygen or may have drowned, anyone trained should immediately begin CPR and get someone else to call for emergency help.

Once the person arrives at the emergency room, they will often undergo medical tests to examine their ability to breathe. Doctors will also check their vital signs, such as their heart rate, body temperature, and oxygen levels.

If the healthcare professionals determine vital signs are in safe ranges, they will usually monitor the person for between 4–6 hours. Depending on whether the person’s condition improves, doctors will discharge them or admit them to the hospital for longer-term monitoring and care.

Myth: Drowning occurs as a result of water in the lungs

Typically, very little water enters the lungs during the drowning process.

A 2017 article states that during the drowning process, fewer than 2 milliliters per kilogram of body weight typically enters the lungs.

The major concern is a lack of oxygen to the brain, depending on how long a person remains under the water.

If rescue happens before a person’s brain runs out of oxygen, the water can either become absorbed into the lungs and not lead to any problems, or it can lead to excessive coughing.

The coughing will ease or worsen within a few hours. If the coughing worsens, a person should contact a healthcare professional.

Myth: A person can “near drown”

In the past, people used the term “near drowning” to describe those who had survived drowning incidents. However, to be clear about whether someone has survived drowning, the medically accurate terms are fatal and nonfatal drowning.

Another medically inaccurate term includes “secondary drowning” or “delayed drowning.” Healthcare professionals used this term before they understood how drowning causes injury. It refers to those who experience a worsening of symptoms after water exposure.

Dry drowning is an outdated and widely misused term. Some have used it to describe the breathing problems that occur when liquid causes the voice box to spasm.

A person should seek medical help if they or a child develops the following after water exposure:

fatigue or sleepiness
confusion
coughing
difficulty breathing
hard or fast breathing

People should always practice water safety and closely supervise children in pools or hot tubs, at beaches, and by other bodies of water.

Last medically reviewed on April 29, 2022

Respiratory
Emergency Medicine
Sports Medicine / Fitness
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How we reviewed this article:

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Collings Hawkins, S., et al. (2017). Drowning in a sea of misinformation: Dry drowning and secondary drowning.
https://journals.lww.com/em-news/blog/breakingnews/pages/post.aspx?PostID=377
Drowning prevention. (2022).
https://www.cdc.gov/drowning/index.html
Drowning. (2021).
https://www.who.int/news-room/fact-sheets/detail/drowning
Duckworth, T. (2017). Debunking ‘dry drowning,’ ‘secondary drowning’ and ‘delayed drowning’.
https://redcrosschat.org/2017/08/24/debunking-dry-drowning-secondary-drowning-and-delayed-drowningthe-silent-emergency-that-can-happen-after-swimming/
McCall, J. D., et al. (2021). Drowning.
https://www.ncbi.nlm.nih.gov/books/NBK430833/

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Medically reviewed by Meredith Goodwin, MD, FAAFP — By Jennifer Huizen and Belinda Weber — Updated on Apr 30, 2022

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5 Dry Drowning Symptoms to Know

Dry drowning symptoms can occur as long as 24 hours after a child is submerged underwater. Here’s what parents should know about dry drowning.

Updated on February 5, 2023

The terms “dry drowning” and “secondary drowning” refer to delayed symptoms experienced after a child has been submerged in water. Technically speaking, the child has experienced a drowning incident and survived, but they can still experience complications later on as a result of being underwater. Dry drowning can be scary for everyone involved because although the child may appear fine at first, symptoms can appear as long as 24 hours after the initial incident.

Dry drowning can lead to dangerous respiratory distress in kids, but it can be prevented with the proper precautions. Here’s what you need to know before your next swimming session.

(Note: “Dry drowning” and “secondary drowning” are not real medical terms. Many experts reject these names as misleading, and instead refer to the incidents as submersion injuries.)

What Is Dry Drowning?

The terms “dry drowning” and “secondary drowning” (medically known as “submersion injuries”) are often used interchangeably—even by some experts—but they’re actually different conditions, says Mark R. Zonfrillo, M.D., MSCE, a pediatric emergency medicine physician.

Dry drowning

Dry drowning is when someone takes in a small amount of water through their nose and/or mouth, and it causes a spasm that makes the airway close up. Dry drowning usually happens soon after exiting the water. Note, however, that medical experts simply refer to this as “drowning.”

Secondary drowning

Secondary drowning, on the other hand, happens when a little bit of water gets into the lungs, resulting in inflammation or swelling. The body subsequently struggles to exchange air properly through the lungs, which can lead to a build-up of carbon dioxide and dangerously low levels of oxygen. With secondary drowning, there can be a delay of up to 24 hours before the person shows signs of distress.

