When temperatures rise, heading to the nearest pool, river or lake is a great way to cool off. But swallowing, inhaling or coming into contact with tainted water can leave you and your little swimmer at risk for waterborne illnesses, including gastrointestinal, ear and skin infections.
What’s behind recreational water illness? Icky as it may be to think about, to some degree it's other swimmers with less-than-pristine personal habits (in other words, they pee and sometimes even poop in the water). Also to blame are some public and private pool operators, whose water-cleanliness standards are not up to snuff.
Fortunately, there is something you can do about it. Follow this advice and you’ll go a long way toward making swimming safer in terms of cleanliness.
What causes waterborne illness in babies and toddlers?
Your child is at greatest risk of waterborne illness from swimming in a pool, hot tub, water park, lake, river or ocean. Causes of recreational waterborne illnesses include drinking, breathing or simply coming into contact with water that's contaminated with bugs — usually parasites, bacteria or viruses.
Because the U.S. has some of the safest public water drinking water supplies in the world, you’re only likely to be at risk of waterborne illnesses from drinking water if you’re traveling to a country without access to sanitized water or sipping on water you've collected from a river or stream.
That said, drinking water in the United States rarely becomes contaminated when a big rainstorm or snowstorm causes flooding of water and sewage treatment facilities. Runoff from farming and manufacturing (like pesticides and fertilizers) as well as naturally-occurring chemicals and minerals (like arsenic, radon and uranium) also sometimes contaminate water supplies.
What are symptoms of waterborne illness in babies and toddlers?
Gastrointestinal issues are the most common recreational water illness symptoms in babies and children. Symptoms can begin anywhere from two days to three weeks after your little one has been infected and may include:
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Some waterborne illnesses can cause ear pain, eye pain or skin rashes that occur within a few days of swimming. Symptoms may include:
- An itchy, bumpy, red rash and pus-filled blisters around hair follicles that appear within 48 hours and are worse in areas that were covered by a swimsuit (signs of a hot tub rash, or folliculitis)
- Small red pimples/blisters and tingling, burning or itchy skin occurring a few minutes to several days after swimming (signs of swimmer’s itch, or cercarial dermatitis)
- Redness, swelling, pain and itchiness in the ear; pain when the ear is tugged on; and fluid drainage from the ear canal (signs of swimmer’s ear, or otitis externa)
What are the most common waterborne illnesses in children?
What illnesses can you get from contaminated water? Common waterborne illnesses in kids include:
Diarrhea
The parasites Cryptosporidium and Giardia intestinalis are the most common causes of recreational waterborne illness, and they’re especially likely to make young kids sick. They’re found in fecal matter and spread through consuming contaminated water while swimming.
Hot tub rash
The bacteria Pseudomonas aeruginosa causes a skin rash (also called folliculitis) that usually appears in areas covered by your child’s swimsuit.
Swimmer's itch
This rash is an allergic reaction to parasites that burrow into the skin. Parasites are released from snails and spread through bird and mammal feces. They’re usually found in marshes and shallow water by the shoreline where kids play.
Swimmer's ear
Outer ear infections sometimes crop up when water stays for too long in the ear canal and allows bad bacteria to grow out of control.
Illnesses linked to contaminated drinking water
These are caused by bacteria (Campylobacter, Salmonella, Shigella and E. coli), parasites (Giardia intestinalis) and viruses (enterovirus, hepatitis A, norovirus and rotavirus). You’re really only at risk of getting sick from drinking water if you’re camping, traveling or otherwise without access to a safe public water supply.
How to prevent waterborne illness in babies and toddlers
These waterborne illness prevention tips can help keep your baby or toddler safe:
- Take precautions before swimming. Test water’s chlorine and pH levels at home before hopping in the pool or hot tub (more on water testing below). If you’re taking a dip in nature, check for local water condition advisories, and avoid swimming in marshy areas or areas where swimmer’s itch is a known problem.
- Dress for success. Outfit your child with a swim cap to keep ears as dry as possible. Use a towel to dry your child’s ears when you get out of the water. (A blow dryer on the coolest setting held a foot away can also dry your kid's ears after swimming.) You can also give your little one ear plugs to wear in the water.
- Look out for your neighbors. Teach your little ones not to pee or poop in the water. Keep anyone who has or recently recovered from diarrhea out of the water for a week or two. Swim diapers don't prevent the leakage of disease-causing bugs.
- Use the bathroom regularly. Keep bacteria and other bugs from getting into water in the first place by taking young kids to the bathroom every hour, especially kids in diapers. Do diaper changes in the bathroom, not poolside. Have everyone wash their hands after.
