The process of drowning begins when the victim’s airway is submerged below the surface of the water. While above the water, a child will typically struggle for only 20 seconds before they become submerged. In contrast, an adult will struggle for approximately 60 seconds before they become submerged. The drowning process begins when the patient’s airway is below the water. Initially, there’s breath holding, and a small amount of water (typically less than 30 mL or 2 tablespoons) may enter the lungs if the patient gasps. During the struggle and the early part of unconsciousness, there’s reflex swallowing as the body attempts to clear the oropharynx of water. Even if water enters the lungs during this period, it’s typically only a small amount (2–4 mL/kg).  Unconsciousness typically occurs within four to six minutes of submersion.