700 Children's® – A Blog by Pediatric Experts

Delayed Symptoms of Drowning: Know the Signs

Jul 21, 2015

Back in 1999, we had a pool party for our daughter’s fifth birthday. And since there would be lots of little ones swimming in the shallow end of our backyard pool, we decided to hire a lifeguard to ensure a trained set of eyes were always on the water. Our daughter and a couple of her friends were already in the pool when the lifeguard arrived. It was then (before the hired help had the opportunity to step out of his street clothes) that our usually hesitant two-year-old son decided to jump in and join the girls.

He went straight to the bottom.

Fortunately, the lifeguard sprang into action (street clothes and all), rescuing our son and validating our decision to hire him. Aside from a brief episode of coughing and sputtering, our son was no worse for the wear.

As it turns out, the overwhelming majority (>95%) of kids with a close call in the water do fine, but a few (<5%) don’t. Those few will go on to develop delayed symptoms of drowning. Knowing the signs and symptoms of drowning—and what to do if they occur—can mean the difference between life and death for kids who initially appear well after a brief struggle in the water.


The term drowning is defined as “the process of experiencing respiratory impairment from submersion or immersion in liquid.”* There are many mechanisms that contribute to the respiratory symptoms of drowning. These include:

  • Physical presence of water in the lungs, which damages lung tissue and interferes with oxygen delivery.
  • Disruption of surfactant, a soap-like substance that keeps tiny airways from collapsing and sticking together.
  • Laryngospasm, which obstructs the airway at the level of the vocal cords, further reducing air flow and oxygen delivery.
  • Pulmonary edema. This involves body fluid building up in the lungs and results from damaged lung tissue, cardiac arrest and other factors.

The number and degree to which these mechanisms take place determines the severity of symptoms and how quickly they occur.

What about near drowning, dry drowning and secondary drowning?

Drowning is drowning. Other terms used to describe the development of respiratory symptoms following submersion in water are considered medically inaccurate and should no longer be used.

Concerning symptoms

You’ll want to keep a close eye on your child for about 24 hours following a close call in the water. Delayed symptoms of drowning include shortness of breath, difficulty breathing, coughing and/or chest discomfort. Extreme fatigue, irritability and behavior changes are also possible.

What to do

Remain vigilant for about 24 hours, even if your child appears happy and playful with no apparent problem at all. If you notice any respiratory symptom (including persistent cough) or unusual behavior, seek medical help right away. If symptoms are severe, call 911. Treatment of drowning ranges from a few hours of observation in the emergency department to supportive care in a pediatric ICU.

On the other hand, there’s no reason to panic if your child does not display symptoms of drowning following a close call in the water. Remember, delayed onset of drowning symptoms is rare and there’s no way to predict who will be affected before symptoms set in. Simply remain watchful and ready to act.

Prevention is important too!

Our two-year old should NOT have been able to dart into the pool, even with a lifeguard present. We were guilty of inadequate supervision, and the results could have been deadly. Be sure to read our tips for Keeping Your Kids Safe in the Pool before heading out to play in the water this weekend.

* Definition of Drowning: A Progress Report. Bierens J, Drowning 2e. Berline: Springer, 2014.

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Nationwide Children's Hospital Medical Professional
Mike Patrick, MD
Emergency Medicine; Host of PediaCast

Dr. Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr. Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.

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700 Children’s® features the most current pediatric health care information and research from our pediatric experts – physicians and specialists who have seen it all. Many of them are parents and bring a special understanding to what our patients and families experience. If you have a child – or care for a child – 700 Children’s was created especially for you.