Whether you have a pool at home, go to a public pool or visit water parks with your kids, you’re going to want to sit down. There’s yet ANOTHER reason to give you pause about swimming with the kids this summer—aside from drowning, secondary drowning, dry drowning, electric shock drowning or small children getting stuck by the pool drain.
If your kids have ever gotten diarrhea after a day at the pool, you’re not alone. In fact, according to a report published by the Centers for Disease Control (CDC), the number of outbreaks of the infection that causes watery diarrhea, stomach cramps and nausea or vomiting has tripled since 2004 and doubled from 16 outbreaks in 2014 to 32 in 2016.
When thinking about protecting their kids while swimming, most parents think about using life jackets, swimming lessons, and childproofing their pool, but waterborne infections are a concern as well. How can you keep your kids safe in the water and free from these germs?
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How are recreational water illnesses spread?
You can get recreational water illnesses if you swallow, have contact with, or breathe in mists or aerosols from water contaminated with germs. You can also get them by having contact with chemicals that are in the water or that evaporate from the water and turn into gas in the air.
Diarrhea is the most common recreational water illness. People who are already sick with diarrhea can spread it to others when they get in recreational water. People typically have about 0.14 grams of poop (similar to a few grains of sand) on their bodies at any given time. When a person who is sick with diarrhea gets in the water, that tiny amount of poop on their body can wash into the water around them and contaminate it with germs. If someone else swallows the contaminated water, they can become infected.
Other recreational water illnesses—such as skin, ear, respiratory, eye, and other infections—can be caused by germs that naturally live in the water and soil. If the chemicals used to kill germs (chlorine or bromine) in pools, hot tubs, and water playgrounds are not kept at the right level, these germs can multiply and make swimmers sick.
Who is most at risk?
Children, pregnant women, and people who have health problems or take medicines that lower their body’s ability to fight germs and sickness—such as people whose immune systems are weakened because of cancer, an organ transplant, or HIV—are most at risk for recreational water illnesses.
People with weakened immune systems should be aware that recreational water might be contaminated with Cryptosporidium (or Crypto for short). Crypto can cause life-threatening symptoms in people with weakened immune systems.
People with weakened immune systems should consult their healthcare provider before participating in recreational water activities, such as swimming.
How can swimmers protect themselves and others from recreational water illnesses?
The best way to prevent recreational water illnesses from spreading is to keep germs out of the water in the first place. This means that if you or your child has been sick with diarrhea in the past two weeks, you should stay out of the water.
To protect yourself from the most common recreational water illnesses:
- Keep water out of your mouth when you swim
- Dry your ears after you swim
Why is disinfection important to help stop the spread of recreational water illnesses?
Disinfection with chlorine or bromine and pH is the first defence against the germs that cause recreational water illnesses in pools, hot tubs/spas, and water playgrounds. At the recommended levels, chlorine or bromine can kill most germs in the water within minutes (some germs, such as Crypto, can live in properly treated water for days).
However, one CDC study found that more than 10% of routine inspections of public pools, hot tubs/spas, and water playgrounds (for example, at hotels/motels and waterparks) led to immediate closure because of serious violations, such as improper chlorine or bromine levels. Swimmers can check for adequate free chlorine (1–3 parts per million or ppm in pools/water playgrounds and 3–10 ppm in hot tubs/spas) or bromine (3–8 ppm in pools/water playgrounds and 4–8 ppm in hot tubs/spas) and pH (7.2–7.8 in all types of water) levels using test strips.
Many people overlook the fact that kids can get sick from the germs in the water of pools, lakes, and water parks. Taking some simple steps can help keep your kids – and everyone else – safe while swimming.
Germs in Water That Can Cause Infections
One danger when swimming is that water can be contaminated with germs that can cause recreational water illnesses (RWIs), including:
- Diarrhea, which can be caused by swallowing water contaminated with parasites, bacteria, and viruses, including Cryptosporidium, Giardia, Salmonella, Shigella, Norovirus, or even E. coli 0157: H7. These germs can get in the water when someone with an infection has a stooling accident in their diaper or the water, has some of the germs or feces on their bottom, or the water is contaminated with sewage.
