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Summer's Health Hazards, Part 4 - Recreational Water Illness

June 14, 2017

It’s one of “Summer’s Health Hazards” – recreational water illnesses (RWIs).

You’ve heard the warning when in Mexico not to drink the water, which is full of contaminants.

The same warning applies here in the United States - not for most tap waters, but for those who might tend to swallow or inhale water up their nose when swimming in both treated and untreated waters found in pools, hot tubs, water parks, and freshwater lakes, rivers, ponds and even the ocean. RWIs are caused by germs and chemicals found in these waters, which can result in gastrointestinal, skin and ear diseases, chemical irritations of the eyes and lungs, and even neurologic and wound infections. However, the most commonly reported RWI is diarrhea, which is frequently caused by germs such as Cryptosporidium and E. coli. Swimmer’s ear, referred to by clinicians as otitis externa, is also a frequently seen RWI.

Those with weakened immune systems and pregnant women are at greater risk for more severe illness if infected.

“Children are especially at risk for acquiring RWIs since they usually play in the water for longer periods of time and swallow more water than adults typically do,” said Dr. Mike Klatte of Pediatric Infectious Diseases at Baystate Children’s Hospital.

While certain infections (including diarrhea caused by Cryptosporidium and E. coli) resolve themselves without treatment in otherwise healthy children, prescription medications to treat those infections are available for kids with persistent or worsening symptoms and for those with weakened immune systems. Swimmer’s ear is most often treated with antibiotic ear drops and topical agents for pain relief.

Dr. Klatte and the Centers for Disease Control and Prevention (CDC) offer the following tips to stay healthy in the water:

  • Don’t swallow the water. Swallowing even a very small amount of water that is contaminated with germs can make you sick.
  • Stay out of the water if you have diarrhea.
  • Stay out of the water if you have an open wound, for example, from surgery or piercing, that is not covered with a waterproof bandage.
  • Shower before you get into the water. Rinsing off in the shower for just 1 minute removes most of the dirt or anything else on your body, such as fecal matter from diarrhea.
  • While chlorine and other disinfectants kill many germs, some bacteria can continue to survive for days. For that reason, once in the water, don’t pee or poop in it.
  • Take kids on bathroom breaks every hour.
  • Check diapers, and change them in a bathroom or diaper-changing area – not waterside – to keep germs away from the water.


The CDC recommends using portable test strips to check for adequate chlorine and proper pH of pool water before stepping in. To find out if you are swimming in a healthy pool, you can order free pool test strips from

While contaminated recreational water is a concern, with not a summer going by without some contamination warning at local pools or bodies of water, Dr. Joeli Hettler, chief, Pediatric Emergency Medicine, Baystate Children's Hospital, says that complaints related to waterborne illness are rare and symptoms generally stop or end without therapy.

Her greater concern is about swimming safety and preventable injury.

According to Safe Kids Worldwide, among preventable injuries, drowning is the leading cause of death for children 1-4 years old.

Dr. Hettler says the most important way to prevent drowning is to never leave your child unattended around water. In addition, Safe Kids offer the following “top tips” for staying water safe this summer:

  • Watch kids when they are in or around water, without being distracted. Keep young children within arm’s reach of an adult. If several adults are present, -more-
    choose a “Water Watcher” who is a responsible adult and who agrees to watch the kids in the water without distraction.
  • Empty kiddie pools immediately after use. Store them upside down so they don’t collect water.
  • Install fences around home pools. A pool fence should surround all sides of the pool and be at least four-feet tall with self-closing and self-latching gates.
  • Teach children how to swim by enrolling them in swim lessons.
  • Know what to do in an emergency. Learning CPR and basic water rescue skills may result in saving a child’s life.


In addition to recreational water illness, other Summer Health Hazards include sunburns, protecting yourself from the ill effects of the heat, food-borne illnesses, exercising in the summer, and ticks.