"Words matter when it comes to caring for our children. The widely spread takes of critically ill "dry drowning" victims succumbing days after swimming to a "rare" medical condition created fear among parents. Many likely grew to distrust physicians who tried to assure them their children did not need to be evaluated for a mythical condition. Worse of all, the "dry drowning uproar drew attention from the real crises we face every summer: Protecting children from all-too-real drownings in swimming pools, natural bodies of water, even 5-gallon buckets for the youngest kids.

"Think of it this way: If someone  develops pneumonia related to food entering the lungs during a choking episode days earlier, he has not experienced 'foodless choking'. That term makes no more sense than 'dry drowning'."

Hawkins, S., & Pescatore, R. (2018). Drowning is never dry: Two ER doctors explain the real swimming danger kids face. Retrieved from http://www.philly.com/philly/health/kids-families/drowning-is-never-dry-two-er-doctors-explain-the-real-swimming-danger-kids-face-20180503.html

"Let's not allow the confusion caused by dry drowning to distract us from the real enemy that drowning is to our children."

Your Kids Aren’t Dry Drowning (Because It’s Not Real). (2018). Retrieved from https://www.kidnurse.org/dry-drowning/

"We are unfortunately entering another season of 'dry drowning' myths being spread far and wide by lay media. Last year's case of Frankie Delgado dying of reported dry drowning (ultimately found to, in fact, be myocarditis), set off a firestorm of Facebook-driven 'fake news' reporting the 'dangers' of this mythical disease. My Peds ED was nearly overrun by the worried well and we know that such fear-mongering created a substantial public health drain."  Rick Pescatore, D.O.

"Nearly every major medical organization has spoken out against misleading terms such as 'dry', 'near', or 'secondary' drowning applied to cases in which a patient got worse within hours of water exposure."

"Before 2002, there were 33 different published definitions of drowning and near drowning. Some of these definitions and terms were confusing and made tracking of drowning patients very difficult.

To standardize our understanding and reporting of drowning, a new definition was proposed in 2002, which was accepted by the World Health Organization, American Heart Association, International Liaison Committee on Resuscitation, and all major medical organizations in 2005. Drowning is the PROCESS of experiencing respiratory impairment from submersion/immersion in a liquid. If someone has difficulty breathing as a result of being underwater, then they have drowned. Drowning doesn’t always end in death. Thousands of people, adults and children, drown every year in the US and survive without any additional complications. There are also some people that suffer a non-fatal drowning and have severe, moderate, or mild brain damage. You can think of it similar to heart attack or stroke. Some people that have a heart attack will die, some will survive without complications and some will survive with some amount of complications. Drowning does not equal death."

Starfish Aquatics Institute. (2015). SAI Position Statement 15-1 on Drowning Terms.

"The medical definition of drowning is "the process of experiencing respiratory impairment from submersion/immersion in liquid." (Definition of Drowning: A Progress Report. Bierens J, Drowning 2e. Berline: Springer, 2014.) Drowning has only three outcomes: fatal drowning, nonfatal drowning with injury or illness, or nonfatal drowning without injury or illness."

Hawkins, S.,Sempsrott, J., Schmidt, A. (2017). Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning. Emergency Medicine News [Blog]. Retrieved from https://journals.lww.com/em-news/blog/BreakingNews/Pages/post.aspx?PostID=377

"Historically, drowning was used to indicate death, while near-drowning was used to describe patients who survive. But many people suffer from strokes, cardiac arrest, or car collisions every year, and we wouldn't consider them near-strokes, near-cardiac arrest, or near-car collisions just because the person survived. The same is true for drowning and near-drowning. A person can drown and survive the same way that a person can have a cardiac arrest and survive."

Hawkins, S.,Sempsrott, J., Schmidt, A. (2017). Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning. Emergency Medicine News [Blog]. Retrieved from https://journals.lww.com/em-news/blog/BreakingNews/Pages/post.aspx?PostID=377

"There is nothing 'near' about the devastating brain damage caused by a non-fatal drowning. The survivor and family endure the life-altering consequences forever from the moment of drowning."

Justin Sempsrott, MD - Drowning Lecture

"According to the World Health Organization drowning is a serious and neglected public health issue claiming the lives of 372,000 people a year worldwide. Fatal drowning is a leading cause of death among children 1 to 14 years of age. The daily toll of this leading global killer continues its quiet rise largely unabated, and in low and middle-income nations certainly does not attract the levels of funding that go into other forms of injury prevention, such as road safety.

