Did my daughter almost drown?
January 26, 2010 7:19 AM   Subscribe

How does drowning work?

The other day I told a friend of mine how I panicked when my 18-month-old child slipped in the tub and went underwater for a fraction of a second. My girlfriend told me that I didn't need to panic because drowning doesn't work the way I thought. She explained to me that anyone can get a whole lungful of water and just cough it up and be fine if they get out quickly enough.

Was she right? If so, does the same even apply to children under 2? If my child slips in the tub at someone else's house, I sure as hell want someone to freak and get her out of there as quickly as possible! Right? Or is it, like she said, ok to calmly walk over to the tub and just relaxedly pick the child up? I'm worrying about this a little bit extra because if we hadn't had this conversation, I would have blithely left my daughter with her whenever I needed a babysitter, and now I won't till this gets resolved.

So as morbid as it is, I'm looking for some information about the technicalities of child drownings - something from an authoritative source that can settle the dispute. I wish to either ease my mind, or give my girlfriend better information.

Can you help?
posted by GardenGal to Human Relations (21 answers total) 2 users marked this as a favorite
Best answer: Here's a quote from a site run by the Oregon gov't:
"Contrary to what many people believe, drowning is a quick and silent killer. In the time it takes to

* cross the room for a towel (10 seconds), a child in the bathtub can become submerged.
* answer the phone (2 minutes), that child can lose consciousness.
* sign for a package at your front door (4 to 6 minutes), a child submerged in the bathtub or pool can sustain permanent brain damage."

And here's a pdf from the consumer product safety commission re child drownings.
posted by melissasaurus at 7:28 AM on January 26, 2010

Young children do drown in bathtubs. Here are some tips.

It's hard to say that "panicking" is ever a good idea, but you're right to be concerned and to take action immediately if you think there's a problem. Children die by drowning in bathtubs every year. Bathtubs and swimming pools are a much greater danger to your child than airplanes or sharks or terrorists.
posted by Jaltcoh at 7:32 AM on January 26, 2010

You don't really drown, per se, with drowning you die by asphyxiation because your lungs are filled with water and not oxygen-rich air. That being said coughing up a lungful of water is an unpleasant experience for anyone.

Take a basic lifesaving class - especially one for parents - and you'll be a lot more relaxed.
posted by three blind mice at 7:32 AM on January 26, 2010 [1 favorite]

Even if you cough most of it up, water in the lungs can lead to pneumonia or other respiratory infections. I'm no expert, but I think caution is in order.
posted by echo target at 7:32 AM on January 26, 2010

I was coming in to post a longerwinded version of dfriedman's [deleted] comment. I don't know about the mechanics of drowning or would never argue against swift response, but "calmly" is the most important response in an emergency.

Go to your local Red Cross, or YMCA, or hospital, and take a course in child and infant CPR. Then read "The Unthinkable: Who Survives Disasters and Why". Measure, controlled, calm response makes such an extraordinary difference in crisis and it is a learned response for most people.
posted by crush-onastick at 7:32 AM on January 26, 2010 [1 favorite]

Even if you cough most of it up, water in the lungs can lead to pneumonia or other respiratory infections. I'm no expert, but I think caution is in order.
posted by echo target

In this line of thought, there's also the risk of secondary drowning. Here's an article about it (PDF).
posted by specialagentwebb at 7:35 AM on January 26, 2010

She explained to me that anyone can get a whole lungful of water and just cough it up and be fine if they get out quickly enough.

I think the girlfriend is missing a key point in her own argument: the phrase "quickly enough". i.e. the longer you're submerged, the more your lungs fill with water (due to your body's reflexive "shit I better take a deep breath (even though you're under water) and cough this water out my lungs" reaction - something an adult might have concious control over, but a child might not) and the harder it is to get it all out.

Considering it is the 2nd biggest cause of death for children under 12 in the US, it's not something I would take my chances with.
posted by EndsOfInvention at 7:35 AM on January 26, 2010

She is kind of right, in that if the water is out of your lungs you certainly stand a much better chance of not drowning, but I totally wouldn't want her to be giving my children baths.

