The good news is, dry drowning or secondary drowning (submersion injury) doesn’t happen out of nowhere. “You’re going to see warning signs,” says Sarah Denny, M.D. a member of the American Academy of Pediatrics’ Council on Injury, Violence & Poison Prevention, and an attending physician in the Section of Emergency Medicine at Nationwide Children’s Hospital in Columbus, Ohio.

• Water rescue. “Any child pulled from the pool needs medical attention,” says Dr. Berchelmann. “At the very least, call the pediatrician.”
• Coughing. Persistent coughing or coughing associated with increased work of breathing needs to be evaluated.
• Increased “work of breathing.” Rapid shallow breathing, nostril flaring, or where you can see between the child’s ribs or the gap above their collarbone when they breathe, means they’re working harder to breathe than normal, says Dr. Denny. This is a sign that you should seek medical help immediately.
• Sleepiness. Your kid was just excitedly playing in the pool, and now she’s fatigued? It could mean not enough oxygen is getting into to her blood. Don’t put her to bed until her doctor gives you the go-ahead.
• Forgetfulness or change in behavior. Similarly, a dip in oxygen level could cause your child to feel sick or woozy.
• Throwing up. “Vomiting is a sign of stress from the body as a result of the inflammation and sometimes a lack of oxygen, also from persistent coughing and gagging,” explains Dr. Berchelmann.

Any time you’re concerned about your child and think he could have symptoms of dry or secondary drowning, whether you’re in your backyard pool or on a beach vacation, call the pediatrician right away for advice. Your child’s doctor should be able to talk you through it, says Dr. Berchelmann, and might advise you to go to the ER, a primary care doctor, or a national urgent care center.

But if your child is really struggling to breathe, call 911 and/or head to the emergency room right away. “Necessary treatment may not be available in settings other than the ER,” says Dr. Zonfrillo.

Treatment for submersion injury depends on the severity of the patient’s symptoms, says Dr. Denny. The doctor will check the child’s vital signs, oxygen level, and work of breathing. Patients with more mild symptoms just need careful observation, in more serious cases, the doctor may also do a chest x-ray or give him oxygen. In cases of respiratory failure, or when a child can no longer breath on their own, extra support is needed — such as intubating or putting the child on a ventilator — but that’s very rare. The goal will be to increase blood flow in the lungs and get the child breathing well again.

Prevention is the same for dry drowning and secondary drowning as it is for any other kind of drowning:

• Swim lessons. Kids who are comfortable and skilled at moving around in the water are less likely to go under and take in water. Around ages 3-4 is an age where they are less likely to take on water in normal activity.
• Supervision. Monitor kids closely in and around the water, and enforce pool safety rules.
• Water safety measures. Children should wear flotation devices on boats; pools should have four-sided fencing around them; and you should never leave standing water where a child could get into it.

As long as you practice water safety, pay close attention to your kids after swimming, and get them checked out if you notice any signs of trouble breathing, you shouldn’t have to constantly stress about dry drowning or secondary drowning. “I can’t emphasize enough how rare they are,” says Dr. Zonfrillo. Heading into vacation season, that’s welcome news.