Submersion Injuries In Children

What are submersion injuries?

Submersion (sub-MER-zhun) injuries are conditions caused by not being able to breathe under any liquid substance, such as water. Liquids entering your child's lungs may prevent him from getting enough air and the brain from getting enough oxygen. Submersion injuries may lead to a water rescue, near-drowning or drowning. Water rescue is when your child remains alert after a submersion or immersion injury. Your child may have temporary (short-term) symptoms like coughing that clears up quickly. Near-drowning is when your child survives but has more serious symptoms after an immersion or submersion injury. Drowning is caused by a long period of immersion or submersion that leads to death. It is one of the leading causes of accidental deaths among all age groups.

What causes submersion injuries?

Submersion injuries usually happen while swimming or being around pools or bodies of water. The following factors or conditions may increase your child's risk of having a submersion injury:

  • Accidents when boating or swimming, or falling through thin ice.

  • Eating a heavy meal before swimming.

  • Lack of an adult watching over babies and toddlers while bathing, swimming, or playing.

  • Medical conditions, such as seizures (convulsions), autism, and physical or mental disorders.

  • Not knowing how to swim or not being able to swim when needed.

  • Pool area that is not fenced.

  • Swimming, diving, and doing water sport activities without using life jackets.

  • Teenagers using alcohol or drugs when swimming or boating.

What are the signs and symptoms of submersion injuries?

Your child may have any of the following:

  • Abdominal (belly) enlargement, nausea (upset stomach), or vomiting (throwing up).

  • Cold skin that may appear as white to bluish-purple patches.

  • Confusion, trouble thinking or remembering, or loss of consciousness.

  • Coughing , increased breathing, shortness of breath, or wheezing (high-pitched noise heard when breathing out).

  • Increased or decreased heartbeat or low blood pressure.

  • Weak or absent pulse.

What problems can happen after submersion injuries?

Your child may have any of the following:

  • Acute respiratory distress syndrome: This is a sudden and very serious condition that occurs when your child's lungs become swollen and filled with fluid. The lung fluid causes a severe (bad) shortness of breath that may lead to respiratory failure. Respiratory failure means your child cannot breathe well enough to get oxygen to the cells of his body.

  • Brain edema: Brain edema (swelling) may be caused by brain cell damage when no oxygen is present for a long period.

  • Hypothermia: Hypothermia happens when the body temperature drops way below normal causing many problems with how things work inside the body. Once the body temperature drops too low for a long period, organ failure may develop and cause death.

  • Pneumonia: Pneumonia is the swelling of the lungs that is usually caused by an infection. The liquid in the lungs may make it hard for your child to breathe. People with pneumonia can have symptoms that range from mild to very severe.

How are submersion injuries diagnosed?

Your child's caregiver will do a complete physical examination on your child. He may also need to know what caused the submersion injury. Tests may be done to know the condition of your child and what other problems may happen. These tests may include any of the following:

  • Blood gases: These tests are also called arterial blood gases (ABGs). Blood is taken from an artery usually in your child's wrist. ABGs may be done if your child has trouble breathing or other problems caused by his illness.

  • Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.

  • CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your child's body. Your child may be given dye, also called contrast, before the test. Tell the caregiver if your child is allergic to dye, iodine, or seafood.

  • EEG: This test is also called an electroencephalogram. Many small pads or flat, metal buttons are put on your child's head. Each pad has a wire that is hooked to a machine. This machine records a tracing of brain wave activity from different parts of your child's brain. Caregivers look at the tracing to see how your child's brain is working.

  • MRI: An MRI uses a powerful magnet and radio waves to take pictures of the inside of your child's body. Caregivers may use the MRI to look at your child's brain, muscles, joints, bones, or blood vessels. Your child will need to lie still during his test. Never enter the MRI room with any metal objects. This can cause serious injury.

  • Neurologic signs: These are also called neuro signs, neuro checks, or neuro status. During a neuro check, caregivers see how your child's pupils react to light. They may check his memory and how easily he wakes up. His hand grasp and balance may also be tested. How your child responds to the neuro checks can tell caregivers if his illness or injury has affected his brain.

  • Chest x-ray: This is a picture of your child's lungs and heart. A chest x-ray may be used to check your child's heart, lungs, and chest wall. It can help caregivers diagnose your child's symptoms, or suggest or monitor treatment for medical conditions.

How are submersion injuries treated?

Your child should be removed from the water quickly. Lay person CPR must be done as soon as possible. CPR is also called cardiopulmonary resuscitation. CPR is used when a person stops breathing and his heart has stopped beating. "Lay person" refers to anyone who is not a trained healthcare worker. If you start CPR early and do it correctly, you may be able to save your child from dying. Ask your child's caregiver for information about CPR. Your child after initial rescue and CPR, must be brought to an emergency facility for further treatment and observation. Your child may also need any of the following:

  • Endotracheal tube (ET) insertion: An endotracheal tube may be put into your child's mouth or nose. It goes down to his windpipe to help keep the airway open and help him breathe. It may be hooked to a ventilator (breathing machine). Your child may get extra oxygen through the ET tube. Your child will not be able to talk while the ET tube is in place.

  • Medicines: Antibiotics may be given for lung complications. Pain medicines are needed especially if there is injury or trauma. Medicines to lower blood sugar may be given to your child if needed.

  • Oxygen: Your child may need extra oxygen to help him breathe easier. It may be given through a plastic mask over the mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside the nose. Tell your child's caregivers if his nose gets dry or if the mask or prongs bother him. Ask your child's caregivers before taking off the oxygen. Never smoke or let anyone else smoke in the same room while the oxygen is on. Doing so may cause a fire.

How can submersion injuries be prevented?

Submersion injuries may be prevented by doing any of the following:

  • Teenage alcohol and drug use should be avoided while doing water activities.

  • Private pools should be fenced in all four sides to block off the pool totally.

  • Children especially those with seizures or autism should never be left unattended when in or close to water.

  • Pool owners, parents and child carers should have CPR training.

  • Swimming lessons for children can improve swimming abilities and water rescue.

  • Use of life jackets is recommended for all children when swimming, boating or doing water activities.

  • When swimming in open water, stay close to where life guards are visible.

Where can I find more information?

For more information regarding submersion injuries, please contact the following:

  • American Academy of Pediatrics
    141 Northwest Point Boulevard
    Elk Grove Village , IL 60007-1098
    Phone: 1- 847 - 434-4000
    Web Address: http://www.aap.org
  • Centers for Disease Control and Prevention
    1600 Clifton Road
    Atlanta , GA 30333
    Phone: 1- 800 - 232-4636
    Web Address: http://www.cdc.gov

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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