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By Anastasia Alcock
Drowning is such an emotive topic as all too frequently it is the result of a small child wandering off on their own, unsupervised.  As a doctor in A&E I am on the receiving end of children following such accidents.  These children come in via ambulance and the team of health professionals are often already assembled and awaiting their arrival.  These children have often been submerged for some time and their lungs are full of water.

There is a less well known phenomenon associated with drowning called Secondary Drowning.  This occurs following an incident where the child has fallen into some water or perhaps slipped in the bath and has been submerged under the water for a very short period of time.  They were scooped up out of the water whilst they were coughing and spluttering- they were able to get their breath back quickly and appeared to recover for the ordeal relatively quickly.  Later on, anywhere from 1 hour to 72 hours later the child shows signs of confusion and not being themselves. 

What has happened is that a small amount of water has got into their lungs and has irritated the lung tissue.  This causes an inflammatory reaction (pulmonary oedema) which inhibits the successful transfer of oxygen from the air into the blood and also carbon dioxide from the blood into the lungs.   This causes the oxygen levels in the blood to fall and the carbon dioxide levels to rise.  This leads to confusion and a varying level of consciousness, also children can be lethargic.

You need to be aware of this illness and hence get your child seen by a doctor if they have had an incident such as this.  They will need to be monitored to check for any signs of secondary drowning.  They will have their vital signs done- heart rate, saturations of oxygen, respiratory rate and temperature. 
They may also need a CXR and a small blood test called a blood gas to
ascertain how their lungs are coping.  They may need some respiratory support depending on how badly affected their lungs were.  This might be via a non invasive method such as a face mask or nasal prongs with oxygen or maybe a little more support is needed and a machine is used to increase the flow of oxygen reaching the lungs- via a tight fitting face mask or nasal prongs.  Rarely they may need us to take over their breathing for them until their lungs recover, they would need sedating and then intubating and ventilating.  Having to put a child onto a ventilator is not a decision we would take lightly and your child would need to be in a Paediatric Intensive Care Unit (PICU) so they may need to be transferred to a larger hospital that has this facility.

The best form of treatment is actual prevention, as is so often the case.  Children under 7 years of age should not be left in the bath unattended, toddlers should not be allowed in the bathroom or near water (ponds, pools, streams and even buckets of water and deep puddles) without adult supervision.  Children should never be left swimming unattended and those who are weak swimmers should have an adult at a maximum of an arms length away.

Ideally appropriate barriers should surround pools and other water features, in many countries there are regulations in place that require this by Law.

You should learn CPR- this may mean you going for a course initially and then a refresher course at least every 3-4 years.  It is vital that you are confident and able to know what to do in an emergency.  There is a fabulous APP that you can get that is free from the British Red Cross called “Baby and Child First Aid by British Red Cross”.  I highly recommend this as it is very easy to use and has video clips to aid you.
About the Author

Dr. Anastasia Alcock
The Prenatal Classroom

Mother-of-two Anastasia Alcock holds a Diploma in Obstetrics and Gynaecology from Imperial College School of Medicine in London. She has worked as a paediatrician in hospitals including Guy’s and St Thomas’ Hospital, London, The Royal Brompton Hospital, London and the John Radcliffe Hospital, Oxford and has significant experience in delivery and newborn care.

Most expectant mums have a multitude of questions as they prepare for their new arrival. Who better to ask for advice and support than an experienced doctor who is also a mum and who above all has the time to listen to your concerns and worries?

Anastasia launched The Prenatal Classroom to offer group and private lessons for expectant parents to teach them the knowledge they need to approach parenthood with confidence.

The course was put together based on Anastasia’s medical knowledge, her own experiences as a mother the psychological wellbeing of pregnant women and with additional input from experts in nutrition, breastfeeding and baby care.

Classes are held in West London and Oxford. They are relaxed and informal but have a clear format and come with the guarantee that the same doctor will teach all your classes.

T: 07940 589 021
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