Some experts reject the terms “dry drowning” and “secondary drowning” altogether, and simply refer to them as submersion injuries. Dr. Zonfrillo says they’re equally dangerous, as both can cause trouble breathing and, in worst-case scenarios, death.

How Common Is Dry Drowning?

Rest assured: Submersion injuries, while incredibly scary, are rare. There aren’t specific stats on how many kids die each year from dry drowning or secondary drowning, but it’s very few, says Kathleen Berchelmann, M.D., a pediatrician at St. Louis Children’s Hospital and Washington University School of Medicine.

In fact, in 12 years of practicing as a pediatrician, Dr. Berchelmann has only seen one patient who experienced drowning that happened long after getting out of the pool. Still, she says, it was a life-threatening scenario, and if you’re going to be spending time at the pool, ocean, or lake this summer, it’s smart to know the signs and symptoms.

Signs of Dry Drowning

Dry drowning might sound terrifying, but there is some good news: It doesn’t happen without clear signs you can spot early on. “You’re going to see warning signs,” explains Sarah Denny, M.D., a member of the American Academy of Pediatrics’ Council on Injury, Violence & Poison Prevention, and an attending physician in the Section of Emergency Medicine at Nationwide Children’s Hospital in Columbus, Ohio.

If your child has required a water rescue, they could be at risk for dry drowning, even if they appear fine when they are pulled out. “Any child pulled from the pool needs medical attention,” says Dr. Berchelmann. “At the very least, call the pediatrician.”

Look out for these dry drowning symptoms in toddlers, babies, and children.

Your child is working harder to breathe

According to Dr. Denny, rapid and shallow breathing or nostril flaring means your child is working harder than normal to breathe—and so does seeing the space between the child’s ribs or the gap above their collarbone when they breathe. If you notice these symptoms, you should seek medical help immediately.

Your child is coughing

Persistent coughing—or coughing associated with increased work of breathing—needs to be evaluated.

Your child appears sleepier than normal

Was your kid just playing excitedly in the pool, and now they’re acting fatigued? It could mean they aren’t getting enough oxygen into their blood. Don’t put them to bed until their doctor gives you the go-ahead. A day of water fun can tucker kids out, but in this case, it’s better to be extra cautious if any sort of water rescue was involved.

Your child is acting different

If your child is acting more forgetful or just not acting like themselves, it could indicate there has been a change in their oxygen status. Similarly, a dip in oxygen level could make your child feel sick or woozy.

Your child is throwing up

“Vomiting is a sign of stress from the body as a result of the inflammation and sometimes a lack of oxygen, and also from persistent coughing and gagging,” explains Dr. Berchelmann.

When to Call the Doctor

If you think your child might have a submersion injury, whether you’re in your backyard pool or on a beach vacation, call the pediatrician immediately. They should talk you through symptoms, says Dr. Berchelmann, and might advise you to visit the ER, a primary care doctor, or an urgent care center.

If your child is really struggling to breathe, though, call 911 and/or head to the emergency room right away. “Necessary treatment may not be available in settings other than the ER,” says Dr. Zonfrillo.

Dry Drowning Treatment

Treatment for submersion injury depends on the severity of the symptoms, says Dr. Denny. The doctor will check your child’s vital signs, oxygen level, and work of breathing. People with mild symptoms might simply need careful observation, while in more serious cases, the doctor may perform a chest X-ray or give them oxygen.

In cases of respiratory failure, which happens when a child can no longer breathe on their own, extra support is required such as intubating them or putting them on a ventilator. The goal is to increase blood flow in the lungs and get the child breathing well again. (Thankfully, respiratory failure is rare with dry drowning.)

How to Prevent Dry Drowning

To prevent dry drowning and secondary drowning—as well as other water-related injuries—consider these expert-approved strategies:

Enroll your child in swim lessons. Kids who have been taught to skillfully and safely navigate the water are less likely to struggle and more like to understand the rules of water safety.
Supervise kids near water. Monitor kids closely whenever they’re around water and make sure to enforce pool safety rules.
Follow water safety measures. Children should wear floatation devices on boats; pools should have four-sided fencing around them; and you should never leave a child alone near standing water.

As long as you practice water safety, pay close attention to your kids after swimming, and get them checked out if you notice trouble breathing, you shouldn’t stress about submersion injuries like dry drowning or secondary drowning. “I can’t emphasize enough how rare they are,” says Dr. Zonfrillo. And for any parent, we know that’s welcome news.

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Signs Of Dry Drowning