You need not travel halfway around the world to acquire “travelers’” diarrhea. A short trip to your neighborhood recreational water facility may suffice. But if indeed someone does become ill, don’t panic. Hold off on treating. Most cases get better by themselves, while medication may cause harm – especially for children.
1. All recreational water facilities can be polluted. Such facilities include pools, hot tubs, water play areas, interactive fountains, lakes, rivers, and oceans. Most intestinal illnesses are due to swallowing water but can also be due to breathing in mist produced by water or by not washing hands after playing in sand.
2. The number of such illnesses is steadily increasing. And young children are especially susceptible, says the Centers for Disease Control (CDC). Children have little or no immunity against the causative microorganisms. Such organisms include cryptosporidium (crypto), giardia, shigella, and norovirus – some of the same organisms responsible for travelers’ diarrhea in poor countries. Crypto, for example, can survive in well-maintained chlorinated pools for several days.
3. “Don’t drink the water.” This old adage is probably more important for recreational water than for tap water. The probability of illness depends on how polluted the water is, how much is ingested, and which organism is involved. For some organisms, swallowing just a few, easily contained in a mouthful, suffices to cause illness. The younger the child, the more likely he/she will swallow water. Dunking infants’ heads to get them “used to water,” a common practice, can make them ill.
4. The chief source of intestinal-causing diseases is fecal matter. In recreational water, the fecal matter comes from people, especially infants in diapers. However, even adults’ routine toilet-related hygienic practices fail to remove all fecal matter from skin. Showering with plenty of soap and water before swimming reduces the incidence of illness. Avoid recreational water entirely while you are ill, and a few days after recovery.
5. Some recreational swimming facilities ban infants in diapers. Think twice before swimming where there are many such infants. While special swim diapers have become popular – they don’t disintegrate in water, fit snuggly around waist and thighs, and have a plastic outer lining – such diapers merely retard and decrease leakage, but do not prevent it.
6. Man-made public water facilities must be professionally maintained. Ask pool operators if free chlorine and pH levels are checked at least twice a day and more often when the pool is heavily used and the weather is hot. Some large pools now use ultraviolet ozone technology or hyperchlorination to treat recreational water. Check backyard pools yourself for adequate free chlorine (1-3 parts per million) and pH (7.2-7.8) levels. Test strips are available at local home improvement stores and pool supply stores.
7. Public beaches are generally checked for pollution. Reports are available from local health departments. Ask for the latest report. Never swim near storm drains or after heavy rain; the water draining into the beach often carries sewage from overflowing sewage treatment plants and may contain fecal material, fertilizer, pesticides, and other pollutants.
8. Most intestinal illnesses in young children need not be treated. The vast majority of cases of loose stools in this age group disappear spontaneously. If a child is happy, playful, and eating and drinking normally, medication and changes in diet are not necessary. Treatment, especially with antibiotics, alters the “good” bacteria lining the intestine and may make children more susceptible to intestinal illnesses in the future.
9. Children who have symptoms in addition to loose stools need prompt medical evaluation. Of concern are fever, blood in the stool, listlessness and not drinking, for example. Even in such cases, fluids may suffice and antibiotics may not be necessary. However, this is a decision to be made by a health professional.
10. Miscellaneous. Well-maintained facilities have no odor. A strong chemical smell of chlorine, for example, may indicate a maintenance problem, especially in hot tubs and spas. When hot tub equipment is working, pumps and filtration systems make noise and you should hear them running. Children less than five years of age should not use hot tubs. Poorly maintained recreational water can also be the source of skin rashes, eye and ear infections, and other illnesses. For additional information about recreational water, see http://www.cdc.gov/healthywater/swimming/protection/pool-user-tips-factsheet.html.