- Pink eye – The category of viruses known as adenoviruses can cause not only the pink eye, but also croup, colds, and sore throats, and diarrhea.
- Molluscum contagiosum – Molluscum contagiosum is a rash similar to a wart which is caused by a poxvirus. Although it may not be spread in swimming pool water, it can likely be spread by sharing swimming pool towels and toys with a child who has molluscum.
- Hepatitis A, a viral infection that affects the liver, causing jaundice, abdominal pain, fatigue, nausea, and fever. Although often associated with contaminated food, it is also possible to less commonly get hepatitis A from contaminated water.
Naegleria, a rare, although extremely serious, and often fatal infection caused by the Naegleria fowleri ameba that is sometimes found in warm freshwater ponds and lakes, and has been coined with the unfortunate name of “brain-eating ameba.’
Chlorine and Water Germs
Doesn’t chlorine kill all of these germs in the water? Chlorine does kill most of these germs, but it can take up to an hour for the chlorine in a properly maintained pool to work. That means that if a child has diarrhea and gets in the pool and your child gets in right after him, that may not be enough time for the chlorine in the pool to kill any germs from the sick child.
And unfortunately, it can take more than a week for chlorine to kill the Cryptosporidium parasite.
Preventing Recreational Water Illnesses
In addition to teaching your child to not swallow water when swimming or playing in the water, you can help keep your child and everyone else healthy in the water if you:
- Keep your child out of the water when he has diarrhea, pink eye, hepatitis A, or other contagious diseases.
- Don’t let your child in the water if he has an open wound since it could become infected.
- Don’t let your child in the water if he has a draining wound, especially MRSA, since it could infect others.
- Don’t share a pool or beach towels.
- Encourage your child to take a shower or bath before swimming.
- Encourage your child to wash his hands after using the bathroom, especially if he is going to get back in the water.
- Take younger children to the bathroom frequently so that they are less likely to have accidents in the water.
- Keep in mind that swim diapers and swim pants are not leakproof and may seep germs into the water. So check and change them frequently for your infants and toddlers who aren’t yet potty trained.
- Don’t change diapers by the pool. Instead, take your child to the bathroom to change his diaper and then wash your child’s bottom well and wash your hands too.
- Cover molluscum lesions with a watertight bandage.
How do germs get into swimming pools?
Germs can get into pool water through:
- skin, sweat, wee, poo, saliva and open sores
- dirt, food and other solids that end up in the pool.
This can happen quite easily. For example, if you’ve had diarrhoea, germs can still be on your skin even if you’ve cleaned your bottom and hands well. So if you get into a swimming pool, germs can go from your skin into the water.
Also, babies or non-toilet trained children are very likely to poo in the water when they’re swimming. If they’ve had a runny poo, germs from their poo can get in the water, even if they’re wearing a swimming nappy. Or if you change a sick child’s nappy near a swimming pool, germs from the nappy can get into the water even if the child doesn’t.
Swimming pool hygiene: keeping pools clean and safe
Here are some simple tips to help keep swimming pools fun and safe for everyone.
For all swimmers
- Don’t get in the pool if you have diarrhoea, or have just gotten over diarrhoea.
- Try not to get water in your mouth, and don’t swallow pool water.
- Wash your hands with soap and water after using the toilet or changing a nappy.
- Shower before you get in the pool and when you get out.
For parents of young children
- Make sure your child has a clean bottom before your child gets into the pool.
- Use well-fitted swimming nappies to help stop poo from getting into the water, but note that these nappies aren’t leakproof. They can delay but not stop the germs getting into the water.
- Change swimming nappies regularly to stop nappy contents getting into the water.
- Keep nappy changes away from the pool area. With lots of water splashing about, it’s easy for germs to end up in the pool.
- For toilet-trained children, try to prevent toilet accidents in the pool by making sure your child has regular toilet visits.
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Incidence of Waterborne Diseases
How common are these infections?
It is hard to say, as not all infections that kids catch from swimming are caused by contaminated water are reported. The CDC reports that 2,698 got sick from waterborne diseases in 2003, which resulted in 58 people requiring hospitalization and one death. Most infections occurred in community swimming pools and pools, spas, and wading pools at hotels and clubs.
