It turns out, I don’t think you do have to be careful what you wait for when it comes to swimming. A study published a few weeks ago suggested that children under the age of 2 were at higher risk for bronchiolitis, a common pediatric lung infection, if they swam in chlorinated pools when they were babies. I’ve mulled this over and done additional reading. If it were my child, I’d sign up for infant swimming lessons. Believe me, I’m not getting off any swim/pool wait list any time soon! Yet, I do think the study offers a chance to re-frame how we think about protecting our kids around the water.
Although O will be well over 2 years old when he gets off the decade long wait list for the pools in our area, he’ll be swimming in chlorinated pools before then. From how I see it, chlorine exposure is only one side of the story when it comes to infant swimming and safety. It’s okay, maybe even wonderful if I dare say, to swim with an infant. The video we have from F swimming in the first time is hilarious. I am far more ecstatic than any normal human should be in a pool. It’s true; most babies simply love the water. So do plenty of adults (read: me).
Swimming if not only delightful, it is also dangerous. Worldwide, drowning while swimming is the 2nd most common injury that kills children under age of 14. Therefore how our infants and children come to know the water may be as important as how we think about using car seats.
Bottom line is this: we have to take the recent news regarding the dangers of infant swimming in perspective when we think about the risk of bigger dangers, like drowning. Both from a safety stand point and a practical, live-your-life-enjoy-your-baby standpoint, swimming can be a marvelous way to enjoy time with your baby. Medical studies just can’t and won’t take that away from parents. We still get to live and enjoy planet earth in the summer or that rare vacation time with our kids, too. This study just affords a chance to think about the risk/benefit ratio of it all.
Some background: pediatricians have previously been trained to think that swimming lessons did not protect against drowning. Basically, research and insights from drowning experts found that lessons may give parents and toddlers a “false” sense of security around water. If toddlers are out of arms reach, or parents are distracted while their child is near water, experts worry that toddlers can fall into a pool, march into a lake, slip out of arms reach and the unthinkable occurs. There is no disputing that an infant or toddler can have a drowning event in a mere seconds. This is still the case. However how I council about swimming lessons all changed when a thorough and nicely done study published last year found that formal swimming lessons between ages 1-4 years of age conferred a 88% reduction of risk from drowning. This is not true for informal lessons (the lesson clowns like me can provide). We still need the trained pros.
Get on that swimming lesson wait list. Pronto!
I bring up the drowning data only to put this chlorine data in perspective.
So, back to chlorine, the delightful stuff that made my hair green and slippery, stretched out my already baggy swim suit, and made my skin dry up and look Gawd-awful when I was a kid. Chlorine keeps pools hygeinic but is the stuff forming all this fuss.
A Belgian study circulated last week in the media found:
- Infants who swam more than 20 hours as infants in/outdoor chlorinated pools were at 3 ½ times greater risk for bronchiolitis (lung infection caused by a virus) compared to babies who didn’t swim.
- Swimming in chlorine may increase the risk of asthma and respiratory allergies by making the airways more sensitive not only to allergens but also to infectious agents (things like RSV infection)
- Parents should be aware that chlorine-based disinfectants and their derivatives are strong irritants not only for the skin but also the airways
- Researchers feel it is “very likely” that chlorine was to blame for the increased rates of infection and asthma symptoms children developed in this group.
The study theorizes that lung injury from irritation/vulnerability from chlorine exposure possibly leads to the increase rates of bronchiolitis in the infant swimmers. However, this study doesn’t PROVE this, just suggests this from previous work by the same group of researchers.
Problems with the study…
I have multiple issues with the study as did Dr Mandy Striegl, a mom, pediatrician, and pulmonary fellow (lung expert) at Children’s. A little science to understand why this study may be “hogwarsh” after all:
- First, the study design is cross- sectional. Dr Striegl points out that you can’t make conclusions about A (chlorine) causing B (bronchiolitis) from this kind of cross-sectional study. Thank you, Dr.
- Only half (51%) of the parents that were asked to participate in the study did. Therefore, who knows how the other half of the kids (swimmers and non-swimmers) did! The study results may be very different with all those other kids included.
- In the group of infants who were swimmers, 38 % of them had a family history of asthma (making them far more likely to wheeze). The group of non-swimmers was different with only 25% of them having the same family history. Maybe the two groups compared really aren’t equal to start! Dr Striegl says that research on asthma finds the 2 biggest risk factors for children to develop asthma/wheezing during childhood are a family history of asthma and a personal experience of eczema .