Non-fatal drowning events, with symptoms ranging from mild cough to severe pulmonary edema, and morbidity ranging from none to sever neurologic impairment, are far more common than fatal drowning. It is estimated that for every fatal drowning, there are at least 5 non-fatal drowning incidents needing medical care, and 200 rescues performed, depending on how surveillance by lifeguards is provided.

In the US, there are almost 13,000 emergency department (ED) visits per year for drowning with about 3,500 drowning deaths. In contrast, in Brazil, there are 1,561 drowning hospital attendances a year, with 2.6% subsequent deaths and 6,697 total drowning deaths. In Rio de Janeiro city, where a highly effective pre-hospital service is provided exclusively to drowning at three Drowning Resuscitation Centers (DRCs) staffed by medical doctors, an analysis of the 46,060 cases of rescues in 10 years (1991-2000) showed that just 930 cases (2%) were drowning cases that needed medical assistance. "

Szpilman, D., Sempsrott,J., Webber, J., Hawkins, S., Barcala-Furelos, R., Schmidt, A. (2018) The Demythification of Dry and Secondary Drowning. Unpublished.

"Drowning is a leading and preventable cause of death for all ages worldwide. The danger is real, and not esoteric or rare, and all health care providers should use this as an opportunity to discuss with the media and patients the importance of the most important tool for treating drowning: primary prevention.

Such prevention includes continuous and uninterrupted supervision within arm’s reach while children are in the water (even if a lifeguard is present), lifejacket usage, four-sided pool/pond fencing, and swim/water safety lessons among many others."

Szpilman, D., Sempsrott,J., Webber, J., Hawkins, S., Barcala-Furelos, R., Schmidt, A. (2018) The Demythification of Dry and Secondary Drowning. Publication Pending, Cleveland Clinic Journal of Medicine, 2018.

"There has never been a case reported in medical literature of an otherwise asymptomatic and healthy child who suddenly developed serious respiratory distress or died days after being in water.

But it is important to know that symptoms can get worse in the hours immediately after a drowning event.  So even mild symptoms after a drowning episode warrant medical attention.

What do we mean by 'mild symptoms' ? Anything that feels worse than the sensation that, while drinking a glass of water, some of it went down “the wrong way. Children with continued respiratory problems or other symptoms after swimming should always be brought to an emergency department for evaluation. A child who maybe had a brief coughing episode but no further symptoms almost certainly requires no further medical care.”

S.Hawkins, MD,  & R. Pescatore, MD, (2018). Drowning is never dry: Two ER doctors explain the real swimming danger kids face. Retrieved from http://www.philly.com/philly/health/kids-families/drowning-is-never-dry-two-er-doctors-explain-the-real-swimming-danger-kids-face-20180503.html

"More significant symptoms would be persistent cough, foam at the mouth/nose, confusion, or abnormal behavior, which requires more attention and further tests/investigation. Drowning deaths do not occur due to unexpected deterioration days or weeks later with no preceding symptoms. The lungs and/or heart or their passages do not 'fill up with water' and water does not need to be pumped out of the lungs."

Szpilman, D., Sempsrott,J., Webber, J., Hawkins, S., Barcala-Furelos, R., Schmidt, A. (2018) The Demythification of Dry and Secondary Drowning. Unpublished.

"Any person - adult or child - who has been in or under the water and has symptoms of difficulty breathing, excessive cough, foam or froth in the mouth, or aren’t acting right  that occur immediately or within a few hours of being in the water had a non-fatal drowning and should seek care from a doctor. Symptoms usually appear immediately, but may be delayed by a few hours or get progressively worse. Onset or worsening of symptoms usually occurs within the first 8 hours of submersion."

Starfish Aquatics Institute. (2015). SAI Position Statement 15-1 on Drowning Terms.

If a child exhibits anything worse than the experience of a drink "going down the wrong pipe" within a few hours after immersion or submersion in water, seek medical help immediately. Significant symptoms would be:

• persistent cough
• foam at the mouth/nose
• confusion
• abnormal behavior

Prevent drowning by doing these things:

• provide continuous and uninterruped supervision within arm's reach while children are in the water (even if a lifeguard is present)
• have children wear a lifejacket when in, on, or near any body of water
• install locked four-sided pool/pond fencing
• take swimming and water safety lessons (for your child and yourself)