Unfortunately, most experts think that cases of waterborne diseases are increasing.
Water Safety Tips
Of course, keeping your child safe in and around the water is also very important.
As with most child safety measures, that usually starts with proper supervision, which is one of the best ways to keep your kids safe in the water, that means watching your kids when they are in or around water, even if they know how to swim. Remember that swim lessons don’t make kids, especially younger kids, drown-proof.
Other important water safety tips include that you:
- Childproof your swimming pool so that it is enclosed by a permanent fence (which is better than a removable pool fence) that has a self-closing and self-latching gate that is difficult for younger children to open. Also, make sure that your child can’t easily get out of your house to the pool area. That way, you have a “layers of protection” system, and if one safety layer breaks down, such as someone leaves the gate to the pool open, your child still can’t get out to the pool.
- Have everyone wear Coast Guard-approved life jackets, and not just floaties, on boats, jet skis, and on other personal watercraft.6
- Only let kids dive in areas that are marked for diving or when you know how deep the water is.
- Only swim in designated areas in the ocean and are aware of how to escape rip currents, which can pull you out to sea, by swimming parallel to the beach (sideways), until you are out of the rip current and can swim back to shore.
- Learn CPR.
- Apply sunscreen or sunblock on your children at least 15 to 30 minutes before going out in the sun to avoid sunburn, and then reapply it at least every two hours, especially if your child has been in the water.
- Have a phone nearby, so that you can quickly call for help when necessary.
Recreational water illnesses can also be serious. Pool water contains chlorine — a chemical used to help get rid of bacteria such as E. coli and parasites. Chlorine may not eliminate all of these germs, so if children swallow pool water they could become sick, Davis said.
If parents and caregivers are aware of these risks, they can take steps to prevent them from happening. By being aware, parents can also recognize warning signs and seek immediate medical attention, Davis added.
To help parents protect their children, Davis advised parents to watch out for the following symptoms that could develop within a few hours or up to 72 hours after swimming:
The first signs of trouble usually include:
- Upset stomach and vomiting
- Persistent cough
- Trouble breathing
As the hour’s pass, recreational water illness, chlorine poisoning and secondary drowning become more distinct conditions with more specific and severe symptoms, noted Davis.
Recreational water illness and chlorine poisoning may lead to digestive distress, such as abdominal cramping and diarrhea. These conditions may seem like a bad case of food poisoning or stomach flu.
Chlorine poisoning may also cause symptoms in the nervous and respiratory systems. Children may experience trouble with their vision. Swelling and burning may also develop in their eyes, throat, nose and ears.
Secondary drowning has a greater effect on the respiratory system. Children will experience trouble breathing and have heavy, wet-sounding, persistent coughs. They will also develop uncontrollable shivering as well as hot and cold flashes.
Children who have any of these symptoms should be taken to an emergency room immediately.
Staying healthy in public swimming pools
If a public pool has been properly treated with pool chemicals, most germs in the pool will be killed.
But when a public pool is very busy – for example, on a hot summer day – germs can get into even the cleanest pool. More people mean more germs and more dirt in the water.
If you want to know how clean and safe a pool is to use when it’s busy, ask the pool staff about the latest pH measurement. They should be able to explain it to you.
If there’s a poo accident in a public pool, get out and let the pool staff know straight away. If you or your child gets sick after using a public pool, contact the pool staff so they can monitor potential disease outbreaks.
If you’re unlucky enough to catch a Crypto infection in your household, the rule is that you should wait to swim again for two weeks from the last day that symptoms were present. Yes, a FULL two weeks. Sorry not sorry, but the rest of us don’t want diarrhea either.
Young children are most at risk since they’re more likely to swallow water, and also have less-developed immune systems. They’re also more at risk of dehydration due to fluid loss if they end up with Crypto-induced diarrhea.
One final piece of advice: Never, ever open your mouth underwater in a public pool or water park again. Experts say they don’t know whether the rise in Crypto infections is because there are actually more of them, or if it’s just because there’s better testing available nowadays to help identify and diagnose cases. Either way, we’re not taking any chances.