Panicking is never good, but acting quickly and deftly is important. You seem to have that part down pat. Take a lifesaving class like others are suggesting, and practice. Chances are you'll never need it, but if you can't remember exactly what you are supposed to do you can end up doing some major, major damage.

Also, if you get CPR certified make sure you always have your cert on you and it's always up-to-date. Doing CPR correctly can/will break ribs, if you're not currently certified you can be sued for damaging your "patient." Yes, it sounds ridiculous if you saved their life, and yes, it happened to a friend of mine.
posted by InsanePenguin at 7:43 AM on January 26, 2010

Drowning is serious risk for small children. No doubt. My nephew got his first helicopter ride after being pulled lifeless out of a swimming pool (because his mother was on the phone and not paying attention when he fell in.) He almost drowned. No doubt.

But you asked "did my daughter almost drown?" because she was quickly dunked in the bathtub and is this something to be worried about?

I'm saying no. My three year old and 20 month old take baths together. Invariably one or the other gets dunked. I am sitting beside and calmly reach in and pull out whomever is the victim. The little boy gives as good as he gets so it's pretty even who gets to play dead baby in the bathtub. Some coughing, lots of crying, dry the face, and then it's over. Ready for the next round.

You can't prevent kids from being dunked, just be there to quickly make sure it doesn't turn into something worse. While there is water in the tub, I never leave the bathroom. And pay attention. That's the key.
posted by three blind mice at 8:01 AM on January 26, 2010 [8 favorites]

There's a big difference between "underwater for a fraction of a second" (original question) and "submerged for 4 to 6 minutes" (the document linked in melissasaurus's answer).

Yes, panic is overreacting. You can't drown from a fraction of a second of anything. The calm retrieval is definitely easier on everyone.

Newborns can already cough out fluid, remember.
posted by rokusan at 8:03 AM on January 26, 2010 [6 favorites]

Mod note: few comments removed - question isn't really about the logistics of panicking, but facts about drowning, thanks.
posted by jessamyn (staff) at 8:04 AM on January 26, 2010

Best answer: The advice to learn first aid and CPR is good, as is the advice not to panic. You also might want to take you child for swimming lessons; one of the first things they teach young kids is to blow bubbles when underwater so they don't inhale water. We live on the banks of a river and took our daughter to classes at the Y starting at 6 months just in case; she is nearly 5 now and is very comfortable in the water.

Having said that, to answer your specific question, it sounds like your daughter did not "nearly drown", but that may well be because you were right there with her. The few seconds it takes to calmly pick her up are not a problem. What is a problem is when someone goes off to answer the phone or the door or whatever and it is a minute or two before they notice the child has gone under and not come up; see the first comment in the thread. Also important to remember is that the bathtub is a very easy place to fall and hit your head, especially if you are a toddler just getting comfortable on two feet. So staying in the bathroom is a must, but if you do that you should be able to head off just about any problem.

The physiology of drowning is more complex than a lot of people realize but it is not an instantaneous event; it takes at least a few minutes to cause brain damage in most cases. Thanks to reflex laryngospasm and other protective reflexes water does not enter the lungs immediately. When it does is usually when you are in trouble. Variables such as the age of the patient, the temperature of the water, salt or fresh water, and others all affect the outcome, such that people underwater for close to an hour have survived with few problems (although that is the exception). And for the benefit of those reading the thread who may witness a near-drowning, the BMJ article specialagentwebb cited is a good example of why anyone who gets so far as to require mouth-to-mouth ventilation should go to the hospital even if they appear fine (treatment has improved greatly since 1980 when that article was published).

Finally, a supervised bath is extremely safe. A much bigger risk are things such as mop buckets left laying around. Often the edge of the bucket is right at the child's center of gravity so that if they fall in head first they become trapped and can then drown in an inch or two of water. You sound like a concerned parent; channeling that concern into education is a good thing.
posted by TedW at 8:28 AM on January 26, 2010 [3 favorites]

I love questions of comparative risk.

