If It Were My Child: Infant Swimming Lessons

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.

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