- Prevent little ones from swallowing water. Watch kids closely so they don’t swallow water while they’re swimming.
- Practice good hygiene. As soon as you get out of the water, remove your child’s suit and give him a bath or shower with soap. Thoroughly wash your child’s swimsuit too. Wash your hands before eating and drinking.
- Choose safe drinking water. Drink and cook with tap or bottled water. Avoid giving your kids water that's been collected from rivers, lakes or streams. Ask your doctor for tips if you’ll be camping or traveling anywhere with your little ones with less access to purified water.
How to know if water is safe for a baby or toddler
Frequent testing is essential to ensure that the water's safe for swimmers. At a public pool, ask the lifeguard or manager if he or she has completed specialized training in pool operation and how often free chlorine and pH levels are checked. (It should be at least twice per day, more when the pool is heavily trafficked.)
If you own a pool or hot tub, buy a water-testing kit, available at most sports supply stores. Test the water every time before you swim; twice a day if you’re spending all day by the pool.
Here’s how to know for sure that water is safe for your baby or toddler:
Pools
Check free chlorine or bromine levels. Look for a free chlorine level of 1 to 10 mg/L or parts per million (ppm) or a bromine level of 3 to 8 ppm. A pH of 7.2 to 7.8 maximizes germ-killing power. Keep in mind that chlorine and other disinfectants don’t always kill all pool germs instantly, and some super strong bugs tolerate most levels of chlorine.
So be an advocate for waterborne illness prevention: Push for ultraviolet or ozone-disinfection technology for pool water treatment, and encourage the facility operator to hyper-chlorinate regularly.
Hot tubs and spas
Check for chlorine or bromine levels and pH levels. Look for a chlorine level of 3 to 10 (or a bromine level of 4 to 8), and a pH of 7.2 to 7.8.
The Pool & Hot Tub Alliance recommends keeping children out of hot tubs until they're older and can stand on the bottom with their heads completely out of the water. It's important that infants and toddlers not be allowed in hot tubs at all — their skin is thin, which makes them prone to overheating.
The group recommends that young kids shouldn't use a hot tub for more than five minutes at a time, especially at higher temperatures; it's best to drop the temperature to 98 degrees Fahrenheit and keep soaks to 15 minutes max.
Public beaches, rivers and lakes
Natural bodies of water sometimes become contaminated, so check online for local water quality conditions. If water is deemed unsafe for swimming, health officials will shut down an area until the water is safe again. Never swim when these areas are closed.
Public drinking water
Under the 1974 Safe Drinking Water Act, the Environmental Protection Agency (EPA) is responsible for ensuring public water supplies are tested frequently and remain within safe limits. If you’re concerned about the safety of your tap water, check your local Consumer Confidence Report (CCR) — a summary of contaminant levels that community water suppliers are required to complete every year.
A change in your water supply’s taste, color or smell is not necessarily cause for alarm, but it’s still a good idea to contact your public water supplier. If you’re not satisfied, you can also look into getting your water tested by a certified laboratory in your state.
Well water
The EPA does not regulate private wells, so get your well water tested every year to ensure it's safe.
What to do if your child gets sick
If your little one has diarrhea that you think might be linked to a recent trip to the pool or beach, waterborne illness treatment involves drinking plenty of fluids to prevent dehydration. If he seems thirsty, try offering electrolyte rehydration solutions (e.g. Pedialyte).
Rashes linked to recreational water illnesses usually go away on their own. If you think your child has swimmer’s itch, try applying cool compresses or baking soda paste to the rash.
Call a doctor if your child has:
- Diarrhea that doesn’t improve after 24 hours or that lasts more than five days
- Bloody stools
- Chills
- A fever of more than 102 degrees Fahrenheit or persistent fevers lasting longer than 24 to 48 hours
- Signs of dehydration (urinating less frequently and dark urine) — this is especially important since dehydration can quickly make young children very sick
- A rash that gets worse or recurs, or that causes severe itching
- Symptoms of swimmer’s ear, especially pain or fluid drainage from the ear
Most importantly, remember the biggest water-related danger of all: drowning, which is a leading cause of death among children. It only takes a few seconds of inattention for an accident to happen. So always follow all recommended pool safety tips for kids any time you’re near an open body of water.
Waterborne illnesses take the fun out of swimming — and they’re more common than you might realize. Fortunately, they’re also often preventable, and symptoms like diarrhea and rashes will most likely go away on their own.
It’s always a good idea to check the water quality before you swim and to thoroughly rinse off when you’re done splashing around. And if you’re concerned about the safety of your local drinking water supply, don’t hesitate to contact your local authorities.
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