- Memory problems. To get their data, researchers asked 430 parents to look back in time and formulate swimming records and memories of health history in their child. They asked parents of kindergarteners what their child’s swimming habits/and wheezing episodes were as infants. I don’t remember what I had for lunch last Wednesday, let alone how many times F swam in a pool 2 years ago or had an episode of coughing.
Dr. Striegl mentioned that her son has been to swimming lessons too, and after reading this she said, “We ain’t stopping!” When she sees families in the pulmonary clinic, she informs them that, “any type of airway irritant (chlorine included) will generate more inflammation and mucous that could make their little airways wheeze.” She reflects, “Kids at higher risk of bronchiolitis because of genes (a family history of wheeze) or anatomy (lung problems) will likely be more sensitive to pool chlorine.” But that doesn’t mean chlorine causes bronchiolitis! She says, “When I see kids who have recurrent wheezing, I always talk to the family about working hard to avoid things like candles, incense, perfumes, cleaners, cigarette smoke and cooking fumes. But I don’t tell them to keep babies out of the pool.”
Things To Consider For Infant Swimmers
If you have the choice, swim in fresh water with your infant (blow up pools in your yard, lakes, protected ocean beach, non-chlorine ionized/ ozone treated/” salted” pools, or safely moving streams).
Outdoor pools likely have better ventilation than indoor pools thus decreasing inhalation of potentially irritating chemicals. With a choice, go outside! Isn’t this always true?
Never let an infant or toddler out of arm’s reach when swimming or playing in water. Although the AAP’s swimming policy statement recommends waiting for lessons until age 4; there is good data from March of 2009 to suggest swimming lessons may prove to be protective against drowning. Waiting until age 4 to learn to swim may not only be unbearable for families who love the water, it may be dangerous. Drowning is the second most common cause of death from injury in kids less 14 or younger. Work to know tips around water safety.
Lots of pediatricians support infant swimming. Read this.
If your infant has wheezing, has ever wheezed/or been diagnosed with an episode of bronchiolitis, talk to your pediatrician prior to starting a routine swimming program in a chlorinated pool.
Consider talking to your equivalent pediatrician before swimming if your:
o Infant or child has underlying reactive airway disease (wheezing)
o Lots of people in your family have asthma
o Infant or child has underlying lung conditions like BPD in preemies
o Infant or child has an acute infection (a cold) and/or an active cough as their lungs are potentially swollen and mucous-filled during that time. Stay home and snuggle
Think about what Dr Striegl says: Any thing you can smell (any where!) can be an airway irritant for infant’s tiny airways. Irritants may trigger increased mucus in small airways and put an infant/toddler at higher risk for wheezing.
Avoid fragrant candles, perfumes in soap and lotions, incense, smelly/spicy cooking smoke & fumes, smoke from fireplaces, cigarette smoke, and even chlorine when you can. Work especially hard if there is a family history of asthma or wheezing for your child.
Ask the pool attendant where your infant swims if they use chlorine. Some pools use bromide, ionization or extra salt to keep the pool safe and hygienic. You may be in luck–these treatments may be much less harmful to infants when compared to chlorine, although more research is needed.
Never trust infant or toddler swimming lessons or time as protective against drowning. Although new data supports formal lessons may help prevent drowning in toddlers, nothing is better than arm’s reach/touch supervision with infants and toddlers in the water.
Remember health class 101 in 7th or 8th grade when you learned about the “life time” sports? Those that are so good for you that you can start when you’re about 5 months old and continue til you’re 5 months shy of 100 years? Swimming is still one of them. Get in the water with your baby and toddler and splash around. Talk to your pediatrician if you’re still worried. Or drop a comment and we’ll wrestle our way to some answers.
