During the summer months, emergency rooms and pediatricians encounter cases of kids who suffer secondary or “dry drowning” after swimming. According to the Centers for Disease Control and Prevention, drowning is the leading cause of death by injury in children ages one to four. And most drownings in this age group  — 69% — occur during non-swim times.

The World Health Organization says that “drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid; outcomes are classified as death, morbidity or no morbidity.”

Medical advisor and emergency room physician Dr. Michael Daignault tells USA Today that immersion is “having water splashed on your face, whereas with submersion, your entire airway is under the water’s surface.” If a child inhales too much water swimming, damage to the vocal cords or lungs can occur. It’s important to understand that drowning is a process, says Daignault, that can be interrupted at any point whether by rapid self-recovery, rescue by parents, or emergency medical professional or treatment in the emergency room.

Time is of the essence. “Submersion for less than five minutes is associated with a 10% risk of death or injury, but that risk increases to 56% for six to 10 minutes of submersion,” Daignault says.

According to WebMD, “dry drowning” or “secondary drowning” are not actual medical terms but they do point to rare complications that parents should know about that are more common in children. With dry drowning the water never reaches the lungs but causes your child’s vocal cords to spasm and close.  That shuts off their airways, making it hard to breathe.

Secondary drowning occurs when water gets into the lungs and irritates the lining causing fluid buildup. This triggers pulmonary edema and a child’s breathing may get worse over the following 24 hours. Dr. James Orlowski of Florida Hospital Tampa tells WebMD that both events are very rare, making up only 1-2% of all drowning.

Parents should monitor their children for the following symptoms for four to six hours after swimming, especially if they were briefly submerged or aspirated a small amount of water.

• Difficulty breathing or speaking

• Irritable or abnormal behavior

• Repetitive coughing

• Chest pain

• Excessive sleepiness

Seek immediate medical attention in the emergency room if you notice these signs in your child after immersion or submersion in water. Your child will probably need an X-ray for an accurate diagnosis, and will be admitted for observation, says WebMD.

“Water is a major concern for young children, and they should never be left unsupervised around any body of water,” says Daignault. That includes bathtubs, toilet bowls, ponds, or small plastic pools.