Two weeks ago, four-year-old Francisco ‘Frankie’ Delgado died after he inhaled water while he was swimming, but he didn’t die from drowning in the water he died from a type of drowning that can occur even when you’re out of the water.

Shorty after swimming at the Texas City dike with is family, Frankie started to complain of stomach pains, but his parents figured he just caught a regular bug, the Daily Mail reported. Over the next week he was vomiting and having diarrhea and just when things seem to get better it took a turn for the worst. Francisco Jr., the boy’s father, said Frankie started to complain about his shoulders on Saturday morning and went back to sleep. When he woke up the second time the pain had gotten worse.

“Out of nowhere, he just woke up. He said, “ahhh,”‘ his father told KTRK-TV. “He took his last breath, and I didn’t know what to do no more.” Frankie was then rushed to the hospital where paramedics and doctors tried to save him, but by then it was too late.  Doctors suspect that the toddler died from a form of dry drowning, a rare medical condition that children are more prone to due to their small statures. Dr. Ray Pitetti from the Children’s Hospital of Pittsburgh of UPMC told the Daily Mail, he believes Frankie died specifically from a case of secondary drowning.

What is Dry and Secondary Drowning?

Dry drowning and secondary drowning are both types of drowning that take place after inhaling water through the nose or mouth, and can occur after swimming. However, both are very different and it’s important to know how. The American Osteopathic Association described dry drowning as a case where water causes a spasm in the airway causing it to close up and impact breathing. Even though water does not get to the lungs, it causes the air passage to the lungs to shut down as a protective response, Dr. Pitetti told Daily Mail. “Dry drowning is a reflex the body has in the upper part of the airway. There is actually no water in the lungs,” he said. On the other hand, secondary drowning or delayed drowning occurs when water gets to the lungs, according to AOA. This water then builds up over time and eventually causes breathing difficulties.

What are the Warning Signs?

Symptoms of dry drowning typically occur right after a water incident. But secondary drowning symptoms can appear hours after a near-drowning experience, according to the AOA. “When they [a child] first get out of the water, they may cough and then will normally be ok,” Dr. Pitetti said. “As the day goes on, breathing gets a bit faster and just progresses. They will be working hard to breathe, with the belly moving in and out or the ribs showing the strain.”

Symptoms include trouble breathing, coughing, sleepiness or a drop in energy level, irritability, chest pain, and vomiting according to the AOA. “Be attentive to sudden changes in behavior,” Dr. Mitchell, an osteopathic emergency medicine physician from Chicago, said in a statement. “Many parents don’t recognize the signs of delayed drowning because they believe their child is fatigued from a long day of swimming, or exhausted from nearly drowning.”

Frankie’s Death Raises Awareness

After Frankie’s story went viral, a father in Colorado, Garon Vega saw the same signs in his two-year-old son Gio and was able to bring him to the hospital just in time. “It was an unfortunate thing that happened, but if I had not told my wife that he swallowed the water, and if she had not seen that article, I think we would’ve ended up dispelling it as a regular sickness,” Vega said. Dr. Pitetti told the Daily Mail he believes that both Freddie and Gio had secondary drowning because X-rays showed they had fluid in their lungs.

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