Trina Wisdom says
From my 15 years of swim lesson instruction and pool operations experience in Washington State, I have a few pointers to help swimmers: 1. ONLY wear polyester swim suits, they last for a very long time. Lycra will fade and disintegrate quickly. There are also suits made out of a fabric called chloraban that last a long time. http://www.swimoutlet.com has a great variety. 2. To protect your hair, get your hair wet in the shower before you get in the pool. That way your hair has absorbed tap water and will not soak up as much chlorine. Showering before getting in a pool is actually a health department regulation. The people who don’t shower and bring their personal funk into the pool is the reason why chloramines get high in a pool which is what makes that “chlorine smell” and in turn makes more chlorine get added to the pool. 3. Washington Sate Health Department mandates that ALL pools have a chlorine residual of at least 2ppm. Even saline pools have chlorine. So, unless you are in a lake or river or some other fresh water you are going to be in chlorine. ~Trina
Jeff Sloan says
Wendy, Thanks for a great discussion and some perspective around risks associated with swimming. Let’s keep in mind that chlorine helps protect swimmers from waterborne germs. Chlorine in pool water destroys germs that can cause diarrhea, ear infections and skin rashes, including athlete’s foot. Chlorine disinfectants help sanitize pool water in the wake of those all-too-common kiddie accidents, for example, restoring parents’ peace of mind. Trina hit the nail on the head regarding “pool smell:” Oils, cosmetics and perspiration on your body react with chlorine to create chloramines, which are responsible for “pool smell.” Swimmers can do their part to reduce chloramines in the pool by showering before swimming and paying attention to a few other tips found at http://www.healthypools.org. Pool managers have a responsibility to maintain pH and chlorine disinfectant at optimum levels. This may surprise people, but a well-managed pool should have no chemical odor. If you detect a chemical odor, report it to the pool manager. Best Regards, Jeff Jeff Sloan American Chemistry Council
Wendy Sue Swanson, MD says
Thanks, Jeff. Such helpful and useful information! Appreciate the help from both you and Trina as to the rationale and reasoning behind showering before entering a pool. I think we’ll all (or at least I am) guilty of not showering each and every time we enter a pool. Now I know the why behind the rule! This will certainly change my behaviors and helps motivate me to teach my kids the why behind that all-important-pre-rinse-shower prior to fun in the pool.
Well if you DO wish to get your kids off the decade long waitlist for pools, and wish to put your yonger children in swim lessons. My son Aiden is enrolled in Water Babies swim lessons. He’s been in them since he was seven months old – and he did have broncolitis once – but he developed that in between swim sessions (at 9mos) so I never (and still don’t) associate the pool with the illness and he is now 18mos and hasn’t had another URI to date. I love that WB promotes water safety first and foremost and then ‘learning’ to swim second. The water being heated between 89′-93′ as a mandate for their pools is a nice perk too! So thank you for the reassurance that my non-medical-background research yielded the same conclusion that infant swimming isn’t harmful, but like all things you need to remain smart about it.
After 20 years of working and saving, we are moving to our dream location on the lake. Our yougest is 8 months old and we’d like to get her into swimming lessons as early as reasonable – so she can enjoy the water with us but especially to increase safety (even though the plan is that she’ll never be out of arms’ reach). Do you recommend a particular swim school (or the YMCA?) or particular credentials for infant swim lessons and particularly water safety? And do you have any recommendations for life preservers, which we want her and our older boys (who’ve had lessons) to wear at all times? Thanks!
I find this culture is determined to not only not think of modern man-made dangers on their own, but to make light of them when shown. Oh yeah, everyone is trying to ruin your fun and your kids fun, so you won’t listen to them or heed obvious unnecessary dangers to humans, animals and the environment, because, well, it would ruin your fun! Please by all means continue soaking yourself and your kids in chlorine and while you’re at it continue to buy the bottled water and the plastic toys and the lunchables etc., etc. etc,
I missed this post the first go-around, and I’m so glad you linked it from your birthday post. I really appreciate the pulmonary specialists input as well. My son has had chronic bronchiolitis since before he was old enough to take swimming lessons. We avoid all the things you mention, but ultimately a simple case of the sniffles will irritate his airway. In fact the sniffled led to bronchiolitis then pneumonia last winter. We were so shocked because he was never “sick” to begin with. By contrast, my daughter was almost 2.5 before she developed a cough. She’s had croup a few times but rarely gets sick. She’s done waterbabies on and off since early infancy and it would be such a shame to discontinue that. My son prefers the lake to the pool anyway, so after reading this I might just not push pool time in the winter.
Carean Kaso-Andrews says
As one who received swim lessons as a toddler, I would like to raise another issue–the trauma that toddlers can experience during lessons. The terror I experienced had been completely forgotten until, one day, when I was thirty-four, swimming in the gym pool while baby swim lessons were in progress. A baby was screaming and crying, while the mother and swim instructor tried to calm him. Suddenly, I was overwhelmed with my own memory of swim lessons. I was so upset I had to go to the locker room. I was crying and felt nauseated. Vividly, I remembered the intense fear that was disregarded by my albeit loving mom and competent instructor. It may be that swim lessons are the right thing to do for babies under 4 years. What isn’t right is to disregard babies’ feelings, as thought they are not true feelings. If your baby seemed upset and frightened by his/her lessons, then do something about it! Although I later learned to swim(around age 9)I never felt entirely comfortable in the water.
My kids are taking swimming lessons and they are learning under the supervision of the instructors.