By Dr. David J. Kim

The story of Elianna Grace, a 4-year-old girl recently hospitalized for a case of "dry drowning" in Sarasota, Florida, has sparked fear amongst parents about whether their children are safe playing in the water.

Elianna’s mother Lacey brought her to the hospital after hearing about other children who had died after swallowing water, she said, like 4-year-old Frankie Delgado in Texas last year.

Fortunately, dry drowning is rare and children suffering from the condition will often have symptoms that prompt parents to seek medical attention.

Here are some facts about dry drowning

The term “dry drowning” has been used to describe a number of scenarios that involve near-drowning or unusual drowning scenarios.

Secondary drowning, the condition that children in Texas, Colorado and Florida had, refers to a process where ingesting a small amount of water into the throat causes spasms of the vocal cords and the airways.

These spasms generate a large amount of negative pressure against the lungs, which can damage the lungs and cause protein and fluids to build up. This prevents the exchange of oxygen and carbon dioxide, resulting in the children having difficulty breathing and coughing. The process usually builds over days and children may not manifest symptoms until 12 to 24 hours later.

Fortunately, secondary drowning is extremely rare. While the CDC does not specifically track incidents of secondary drowning, the agency estimates there are approximately 4,000 total drowning or near drowning incidents in the United States every year -- and experts estimate secondary drowning occurs in one to five percent of these cases.

Elianna developed a fever the next day, which can be a sign of an infection of the lungs -- possible secondary pneumonia -- which occurs in up to 10 percent of the cases.

What are the symptoms of dry drowning?

The main signs of secondary drowning are coughing and difficulty breathing from the fluid and protein in the lungs.

Young children, who may not be as expressive, can appear to be breathing significantly faster than normal with fast up-and-down stomach movements. Vomiting can also accompany the breathing difficulties, as was the case with the Frankie in Texas. Headaches can also result from breathing in less oxygen and breathing out less carbon dioxide.

Children may also exhibit a change in behavior, either appearing more sleepy because of the buildup of carbon dioxide in the blood or extremely agitated because they are gasping for proper breath. Diarrhea is a very unusual symptom of secondary drowning and may have been one of the delays in the diagnosis for Frankie.

How is dry drowning diagnosed?

A young child with secondary drowning usually appears ill and has abnormal vital signs. Health care providers may hear crackles in the child’s lungs during a physical exam; they commonly will use chest x-rays to further assess, which will show areas of “wet” lungs.

Diagnosis may take several visits to a doctor’s office or an emergency department, however, because early on the disease may not be advanced enough to be picked up on an exam or even an chest x-ray.

Parents should be prepared to make additional visits to the doctor if their child is not improving or is becoming sicker.

How is dry drowning treated?

Treatment is different for each child. Some children may only need 100 percent oxygen through a mask for a certain period of time. The mask may or may not have additional pressure to help expand the lungs.

If a child is very ill, a breathing tube or even a ventilator may be necessary for a short period of time. It's extremely rare for a child to require additional interventions beyond the ventilator, but it is possible if the lung failure is extensive.

The overwhelming majority of children with dry drowning will improve with breathing support. Some children may require antibiotics for a period of time, if there is a secondary infection.

Can a child swim again after a dry drowning event?

Secondary drowning is such a rare condition that there is very little data about the likelihood of reoccurrence. The decision to participate in water sports or go into the water again should be made with a health care professional and include a close discussion of risks, benefits and precautions.

The condition, also called noncardiogenic pulmonary edema, is not only caused by secondary drowning, but also can result from anesthesia, infections, certain medications and a number of other scenarios.

Parents and children should mention having had dry drowning if they ever require surgery, need a medical procedure or need hospitalization, so future health care providers can take appropriate precautions.