Drowning: America’s Second Killer

• Drowning is the second leading cause of death, behind guns, of children in the US. 
• It is not secret that minorities experience higher rates of illness and death due to health disparities. That applies to drowning incidents as well. The rate among African American children is twice greater than the Caucasian counterparts. 
• This article provides an overview on the physiology of drowning, and serves as a reminder to practice water safety with your little ones this summer. 

Gun violence in the United States is abhorrent. Rhetoric on the senseless, unnecessary, and tragic killings cannot address the suffering of parents who have lost a child or loved one. In the United States, firearms are the leading cause of death for children ages 1 to 19, with 18,000 children killed or wounded by gun violence. 

But another unsuspected danger lurks with summer approaching, gas prices skyrocketing and pools, lakes and oceans, easy portals for cheap access. Drowning is the second leading cause of unintentional injury and death for children up to age fourteen, and the leading cause for those ages one to four. Accident death and injury to our children should not occur with addressing the racial disparities that exist across healthcare.

Statistics on Drowning 

Exsisting data show that racial and ethnic minorities across the country experience higher rates of illness and death across a wide range of health conditions. Racial disparities that exist in healthcare translate into accidental drownings.

In parents’ eyes swimming pools have defined depth, visible bottom, lack of currents and underwater hazards. Yet, in the United States, drowning in the swimming pool is a major threat to young children. And rates for minorities increase.  

Accidental drowning death rates for those aged ≤29 years was 1.3 per 100,000 population. The rate per 100,000 among African Americans was (1.8x) higher than other racial/ethnic groups and was greater than (2.0x) than Caucasian children.  

As defined by the 2002 World Congress, drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. We can classify drowning outcomes as fatal or nonfatal.

Does water have to enter your lungs to drown? No, secondary to persistent laryngeal spasm, 10-20% of drowning victims have no water in their lungs. What lay individuals and medical professionals call dry or secondary drowning is, by definition, still drowning.  

Pathophysiology on Drowning

The physiology of drowning relates to discrete events: immersion (upper airway above water) and submersion (upper airway under water). For children, drowning can be silent. As fluid gets into their upper airway, they cannot scream or shout.

The upper airway comprises the nose, pharynx, larynx, and extra-thoracic part of the trachea. What happens when water enters a child’s upper airway? Spasms occur, driven by reflexes protective of human life.  

Any irritation of the laryngeal mucosa can lead to laryngeal closure, protection against foreign bodies entering the tracheobronchial tree. Drowning beings with the larynx.

The first gasp of water into a child’s mouth that stimulates laryngeal spasm and, later, hypoxemia through breath holding. For children, their ability to prevent water from going into their lungs lasts less than thirty seconds.  

90% of drowning cases occur in freshwaters such as rivers and pools. This skewed presentation hints to the physiological effects of seawater and freshwater drowning on the human body, even though the result is death.

The effects of seawater on pulmonary surfactant include blood-air barrier disruption, pulmonary edema, inflammation, and other hypertonic stimulation. Surfactants are essential for gas exchange and alveoli function.

Salt water, being high salt (sodium), prevents seawater from crossing the membranes of the peripheral capillaries. Instead, the blood and seawater cross over the membranes and into the lungs. What results is hypoxia, death and drowning in the victim’s own fluids. 

Key Takeaways on Drowning

As a rule, in the pool, keep your young children at arm’s length. It is important for parents to understand what drowning looks like in small children.

The act of drowning may be more subtle than you think. If a child is not wearing a life jacket and drops below the water line, or bobs in the water, they may be in trouble. If children go under water, inhale water, they are at risk.

This can occur in the bathtub, dog bowel, or toilet. If this exposure irritates the lungs, causing secondary fluid build-up, the lungs become vulnerable. With any suspected exposure, parents need to watch for abnormal breathing, sluggishness, changes in behavior, persistent coughing, and chest discomfort. 

 A large portion of children who drown do so with their parents within 25 yards. What lay individuals call dry drowning results from inhaled water and fluid buildup in the lungs (pulmonary edema). When untreated, pulmonary edema can be fatal.

Of concern to parents, symptoms may appear for 24-48 hours after water exposure. For parents, nothing replaces the vigilance of parents and those overseeing small children in any bodies of water.  

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