Babies

ISRM Guidance September 2006

What age is it safe and appropriate for a baby to be taken swimming in a public pool?

The ISRM has always advocated that it makes sense to introduce children to swimming at as early an age as possible. Babies particularly display a natural affinity with water and have little or no fear of an aquatic environment. In 1992 in conjunction with the BBC, Sports Council and ASA we produced a document giving advice to parents on swimming for children. Essentially the Institute’s advice to you today varies little from this and that is:

"You can take a child of six months swimming providing the conditions are right. However it is unwise to take them swimming much before this as they become chilled very easily".

In this respect we concur with the views of the College of Paediatrics and Child Health and the Community Practitioners and Health Visitors Association in saying that immunisation is not a consideration. The immunisation programme given to babies does not affect their opportunity to go swimming. The advice to wait until the baby has had some or all of their immunisations goes back to the days when polio was much more common and people were worried about its spread in swimming pools. It is now an extremely rare infection and hardly ever seen in the UK. The live polio vaccine drops are no longer given and therefore there is no longer a concern that swimmers will come into contact with the virus from recently immunised babies.

The vaccines given to young babies protect against:

• Diphtheria, Pertussis, Hib (Haemophilus influenzae type b, Men C (Meningococcal group C) and pneumococcal disease. These organisms are in the air. Swimming pools do not carry a greater risk of infection.
• Tetanus. Tiny spores from this organism exist in the soil and manure, NOT swimming pool water.
• Polio. It is extremely unlikely that water will be the means by which this infection gets passed on. It is more likely to be from hands soiled by stools containing the organism.

The above infections are not contracted in the chlorinated water environment of a well-run swimming pool.

Are the chemicals in the water harmful to my baby?

There is little to commend a baby to commence their swimming experience in a public pool before six months. The reason for this recommendation is that the temperature of the water is unlikely to be to a baby’s comfort and the chemicals used to treat a pool can produce by-products, chloramines etc that are not healthy to a baby’s delicate lungs and are somewhat harsh for a baby’s delicate skin. A baby’s skin is more delicate than an adults and the chemicals used to sterilise swimming pool water can irritate the skin and eyes of some babies. Your health visitor will be able to advise you on skin care products. It is recommended that you build up the time in the pool, starting with no more than 10-15 minutes for the first few visits. Shower your baby down immediately after leaving the pool to rinse off any chemicals that could irritate the skin. Prior to 6 months, many preliminary swimming activities can be taught to a baby in an ordinary bath at home.

Points to bear in mind when babies start swimming are:

• Babies should wait one hour after a feed before swimming.
• Babies should not go swimming if they are ill - a child who is ill should not be exposed to big swings in temperatures.
• The temperature of the pool, changing rooms and outside are really important, as a baby cannot control their body temperature. Pool water should be at least 30°C.
• If your baby has suffered from a tummy bug, it is important to wait two days after the first solid movement before going swimming.
• Babies with ear infections should not swim.
• Don’t go swimming with your baby if they have an infectious disease. This includes diarrhoea and a heavy cold. Wait for 10 days after the illness has cleared before going swimming.
• Sometimes babies experience side effects after their vaccines. These are generally quite mild, and should not prevent you taking your baby swimming. Babies who are feverish, or who get a mild form of mumps in the weeks after the MMR vaccine, may not feel up to swimming for a few days.

Babies should wear an elasticised type of swimming costume when they do attend a pool that will help to contain solid faeces in the event of accidental soiling. It is more hygienic to put your baby in a swim nappy such as kooshies or aquanappies or Huggies. It is important to remember that stomach and bowel upsets can be passed on to other users if a pool has been contaminated by an accidental faecal soiling. The following advice should be followed.

• Avoid changing the nappy by the side of the pool.
• Dress toddlers in close-fitting swimsuits to better contain faeces.
• Occasionally check in their bathers for soiling. 
• Reduce the risk of accidents by taking children for frequent trips to the toilet. 
• Don’t rinse hands in the pool water after a trip to the toilet or after changing a child’s nappy. Use warm water and soap.
• Pool operators should provide suitable disposal points for soiled nappies etc. and safe hygienic baby changing facilities.
• Usually if a baby has an accidental faecal soiling in a pool then while this may be embarrassing there is little that can or needs to be done other than to remove the material. However in very special circumstances when a baby may be ill, where loose, runny stool (diarrhoea) is involved, then there may be a risk to other bathers from pathogenic bacteria. In this case we would advise closing the pool and carrying out the ISRM recommended procedure with both the filters and pool disinfection negate the problem (see the box below). Accidental faecal soiling is not unusual when babies use swimming pools and for this reason consideration should be given to limiting babies to specially designated baby pools, where the water can be shallower and warmer and where in the event of accidental soiling the pool can be closed and drained down, cleaned and refilled. 
• In either case it is important that the parent or carer tell the pool’s staff. Also all pools should have a policy that encourages any ill person, including babies, or a person with an infectious illness, wound or disease, not to go swimming.