Water safety/Secondary and Dry Drowning

When frightening stories make the news, I know that I can anticipate some calls about whatever the issue is. There were some recent stories in the media about secondary drowning. Several parents have reached out and asked me to address the topic in a blog post. Next week I will continue the swimming theme. I had it all rolled into one but it was way too long. You would be surprised how many different body parts we get calls about that are swimming related. You can read all about those next week.

Let’s get the scary stuff out of the way first. Drowning is the second most common cause of death in children in the United States. Prevention is key. A person who is drowning may not thrash about and call attention to the fact that they are having trouble. They can slip silently under the water without being noticed until it is too late. Even if your child has proven themselves to be solid swimmers, you need to stay actively focused and engaged on watching them like a hawk while they are in the water.

If you are staying anywhere with a pool, make certain that your child has absolutely no access to the pool area when there is no adult present. If you do have pool access, there are lots of pool alarms and safety monitors on the market. Hotels or apartments with fountains need to be treated with caution as well.

 

We had a scare with one of our families a few summers ago. Several adults and children were enjoying a day at a friend's pool in the East Bay. They got out of the pool to have some lunch. Some of the oldest kids started to bicker. While the adults turned their attention to the squabble, a one year old got back into the pool unnoticed and submerged. Thank goodness another of the adults looked up, noticed and was able to get her out and perform CPR. The little girl is perfectly fine, but this was terrifying for everyone. Dr. Karen Makely, one of the wonderful urgent care physicians over at St. Lukes, says that sometimes having a lot of adults around lends a false sense of security. Consider having each adult take turns being on a shift as the designated lifeguard.

 

Drowning is horrible, but the recent stories that scared the bejesus out of my families were about delayed drowning. You may have heard of dry drowning as well. They are not the same thing.

The primary difference between dry drowning and secondary (or delayed) drowning is the presence or absence of water in the victim’s lungs.

Dry drowning is something that can be brought on in several different ways. The first theory is that a sudden rush of water into the throat causes the airway to go into spasm. During this event, although no water enters the lungs, no air enters either, so the victim dies of asphyxiation. Another explanation is that  the shock of a swimmer’s suddenly entering extremely cold water causes the heart to stop.

Distinct from “Dry Drowning” is secondary or delayed drowning. This is also very rare, but  is something that parents need to know about. Symptoms usually develop within 6-24 after an incident. If someone had a near drowning or accidentally swallowed a lot of water, they are at risk for pulmonary edema from the fluid imbalance to the lungs. They may seem fine initially but then present with cough and increased labored breathing. This usually shows up within 24 hours of the event.

Caregivers of young swimmers should try to head off some of these issues by training their kids to keep their mouths closed when jumping into water and to enter very cold water slowly.  This should help avoid aspirating large amounts of water. There is a big difference between water in the lungs and water in the belly. If your child swallows a lot of water they may end up with a tummy ache but it is rarely dangerous. The recent tragic news story about a child who died in Texas with this diagnosis is a bit of a puzzle. He had days of vomiting and diarrhea. Every physician that I spoke to says that it is respiratory, NOT tummy symptoms, that they would be on the lookout for. There is likely more to that story than is getting reported. It is the outliers that make the news.

Here is the takeaway message. It is important to closely monitor any child who has come out of the water coughing and sputtering. Especially keep 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. If there is any concern, an emergency room or immediate medical intervention is needed. The first 24 hours are probably the most critical period. It is important to know what to look for, but to reiterate, in over 30 years with a practice full of swimmers, I am not aware of any of our patients having any serious complications from a mouthful of water. 

I spoke to Dr. Tamariz from the CPMC ER. He reiterates how extremely rare this is, but stresses that if any CPR or resuscitation was needed, a follow up emergency room visit is essential regardless of how well they may appear. For the majority of swimmers that accidentally get a mouthful of water, observation at home is fine unless they are showing the obvious symptoms that are listed above. If you are concerned, go the the emergency room. They will check the oxygen level, listen to the lungs, and keep an eye on things until everyone feels comfortable. If clinically indicated they might do an x-ray but it is not automatic.

I am going to close with a little tidbit of common sense. Labored respirations should ALWAYS prompt you to seek medical attention, even if there is no concern about recent swimming.

