Thursday, May 26, 2016

Swimming with your kids/ An advice nurse's guide

 
 
We get a wide variety of calls related to swimming with your kids. The earliest one may be from the family who is going on vacation and wants to know if it is safe  for the baby to go into the hotel pool. In general I don’t recommend optional travel until your baby is several months old and has had their first set of vaccines (two sets is better). I am assuming that you are sensible enough that you aren’t planning on taking your one month old on a tropical vacation. If your baby isn’t brand new, then generally my answer about getting into the pool is “sure!”, but there are several factors to consider.

Is the pool outdoors? We all need to be careful with sun but baby’s thin skin is especially vulnerable. Babies need to have a big floppy hat and perhaps sunglasses and sunscreen. Just this week one of our fair young babies got a rotten sunburn on his face  (and it wasn't even particularly sunny out). Recent studies are finding that regardless of the labels, many sunscreen products do not give as much protection as they claim. Sprays especially don’t seem to protect as long.

Be aware that the reflection from the  water can add to the risk of burning and remember that sunscreen does need to be reapplied even more often if the kids are getting wet. Get in the habit of  paying a moment of attention to everyone’s skin at least every 15 minutes. If they are getting pink, it is time to get out of the sun. Don’t wait until they are bright red. While it is true that my fairest patients are the most at risk for a sunburn, all skin pigments should be protected. Shade is best! There are some cute little umbrella baby floats that offer quite a bit of shady protection if you are in a pool.

The next factor is the water temperature. Young babies don’t regulate their body temperatures very well, so make sure that any pool water is nice and warm and that the outside temp isn’t too chilly for them. Most hot tubs and Jacuzzis are too hot for young kids. For any of my older patients and families who do enjoy the hot tub, be on the lookout for any pimply rashes that show up within the next several days. These are often bacterial and may need to be treated.

For young babies, a little splashing is okay, but I wouldn’t let them submerge their heads until they are old enough to keep their mouth closed. There are claims that very young infants are natural swimmers and don’t take in a lot of water; I prefer not to test that out. A big gulp of chemical filled water is yucky.

If you are staying anywhere with a pool, make certain that your child has absolutely no access to the pool area when there is no adult present.

Many folks like the idea of swim lessons for their children as part of their normal routine, not just reserved for vacations. We don’t usually recommend formal lessons until your child is at least 6 months old. For the most part, swimming lessons for kids under 3 years are all about getting your child comfortable in the water. As a bonus, water play is a healthy form of exercise for the entire family and may improve motor skills.

Some studies claim that  participation in formal swimming lessons is associated with a huge reduction in the risk of drowning. That is a big deal because drowning is in fact the leading cause of unintentional injury and death among children aged 1–4 years in this country.  Even if your child seems like they are a good little swimmer, it is important that parents not have a false sense of security. Regardless of the situation, kids need to be watched like hawks whenever they are around water.

A person who is drowning may not thrash about and call attention to the fact that they are having trouble. They can slip silently under the water without being noticed until it is too late. Even if your child has proven themselves to be solid swimmers, you need to stay actively focused and engaged while they are in the water.

We had a scare with one of our families last summer. Several adults and children were enjoying a day at a friend's pool in the East Bay. They got out of the pool to have some lunch. Some of the oldest kids started to bicker. While the adults turned their attention to the squabble, a one year old got back into the pool unnoticed and submerged. Thank goodness another of the adults looked up, noticed and was able to get her out and perform CPR. The little girl is perfectly fine, but this was terrifying for everyone.

If you are exposed to any media, then there is a good chance that you have heard of Secondary Drowning.  Nurse Kenlee, who worked for many years in the ER, explains:

If someone had a near drowning in a pool, they are at risk of  flash pulmonary edema from chlorine irritation to the lungs. They may seem fine initially, but then present with cough and pinkish sputum. This usually shows up within 12 hours of the event.
Aspiration pneumonia from inhaling too much water into the lungs will have a slower onset and would present with cough, high fever and lethargy.

The bottom line is that caregivers need to closely monitor any child who has come out of the water coughing and sputtering. Especially keep an eye out for any further difficulties in breathing, extreme tiredness, or marked changes in behavior, all of which are signs that a swimmer may have inhaled a dangerous amount of fluid. If there is any concern, an emergency room or immediate medical intervention is needed. It is important to know what to look for, but to reiterate, in over 30 years with a practice full of swimmers, I am not aware of any of our patients having this issue.

