Skip to Main Content


  • Drowning is the second most common cause of nonintentional death in children and adolescents, with a bimodal distribution of peak incidence between the ages of 1 and 4 years and 11 and 14 years.
  • While wet, dry, fresh water, and salt water drowning differ in pathophysiology, there is little difference in their clinical presentation and management.
  • Early oxygenation and resuscitation, including establishment of an airway and provision of chest compressions, are the most important interventions in determining prognosis and survival.
  • Poor prognostic indicators include prolonged submersion, asystole upon emergency department (ED) arrival, and delay in effective cardiopulmonary resuscitation.
  • Hypothermia from immersion in extremely cold water may exert a protective effect, especially if the hypothermic event occurs before the immersion.
  • Patients who have been asymptomatic and remain so, with a normal CXR and oxygenation, may be discharged after a 6-hour observation period.


In the past, there have been a number of terms associated with drowning that caused much confusion. Medical literature has used terms such as near-drowning (survival from a submersion event beyond 24 hours) and secondary drowning (drowning because of another abnormality that triggered the event).1,2 In 2002, the World Congress on Drowning published the following consensus definition for drowning.


“Drowning is a process resulting from primary respiratory impairment from submersion/immersion in a liquid medium.” Given this definition, duration of survival and initial cause of submersion are irrelevant. This chapter will use this definition for drowning and will identify mortality as “death from drowning.”3


Drowning is the second leading cause of death from unintentional injuries in children aged from 1 to 14 years. It is the leading cause of death in children aged from 1 to 4 years. Males are more likely to drown than females in all age groups, with the highest rate in the 0 to 4 age group.4


Drowning occurs when airway submersion impairs respiration and causes hypoxia. The pathophysiology surrounding this event is complex and influenced by a number of factors (Table 137–1). Drowning medium, water temperature, associated trauma, and patient-specific factors are just a few of them. Despite the multitude of influencing variables, the primary insult is always hypoxia.

Table Graphic Jump Location
Table 137-1. Pathophysiology of Drowning 



After the patient is submerged, he or she aspirates a small amount of water causing reflex laryngospasm. Apnea leads to hypoxia and loss of consciousness. Once unconscious, most patients will aspirate a moderate amount of water. Approximately 10% of patients will maintain laryngospasm, causing what was previously ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.