Would you allow your child to visit a friend that kept a loaded gun in the house, or a friend with a swimming pool? Guess which is more likely to cause an accidental death.

You can't drown in a fraction of a second. But as this answer points out, serious damage or death can occur faster than most people think.
posted by Cool Papa Bell at 8:31 AM on January 26, 2010

Your daughter didn't almost drown, and your friend is way too blithe about lungfuls of water.
posted by rhizome at 8:57 AM on January 26, 2010 [5 favorites]

Secondary drowning is also not unheard of. This is where someone inhales water, perhaps from a near drowning incident, and subsequently dies of drowning out of the water despite being seemingly OK. Water that enters the lungs can cause a steady deterioration in lung function, leading to death. I doubt if anyone really knows how much water is OK.

Technically it's caused by a loss of surfactants from chemical or osmotic damage to the cells that line the alveoli. Without these surfactants, the alveoli can collapse and/or become stiffened. Typically you'd have a period of relative well-being for several hours after the incident, but then deterioration as alveolar function declines and the person gets less-and-less oxygen. This is why all near-drowning casualties need to receive proper medical attention, even if they seem ok.

So, yes caution is in order. However, fatalities in the article I read on this subject were submerged for >2-3 mins. Interestingly, humans are born with an instinctive sense to hold their breath underwater. I'm not sure when we lose that instinctive sense though.

posted by jonesor at 9:30 AM on January 26, 2010

Water in the lungs could lead to pneumonia, so I wouldn't encourage it. Small children can and do drown in 3 inches of water left in a 5 gallon bucket. Of course you felt panicked, it's your baby, but your panic didn't stop you from taking appropriate action, and it shouldn't stop you from bathing your child, letting your child go swimming, learn to swim, etc. You're doing fine. People love to tell parents they're doing it wrong. Evaluate what they say, but let a lot of it slide off.
posted by theora55 at 10:56 AM on January 26, 2010

with drowning you die by asphyxiation

Depends whether you're in salt or fresh water. Osmosis can take a lungful or two of bathwater into the bloodstream and increase the blood volume to the point where you die of congestive heart failure brought on by hypervolemia. These people won't even necessarily have anything in their lungs to cough out, which passes your girlfriend's "he's fine!" test but not anybody else's.

Apparently you can take in as much as 10% of your body weight in extra fluid that way.

Listen to Tedw. Even if you think you're fine, if you breathed water, go to the hospital.
posted by Sallyfur at 11:30 AM on January 26, 2010

Anecdote Alert!

I was bottle feeding my newborn and the cap came off the bottle. At that same instant, my daughter took a big breath, and I watched the entire contents of the bottle disappear into her lungs. I had, indeed, taken infant CPR, and deftly turned her upside-down over my thigh and, basically, emptied her out. There was a little gurgling for the rest of the day, kind of like she had a cold, but she was fine.

That was 14 years ago, and I'm still not fine.
posted by MrMoonPie at 12:13 PM on January 26, 2010 [2 favorites]

She was right - under most circumstances. As others have said, there are conditions that can make it not so pat as "just cough it up and be fine".

A watchful parent has nothing to worry about. A quick dunk is unlikely to cause any issues. In our house, the more common problem is when one of the tykes decides to drink bath water - something that can happen very quickly - and ends up with diarrhea from the soap.
posted by plinth at 2:15 PM on January 26, 2010 [1 favorite]

Not specifically about children, but the more you know the better.
Understanding the physiology of the process may calm you about your experience.

This link has very good detail: Drowning

Look into swimming lessons for your child, learning early gives you some confidence in your child around water, bathtub or otherwise.
posted by clanger at 3:48 PM on January 27, 2010

Response by poster: Thanks guys: all this information has *really* helped ease my mind. I can't emphasize that enough. Glad I asked.

BTW, we were taking regular swimming lessons when she was 6 months old, and I hope to continue that as soon as we have enough money for lessons.
posted by GardenGal at 4:24 PM on January 27, 2010

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