THE OLD SWIMMING HOLE By Mark B. Levin, M.D. The Pediatric Group, P.A., Princeton

This is the second article in a series written for Princeton Online on warm weather hazards for children.

It is hard to imagine a summer sport as popular as swimming. Since before Huck Finn days to the present, children of all ages have used any available body of water for cooling and fun in the summer heat. Water, so necessary to life and so enjoyable, can also be a source of rare but tragic events. As in any other aspect of life, with proper preparation we can enjoy the water and water sports.

Before progressing any further, read the previous article in this series regarding sun protection. Being in the water increases your risk for sunburn because the water washes off sunscreen and toweling can rub it off. The water droplets on the skin can act like little magnifying glasses, intensifying the effects of the heat, even though the evaporation of the water makes the skin feel cool. Sunscreen should be re-applied often during swimming; fair-haired freckled children should wear a shirt in the water.

We encourage parents to obtain swimming lessons for their children as early in life as possible. Some institutions, for example the local YWCA, offer swimming lessons for children as young as 5 or 6 months of age. No one expects a child of this age to be an Olympic champion, but we do hope this training teaches the child to hold his or her breath or do a "dog-paddle" stroke in case of an accidental plunge. The "forced dunking" method of teaching a child to breath-hold is dangerous (children can swallow so much water that they develop hyponatremic seizures). The gradual acclamation method used in most lessons is acceptable.

Likewise, it is imperative that no child is ever allowed in a pool without some CPR-competent adult AT THE POOLSIDE. Watching a child in a pool from the house or attending to distractions, such as answering a telephone call, can cause a delay in instituting resuscitation in the event of a serious accident. Even seconds can be precious in this situation. CPR training can be obtained at the local Red Cross. Hospitals and/or Rescue Squads may offer public courses in CPR from time to time. Inflatable pool toys are not adequate floatation devices for the purpose of life saving. Treat them as if they were not there.

Each swimming environment has its own attendant risks. Swimming pools are usually sterilized with chlorine compounds. As an oxidizing agent, chlorine destroys bacteria. The level should be checked daily in private pools and several times daily in heavily used public pools to assure optimal concentrations. Too little is ineffective and too much causes a chemical irritation of swimmers' eyes and nasal passages. Some pools are sterilized with bromine, a chemical relative of chlorine. Some people find this chemical less irritating to their eyes. Used properly, it is equally effective in cleansing the water. A third preparation, used by those allergic or intolerant of halogens, is Baquacil®. This preparation is a surface tension agent that kills bacteria like soap. Instead of the bleach smell of chlorine, Baquacil® has a light almond odor and it makes the water foam when agitated.

Many parents are surprised to learn that the sterilization techniques for swimming pools do not kill viruses. The chemicals in the pools are intended to kill bacteria, particularly the enteric organisms, such as salmonella, shigella and E. coli. Some of the common summer viruses-- in particular the enteroviruses that can cause diarrhea and the well known hand-foot-mouth disease-- are easily acquired from other children who swim in the same pool. Drinking too much pool water can also cause diarrhea because of the chlorine. Although swallowing some pool water is inevitable, teaching a child proper technique in the water may save you from having to deal with this intestinal complaint.

Water in the ears can cause an external ear infection (not the kind that follows a cold), called "swimmer's ear"-- a painful swelling of the ear canal. This annoying condition can often be prevented by instilling a 50/50 mixture of white vinegar and rubbing alcohol in a child's ear when the day's swimming is done. Vinegar retards growth of bacteria and fungi while alcohol helps dry the ear canal by evaporation. This should not be done if a child has tympanostomy tubes, a perforation or pre-existing pain. Call your physician if you have questions regarding illnesses contracted in a swimming pool. Hepatitis B and HIV are NOT acquired by swimming in public pools.

Most of us can recall being admonished to walk around a pool, rather than run. The reasons for this on a wet slippery walkway around a pool are self-evident. However, children still run to be the next off the diving board. Supervising adult(s) should make rules regarding how many times a particular child should be told before restricting him or her from the pool for 5 or 10 minutes. Then the adult must enforce the rules. With enough time-outs from pool activities, a child will comply. Restrict swimmers from the water around the diving board and allow only one diver on the board at a time. Allow one child enough time to get out of the water before the next child jumps into the same area.

In large pools at amusement parks, there have been occasional drownings because of swimmers approaching too close to underwater intake tunnels. Inquire as to their whereabouts in the pool and whether they are covered with a grating. An unattended closed pool can be as dangerous as an occupied pool. When the pool is closed to swimmers, it should be fenced with the gate locked. Floating pool alarms that detect motion in the water are a good idea. In the off season, use a secure sturdy pool cover that can support an adult's weight.

Other swimming environments carry their own set of hazards. Of course, sun protection and the necessity for adult supervision and CPR competence are common to all situations. Naturally occurring bodies of water may not be safe. Quarries and swimming holes may have boulders hidden beneath the water's surface. The ocean can look calm on the surface yet be harboring a strong undertow. A lake can have underwater reeds that can tangle a swimmer's legs. Be sure that the environment is safe before permitting any swimmers to go in. None of these environments should be used for diving. Swimming should be prohibited in areas where fishing and boating occur. The discussion above regarding floatation devices holds true here, as well. Sterilization is not an issue in most larger bodies of water because there is so much water to dilute out any possible contaminants (except in the instance of water polluted with sewage or industrial waste).

Scuba diving has particular hazards related to depressurization. Lessons and certification before attempting scuba are imperative. Children with certain pulmonary conditions (cystic fibrosis and asthma) are at increased risk for complications during scuba diving. Any child with these problems must check with their physician before attempting this activity. Children with allergies may have trouble equalizing the pressure in their ears. They should also check with their doctor before engaging in this activity.

Swimming exercises all of the body's muscles in a non-weight bearing way. It enhances cardiopulmonary fitness. With appropriate precautions, swimming can be safe as well as healthy and fun.

All Rights Reserved 5/98 The Pediatric Group, P.A.

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.