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What’s the No. 2 Cause of Accidental Death in Children?

June 19, 2013 | 58,762 views
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By Dr. Mercola

Drowning is the fifth leading cause of unintentional injury death in the US, where about 10 people die from drowning every day.

The risk is even greater among children aged 1-4, who have the highest drowning rates, and it remains the second-leading cause of accidental death (second only to motor vehicle accidents) for kids 1-14.1

What’s shocking, however, is that many drowning deaths among children occur when the child is being supervised and may be only a short distance from an adult. Occurring quickly and quietly, a drowning can happen right before your eyes, before you even realize what happened…

A Drowning Person Cannot Call for Help

This is a Flash-based video and may not be viewable on mobile devices.

Many people believe a drowning person will flail about in the water, splash and make noise to call for help. But this image, widely used on TV shows to depict a drowning, is far from reality.

Francesco A. Pia, Ph.D., a former lifeguard and educator, coined the term “instinctive drowning response” to describe what happens when a person is very close to drowning. In the video above, you can see an example, in this case a boy who is little more than an arm’s reach away from several other swimmers who are oblivious to his distress.

As Pia explains, when a person is drowning, nature takes over and the movements become a result of instinct. For starters, the person will not be able to call for help, as their body is working on struggling to breathe first and foremost.

They also will not be able to wave their arms to attract attention, as the instinctive response is for your arms to extend out laterally and press down against the water’s surface in an attempt to keep your head above water. Children may even appear to be dog-paddling when in fact they’re drowning.

The other telltale sign of a drowning person is no movement from their legs; a drowning person will not kick but will instead remain upright in the water, sometimes appearing to be climbing an invisible ladder with their feet.

5 Signs of Drowning to Memorize Before Your Next Trip to the Beach or Pool

According to Dr. Pia and Mario Vittone, a former US Cost Guard rescue swimmer:2

The Instinctive Drowning Response represents a person's attempts to avoid the actual or perceived suffocation in the water. The suffocation in water triggers a constellation of autonomic nervous system responses that result in external, unlearned, instinctive drowning movements that are easily recognizable by trained rescue crews.”

You, too, can learn to recognize the signs that a person is in need of immediate assistance in the water. If a person is shouting and waving for help, they may still be in distress and need assistance. However, the five signs that follow, reported in On Scene, the journal of US Coast Guard Search and Rescue,3 may occur when a person is only 20-60 seconds from disappearing below the surface:

  • Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary, or overlaid, function. Breathing must be fulfilled, before speech occurs.
  • Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
  • Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
  • Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
  • From beginning to end of the Instinctive Drowning Response, people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

Other “quiet” signs of drowning reported by Vittone include:4

Head low in the water, mouth at water level Head tilted back with mouth open Eyes glassy and empty, unable to focus
Eyes closed Hair over forehead or eyes Not using legs – Vertical
Hyperventilating or gasping Trying to swim in a particular direction but not making headway Trying to roll over on the back
Appear to be climbing an invisible ladder Children who are suddenly quiet  

‘Dry Drowning’ and ‘Delayed Drowning’ Are Also Risks

It’s possible to die from drowning even out of the water. In 2008, one widely reported case described a 10-year-old boy who inhaled some water while swimming but otherwise appeared normal. Later that night, after walking home and taking a bath, the boy died in his bed as a result of delayed drowning. This type of drowning, sometimes called secondary drowning, can occur up to 24 hours after exposure to water, and occurs when a small amount of water in the lungs prevents oxygen from being transported into the bloodstream properly. A person who has experienced a near-drowning is especially at risk, but anyone who has spent time in water can be at risk. Signs of delayed drowning to watch out for include:

  • Vomiting or involuntary defecation immediately after swimming
  • A sudden change in behavior, such as extreme fatigue, lethargy or agitation
  • Trouble breathing

Dry drowning, on the other hand, occurs when no water enters the lungs, but rather a sudden rush of water into the throat (such as might occur from jumping into a pool with your mouth open) causes the airway to shut, causing suffocation. 

What Makes Spinal Cord Injuries More Likely at the Beach?

Playing in the surf is a favorite pastime for many, but aside from drowning, one of the greatest risks it poses is spinal cord injuries that can occur when a wave picks you up and throws you head-first into the sand.

The spinal-cord injuries that follow can lead to paralysis or even be fatal, and Paul Cowan, head of the emergency room at one Delaware hospital, noticed that they often come in waves. He and a team of researchers are now trying to track down whether certain environmental factors, such as wind speed, air or water temperature, or the angle and height of waves, make these traumatic injuries more common, but so far the research hasn’t revealed an obvious pattern.

Others, however, believe that beach replenishment, in which sand is pumped onto beaches to help stop the erosion process, may be creating steep slopes and waves that break close to shore, creating the perfect storm for spinal cord injuries.

While this issue has yet to be formally studied, data from the United States Lifesaving Association (USLA) shows that major medical injuries often rise on beaches following replenishment projects. For instance, in Ocean City, Maryland after a beach replenishment, major medical injuries rose from 87 in 2006 to 345 the following year.5 Veteran lifeguard Peter Hartsock said the dangers prompted him to quit bodysurfing altogether:6

“I’m not going to tell anybody else not to bodysurf, but as far as me, I stopped during my first year of lifeguarding. Sure it’s fun, but you have nothing between you and the bottom (of the ocean) … I saw so many people get hurt bodysurfing. You don’t know where you’re going to hit, and you’re going headfirst. It’s like diving off a pier when you can’t see the bottom.”

6 Top Water-Safety Tips

If you plan to spend any time in a pool or natural body of water this summer, keep the following tips in mind.7 They could save a life:

  • Learn to swim; formal swimming lessons have been shown to cut the risk of drowning among small children by up to 88 percent8
  • Wear a life jacket
  • Supervise children when in the water (including in the bathtub); supervisors should be in arm’s reach of preschool children at all times, and should not be involved in other distracting activities, such as reading or talking on the phone, when watching children in the water
  • Always swim with a buddy
  • Avoid alcohol when swimming or supervising other swimmers
  • If you have a swimming pool, install a fence completely around the pool and remove toys after use (they may encourage children to enter the pool area); also be aware that air-filled and foam toys are not designed to keep swimmers safe, nor are they an acceptable alternative to a life jacket
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