Kids should be trained to keep their mouths closed when jumping into the water
and to enter very cold water slowly. This should help avoid aspirating large amounts of water. There is a big difference between water in the lungs and water in the belly. If your child swallows a lot of water they may end up with a tummy ache but it is rarely dangerous.

Anytime you are hanging out at a pool please wear flip flops when wandering around poolside or in the locker room. Fungal infections and athlete's foot do happen. A spray bottle with some diluted vinegar solution to spritz on the feet and then making sure that the feet are very dry before putting shoes and socks on, are good preventive measures.
Little girls that spend a lot of time wearing a wet bathing suit can also get irritations. It is a good practice to get the kids out of the wet suits as soon as possible. Do a good rinse off as soon as you can and then apply a nice moisturizer to avoid exacerbating dry skin.

We also get a bunch of calls about swimming and ears. If your child has had a recent ear infection they are fine to swim as long as the tympanic membrane is intact. If your child has had ear tubes or a recent ruptured eardrum, they should NOT be submerging their ears in the water (or the bathtub for that matter) without having protective ear plugs.  Sound Speech and Hearing makes custom ones with sparkly color options that may help with compliance.

If your child has been doing a lot of water play, they may be prone to otitis externa (better known as swimmer's ear.) As opposed to an inner ear infection that requires an otoscope to make a diagnosis, an outer infection is often visible to the naked eye. The ear looks red and sore and may have some drainage. If that is happening, it is worth an office visit so that we can see what’s happening and prescribe some antibiotic ear drops if warranted. Keeping the ear canal as dry as possible may help prevent this condition. There is a simple proactive measure that can be cheaply and easily made by mixing equal parts of rubbing alcohol and white vinegar (50:50 mixture). This solution will increase the rate of evaporation of water in the ear canal and has antibacterial properties. Using this solution to rinse the ear before and after water exposure can help protect against infection.

If you are planning on swimming in open water (lake, river etc) make sure you check ahead of time to make sure there are no advisories. Last year the Russian River had some toxic algae bloom that I would not have wanted any of my patients to get near.

I mentioned that drinking pool water is yucky, but I am going to double down on the yuck factor in some lakes and rivers. These are the kids that end up with Giardia. A good rinse after swimming and making sure no water is ingested in very important.

Most of my local families know to be very wary of our local Ocean Beach, but if you are traveling to a place with a warmer and more inviting ocean, never turn your back on the water and beware of currents and strong waves.

Okay, don’t let the “Debbie Downer Advice nurse” spoil your fun. Go have fun swimming!

If you are looking for swim lessons, there are plenty of great options here in SF. Here are some of the more popular options

La Petite Baleen Swim School . They have several different sites. The one in SF is in the Presidio at 933 Mason St.  866-896-3603

3200 California St
San Francisco, CA 94118 Phone number (415) 292-1200


Mission Bay 1675 Owens St
Phone number (415) 514-4545

There is an indoor and outdoor pool here with all sorts of options for just swimming with your baby or doing classes.

YMCA
there are several branches in SF that offer swim classes:
The May/June sessions are likely full already, but if you plan ahead you may be able to join some July classes
Stonestown  415-242-7100
Presidio 415-447-9622
Embarcadero 415-957-9622

The city pools also have some classes available but they also fill up fast. Register at www.sfreconline.org to sign up for swim lessons ( and other great classes)
This website will also give info about the city pool hours if you are interested in just having some pool time with your kids and skipping the expensive lessons
You may want to go by yourself first to scope out the water temperature.

My kids grew up going to the Janet Pomeroy Center. This is out by the zoo at 207 Skyline Blvd. It used to be called the Recreation Center for the Handicapped. The lovely thing about it is that the pool is very warm. They have several slots every week where you can go and play in the pool with your child. It is reasonably priced, but you need to call to enroll in advance, They don’t have any drop in sessions. The phone number is 415-665-4241 http://www.prrcsf.org/index.php/aquatic-services/recreational-swim-lessons


Do you have a pool that should make the list? Please share the info and I will add it to the post.

If your child is enrolled in swimming classes and they have a mild cold or cough, they can probably still go swimming if they are feeling up to it. If they are vomiting or have diarrhea, do everyone a favor and keep them out of the pool!






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