Understanding Pediatric Drowning

My child had a drowning episode, what happens now?

Pediatric drowning happens when a child is submerged in a liquid-like water. The injuries from drowning can vary based on the situation, how long the child was underwater, and any medical conditions they had before. Each case is different. How your child is taken care of will depend on their specific needs, the type of care initially needed, and how they progressed, especially breathing and awareness. You may hear members of the healthcare team use the terms “drowning” and “submersion” interchangeably when referring to your child and injuries. They mean the same.

Child drowning event

Drowning is a serious event that can happen quickly, especially with children. Understanding what happens after a drowning incident involves several phases of care.

1. After rescue

When a child is rescued from the water, the first step is to check if they are still breathing. If they are not, emergency responders will provide rescue breaths, start CPR (Cardiopulmonary Resuscitation), and apply oxygen to prevent further injury. 

An Automatic External Defibrillator (AED) may also be used to help get their heart working again in some cases. After the initial rescue, the child will be transported to the hospital emergency department for further evaluation. The healthcare team will continue their efforts for the heart to beat and the lungs to breathe. These recommendations are consistent with the American Heart Association Guidelines.

2. The hospital course 

At the hospital, the healthcare team will assess the child’s condition. They will perform several tests and observe your child to check how well they are breathing and if there is any unfortunate damage to the brain, lungs, or heart. Sometimes, even if a child appears fine at first, they may develop complications later, so be careful. It will also depend on how long your child was submerged in the water and prior health issues.

• • Monitoring: The medical team will closely monitor the child’s vital signs, like heart rate (how fast the heart is beating) and oxygen levels. They may use machines to follow these numbers with heart and oxygen monitors.
  • Tests: Your child may need tests like X-rays or CT scans to see if there is any injury to the lungs or other organs. These tests help them understand if the lungs have water in them or if there are other infection-related issues. They may also check your child’s blood to look for signs of organ damage.
  • Oxygen Therapy: If your child shows trouble breathing, they will receive oxygen through a mask on their mouth and nose and sometimes they will need a special mask with continuous positive pressure (CPAP) to help remove water from the lungs. This helps ensure they get enough oxygen while their lungs recover. If the injury is severe or your child is unable to breathe on their own, they may need a breathing tube in their trachea and a ventilator may be used to support their breathing.
  • Fluid & Electrolyte Management: Sometimes, the health care team will give fluids through an intravenous line to keep your child hydrated, electrolytes balanced, and kidneys working. This is especially important if your child is unable to drink water.
  • Neurological Checks: The health care team will frequently check the child’s brain function. They will look for signs that your child’s brain is functioning well or healing from injury. Neurological checks look for responsiveness and movement. Sometimes other tests are needed to evaluate how the brain is recovering after drowning.

3. Recovery process

Recovery after a drowning event will be different for each child. Some may improve quickly, while others might need longer or ongoing care. You and your child may experience the following:

• • Emergency Department: Each child who experiences drowning will be evaluated and observed in the emergency department. For non-fatal drowning with no to mild injuries, your child may be observed for 6-8 hours before being discharged to home with you. For more serious drowning events, your child will be admitted to the hospital for ongoing observation, close monitoring, and care.
  • Observation: Children with moderate injuries will often stay in the hospital for observation, sometimes for 24 hours or more. This allows the healthcare team to watch for any delayed injuries or complications. 
  • Critical Care: If your child’s condition is severe, they may be admitted to a critical care unit. Here, specialized healthcare staff can provide intensive monitoring and treatment, to ensure your child receives the necessary support for their recovery. Admission to a critical care unit usually means a longer hospitalization.
  • Rehabilitation: After initial treatment, some children may need rehabilitation services for continued recovery or ongoing care. This can include physical therapy to regain strength and coordination, as well as occupational therapy to help with daily activities. Speech therapy may also be needed if the child has difficulty communicating.
  • Emotional Support: Experiencing a drowning event can be traumatic for the child and the family. Hospitals may have counselors, child life specialists, or social workers available to help both your child and your family process what happened.

How can the family be involved?

Family plays a crucial role during this time. There are several ways you can support your child:

• • Stay Close: Your presence can be comforting during a scary experience.
  • Ask Questions: Do not hesitate to ask the healthcare team about your child’s condition. Understanding what is happening can help ease your worries. 
  • Encourage Communication: Let your child express their feelings. Talking about their experience can help them cope with any fears or anxieties.
  • Follow-Up Care: After leaving the hospital, following care instructions from the healthcare team is important. Attending follow-up appointments can aid in your child’s recovery process.
  • Include siblings and peers: Depending on the age of your child, peer groups can be helpful in the emotional recovery of the event. Siblings will also be affected by the event and may need emotional support as well.

When recovery doesn’t happen per your expectations

Unfortunately, not all children recover fully from drowning incidents. In some cases, the lack of oxygen to the brain can lead to severe brain injury or even death. If a child does not respond to treatment and shows signs of severe brain injury, families may have to face difficult decisions regarding their care.

Families need to receive support during this time, whether from medical professionals, counselors, or support groups. Grieving and processing the situation can be incredibly challenging, and seeking help can provide comfort and understanding.

Sources

American Heart Association. (2024, November). Highlights of the 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstance: Resusciation following drowning: An update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. https://cpr.heart.org/-/media/CPR-Files/CPR-Guidelines-Files/Highlights/2024_Drowning/Hghlghts_2024GLFU_Drowning_240927.pdf

Berger, S., Siekmeyer, M., Petzold-Quinque, S., & Merkenschlager, A. (2024). Drowning and nonfatal drowning in children and adolescents: A subsequent retrospective data analysis. Children, 11(4). 439. https://doi.org/10.3390/children11040439

Brown, K. L., Agrawal. S., Kirschen, M. P., Traube, C., Topjian, A., Pressler, R., Hahn, C. D.,…Tasker, R. C. (2022). The brain in pediatric critical care: Unique aspects of assessment, monitoring, investigations, and follow-up. Intensive Care Medicine, 48(5). 535-547. doi: 10.1007/s00134-022-06683-4 

Cantwell, P. G. & Verive, M. J. (2021). Drowning treatment & management. Medscape Emergency Medicine. Retrieved from https://emedicine.medscape.com/article/772753-treatment#:~:text=Victims%20of%20drowning%20have%20most,attention%20to%20cervical%20spine%20precautions.

Laudato, N., Yagiela, L., Eggly, S., & Meert, K. (2020). Understanding parents’ informational needs in the pediatric intensive care unit: A qualitative study. Progress in Pediatric Cardiology, 57. https://doi.org/10.1016/j.ppedcard.2019.101172 

Pellegrino, F., Raffaldi, I., Rossi, R., De Vito, B., Pagano, M., Garelli, D., & Bondone, C. (2023). Epidemiology, clinical aspects, and management of pediatric drowning. Italian Journal of Pediatrics, 49(1).74. doi: 10.1186/s13052-023-01464-1. 

Peri, F., De Nardi, L., Canuto, A., Gaiero, A., Noli, S., Ferretti, M., Vergine, G., … Norbedo, S. (2023). Drowning in children and predictive parameters: A 15-Year multicenter retrospective Analysis. Pediatric Emergency Care, 39(7). 516-523. doi: 10.1097/PEC.0000000000002987.

Thank you to our contributors

Kelly Bouthillet & Janise Tijssen