Next week I will continue the swimming theme, sharing all the possible swimming related call that the advice nurse team receives!

And now a word from Mr. Nurse Judy - Father's Day 2017

Happy Father's Day to all who are celebrating this weekend. 

Warning: Last year when Sandy wrote his first Father's Day Post for my blog, I got reports of parents sniffling all over Bart. Welcome to "Mr. Nurse Judy's" annual post.

XOXO  Nurse Judy

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I want to thank you all for the kind comments I received after last year’s post about my wonderful relationship with my children, a relationship that continues to get better, even now as I close in on the end of my 6th decade of life, and my daughters near the end of their 3rd decade. It is a role that is paramount to me, and I refuse to let time and distance interfere with my efforts to continually improve it. So far, I think I’ve been pretty successful, and the rewards are immeasurable. Certainly it’s a lot easier when they are young, living in your home, and “need” you to be involved in their lives. But the foundation you create early for how you want that relationship to be makes it a lot easier to enable it to grow, flourish and blossom at any stage of life, even now as they establish their own lives, careers, and relationships. For those of you who didn’t have the chance to reads last year’s post, you can find it here:

 https://nursejudynvp.blogspot.com/2016/06/a-fathers-day-post-from-mr-nurse-judy.html

I want to make clear that I have no special training or educational background in this area. What follows are simply my own philosophies about fatherhood; you may disagree with some or all of them. But this is what has worked for me and I cannot really imagine a father with a better relationship with his adult kids than I have!

So first an update on my relationship with my daughters.  At this time last year, Lauren and I were weeks away from traveling to Tanzania for the challenge of a lifetime. AND WE DID IT!!! We summitted Kilimanjaro on the morning of July 19th, an absolutely grueling climb that took me to the very limits of physical, intellectual, and emotional endurance. In fact, I couldn’t have done it without Lauren’s support, and I was quick to make sure she knew that. We spent two weeks together in very close quarters, most of that time unwashed, extremely sleep deprived, and cold. Summit temperature was 24 below zero! The only cross words that were exchanged were over a misplaced towel (I both misplaced it and spouted those cross words!) I never want to face an ordeal like that again!! At least not until April 2018 when we climb to the base camp on Mt. Everest! See – the relationship just keeps giving!

If you are an avid reader of Nurse Judy’s blog, you may remember that when she was in grade school, Alana ended every night by telling one of us all about her day…in exquisite, and often lengthy, detail! The big, the little; the important and the minutiae. Well, more than 20 years later, I get to do that with her all over again. Every day. And I look forward to it and resent it when another friend has a need for Alana’s time! After obtaining her MSW last June, Alana is now a practicing therapist in a community mental health center in Michigan. She has about a 30-minute commute in each direction and on her car ride home, I get to keep her company!!!! And we talk all about our respective days. The time flies past and she is home before we both know it, but not without each of us learning a little bit more about something in each of our lives. What I have primarily learned is that her counseling clients are the luckiest people in the world because they have Alana as their therapist. I listen in wonder and respect as I get to share in the progress they make dealing with the issues that brought them to her in the first place. She is changing lives on a daily basis and I get to be the fly on the wall. I am overjoyed that she still wants to spend that time of her day with me. I frequently tell her that I am in awe of what she is doing and remind her that she has to take the time to sit back and reflect on that also, and not just move on to the next client…  which brings me to my first point of this year’s father’s day recommendations for building that relationship with your children:

Find reasons to be proud, and praise them whenever you can!  From the first time they can lift their head by themselves, to the first crawl, to standing up, and that first use of the potty, let them hear your voice filled with pride and encouragement. Let it become ingrained in them that you are their number 1 supporter, for both the little and big accomplishments in life.  As I mentioned last year, that’s why I took a day off of work to go see a very shy 2nd grade Alana (right now, all her friends are saying “who the heck are you talking about?”) get up on stage just to say one line in a play; it was a grand small accomplishment that deserved to be recognized. When younger, even though they can’t understand the words, they can hear and feel the sentiment in your voice, and for the rest of their lives, that sound will provide great sources of satisfaction and comfort, and it will provide a lifetime of encouragement for future exploration. Now, I am not one of those in favor of participation trophies and I am not saying that everything they do should get this level of exuberance. But be generous with the praise, especially in their formative years.  This brings me to my next recommendation:

Value the efforts too, not just the successes! There is an old saying that good judgement comes from experience; experience comes from bad judgement! It is a cycle that cannot be completed without falling down. So let them fall down, but don’t bemoan the failure; commend the attempt, and any part of the effort that will help them gain “good judgement” next time. It is quite easy for children to focus on your critical evaluation of whatever it is they are attempting, while underappreciating the praise you may simultaneously be conveying. For example, if you’re trying to teach them to throw a ball, don’t focus on the fact that the ball landed by their feet. Appreciate that there are things they may simply be incapable of at any given age. It’s up to you to understand that, not them, so focus on the things that they can do well (gripping the ball, placing the feet, shifting the weight…) and celebrate these building blocks that will one day end up in those ultimate tasks being that much easier, and enjoyable! Simply focusing on the failure of achieving the end result will certainly lead to frustration, and possibly anger and resentment.

It's ok to be wrong. In fact, it’s good! Admit it, and apologize!It is sad when I see a parent who either insists they are never wrong, or twists circumstances to make it seem that they were not wrong in a specific situation. It’s very easy to play that mental game with a child in an effort to demonstrate that you always know what’s best, or think you will be respected because you are always right. Satisfied that you out-strategized a child in this mental arena? Get over it; it’s not that hard. And it’s not that smart. I (and I think my daughters would agree,) created some of our most profoundly important relationship building moments by admitting I was wrong about something, and apologizing for it. Think about it – is there anything more empowering to your young child than having a person in a position of authority implicitly say to them “I not only heard you but I really listened to what you had to say. I thought about it with all my years of advanced experience, education, and knowledge, and I realized that you were right and I was wrong.” Trust, confidence, consideration, kindness, communication…. there are innumerable benefits to acknowledging your own fallibility to your child! And it tells them it’s ok to be fallible too! You don’t expect/need/want perfection, and they don’t have to live up to that standard. And it teaches them that being wrong is a part of life, not something to be defensive about, and can be dealt with responsibly and respectfully.

Tolerance! I mentioned above that you should “appreciate that there are things they may simply be incapable of at any given age. It’s up to you to understand that, not them…”  You must acceptvery early on that you are incapable of thinking like a child, nor they as an adult. Kind of like the “Men are from Mars, Women are from Venus” paradigm, you and your children speak the same language, live in the same environment, are familiar with the same behavioral mannerisms, yet you have such different frames of reference, experiences, emotions, intellect…that at times it will seem to each of you that the other is speaking a foreign language. And you are!! It is so very easy at those times to get frustrated, and even worse, angry. But it is unrealistic for you to expect them to be able to think, analyze, and express themselves at the level you do. They don’t have your emotional and intellectual development and it is unfair to simply use your advanced capabilities as the measure of their intent. When you feel that coming on, take a break, remind yourself of this, and try your best to see things as they do. You most surely won’t completely succeed, but every little bit of empathy you can muster will bridge that gap just a little. It’s also never a bad idea to voice this self-realization; let them know that you are consciously aware that you are cross communicating and invite them to help think about how each of you can get your respective thoughts out. They’ll develop patience, compassion and problem solving skills!

Establish ground rules for how to disagree! My girls and I had a very useful rule – we weren’t allowed to go to sleep mad! The rest of the argument or disagreement could proceed along its natural course, but ultimately it had to end at this rule. It was really quite simple in its effectiveness since it forced (encouraged?) us to resolve our differences. There were times long after bedtime that one of them would either come out of their room to say “I’m still mad” or amusingly, would slip notes under our door detailing the issue (Alana was the talker; Lauren the writer!) This led to frequent comical exchanges of notes going back and forth under each other’s doors but it was such an easily understood rule that it almost always worked! The key though is to take it to heart! As my brother-in-law sometimes says “gravity, it’s not just a good idea, it’s the law,” my daughters and I made this a law, and if one of us was “violating” the law by claiming fatigue, or anger, or issue complexity, or…etc., the other party was free to demand that we follow the law, sometimes leading to late nights and missed bedtimes! But always successful resolutions of the issue. And guess what? Most of what I wrote above represents the philosophies that I tried to use to help make sure each day ended on a happy note.

Happy father’s day to all. See you next year when we get back from Everest!