Account of a 10-year-old boy's death explains dry drowning and its symptoms.
The following item was the text of an article titled 'Boy's death highlights a hidden danger: Dry drowning' that was posted to the TodayShow.com site on 5 June 2008 and circulated widely online: The tragic death of a South Carolina 10-year-old more than an hour after he had gone swimming has focused a spotlight on the little-known phenomenon called 'dry drowning' - and warning signs that every parent should be aware of. 'I've never known a child could walk around, talk, speak and their lungs be filled with water,' Cassandra Jackson told NBC News in a story broadcast Thursday on TODAY. On Sunday, Jackson had taken her son, Johnny, to a pool near their home in Goose Creek, S.C. It was the first time he'd ever gone swimming - and, tragically, it would be his last. [Rest of article here.] Although the account is essentially true, the article contains some confusing elements that could send parents scuttling to protect their children from one danger when they should be trying to guard them against a quite different one. A 10-year-old boy named Johnny ('Jon Jon') Jackson died as described above on 1 June 2008 in Goose Creek, South Carolina, subsequent to swimming in the pool at the apartment complex where he lived. Although Johnny, a child who lived with autism and attention deficit disorder, was wearing flotation devices on his arms and was being monitored by his mother during his time in the pool, he did inhale some water while swimming; his mother described him as 'taking a little bit of water in and coughing and then calming down.' He afterwards appeared fine, but less than two hours after leaving the pool he twice defecated in his pants and complained of being tired. After being bathed and dressing himself back at the apartment, the boy walked to his bed unaided, leaving his mother to believe he was simply worn out. Yet when his mother checked on Johnny a few minutes later, she discovered that white foam was issuing from his mouth, his lips were blue, and his tongue was sticking out. The family called 911, but the Johnny suffered cardiac arrest during transport to the hospital and was pronounced dead on arrival at Trident Medical Center. According to the coroner, water was found in Johnny's lungs, and the cause of his death was listed as asphyxiation by drowning. While the article about Johnny's death is factual, it contains one key element of confusion: Jon Jon Jackson was not technically a 'dry drowning' victim, but rather a victim of 'delayed drowning,' also termed 'secondary drowning.' That distinction is important because numerous news articles that mentioned Johnny's death and attributed it to dry drowning also supplied the information that dry drowning is responsible for ten to fifteen percent of all drowning deaths, thereby making it seem as though the tragic circumstances that swept away this one particular child loom as a huge risk to other children. This is not the case: The incidence of delayed drowning (which is what killed Johnny) is relatively uncommon; the incidence of true dry drowning is much greater. The latter is therefore what adult swimmers and the parents of juvenile swimmers need be more concerned about, but that form of drowning was not truly described in the article about Johnny's death. Many news stories, by the way, indicate they drew the 'ten to fifteen percent' figure from the Centers for Disease Control. The CDC denies this, distancing itself from that particular factoid with this statement: UPDATE: Recent media reports have incorrectly attributed to CDC data about incidents of 'dry drowning.' CDC supports international consensus defining drowning as 'the process of experiencing respiratory impairment from submersion/immersion in liquid' and does not distinguish between 'wet' and 'dry' drowning. The primary difference between dry drowning and secondary (or delayed) drowning is the presence or absence of water in the victim's lungs. In Jon Jon Jackson's case, he died with water in his lungs, so his death was more typical of 'ordinary' drowning victims (i.e., water in the lungs prevented those organs from transporting oxygen into the bloodstream) even though he lived for a couple of hours after leaving the pool. By contrast, true dry drowning deaths do not involve the presence of liquid in the lungs. There are two primary theories as to what causes dry drowning, and it may well be that both are correct and that this form of death can be brought on in two different ways. The first theory is that a sudden rush of water into the throat causes the airway to snap shut, a condition known as a laryngospasm. During this event, although no water enters the lungs, no air enters either, so the victim dies of asphyxiation. The second explanation posits that the shock of a swimmer's suddenly entering extremely cold water causes the heart to stop. Dry drowning accounts for ten to fifteen percent of all drowning deaths. Considering that approximately 4,000 people drown in the U.S. each year, that means dry drowning kills about 400 to 600 U.S. victims annually. It therefore poses a significant enough mortality risk that those who swim (or who supervise swimmers) should know what can be done to decrease the chance of its happening to them or their loved ones. To help prevent dry drowning, keep your mouth closed when jumping or diving into water, thereby protecting the larynx from a sudden inrush of water that could cause it to spasm and cut off the airway. Also, do not dive or jump into extremely cold water; instead enter cold water gradually. Those who have a history of heart problems should avoid entering very cold water at all, even if they plan to go slowly. Drowning is the second most common cause of death in children in the United States. In addition to following the more usual cautions (e.g., watch them like hawks all the time), caregivers of young swimmers should try to head off dry drowning by training their charges to keep their mouths closed when jumping into water and to enter very cold water slowly. Caregivers should also guard against delayed drowning by monitoring very closely any child who has come out of the water coughing and sputtering (signs of water having been breathed in), especially keeping an eye out for any further difficulties in breathing, extreme tiredness, or marked changes in behavior, all of which are signs that a swimmer may have inhaled a dangerous amount of fluid. Should such difficulties be noted in a swimmer, that person should be taken promptly to an emergency room for medical observation and, if necessary, intervention. One additional caution should be noted regarding drowning: It is a fallacy that those who lose their lives in such fashion will flail about wildly even as they are slipping beneath the water's surface. Drowning generally occurs silently and smoothly, the victim quietly passing away wholly unnoticed as friends or family chatter nearby. Therefore, never mistake a lack of commotion for a sign that everything is all right; instead, keep your eyes on those you are supposed to be watching rather than trust that they will do or shout something to alert you if anything goes awry. Forget about trusting that old saw about drowners' going down three times: they go down once, and they stay down.
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