Safe swimming tips can help protect you and your family this summer.

Swimming can be a great way to cool off during the summer. And it’s a healthy, low-impact aerobic exercise.

Yet swimming can carry risks. A Centers for Disease Control and Prevention report released in May 2018 shows that between 2000 and 2014, more than 27,000 people got sick from contaminated water in pools, hot tubs, or playgrounds, and eight died.

Along with the risk of disease, swimming comes with the risk of drowning, sunburn, and—very rarely—infection by a brain-eating amoeba.

Before you or your kids swim this summer, protect yourself from potential hazards by following these tips.

Stomach Bugs

If you or your child comes down with a case of diarrhea after going to a swimming pool, the culprit could be a parasite called cryptosporidium, or crypto for short. Crypto is a common cause of swimming-related illness, and outbreaks are on the rise. A new CDC report out today found that the number of reported outbreaks of crypto rose by about 13 percent every year between 2009 and 2017.

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You can’t always tell by sight how clean the water is in public pools, and crypto isn’t easily killed by chlorine. It can live for days, even in pools that are properly maintained. Other bugs, such as norovirus and giardia, can also survive in chlorinated pools, though not for as long as crypto.

The 2018 CDC report also found that the largest percentage of disease outbreaks occurred in hotel hot tubs, spas, or pools, so you may want to be extra-cautious while traveling. Some bugs, such as legionella, proliferate in poorly maintained pools. 

Public pools often have reports detailing violations found by inspectors. The CDC recommends asking to review those reports if you’re concerned. (For private pools, your only recourse may be buying a pool test kit, available at hardware or pool-supply stores.)

How to Prevent It
• Don’t swallow water in pools, hot tubs, or playgrounds.
 And remind children not to swallow it.
• Keep sick kids out of the water. Don’t swim or allow kids to swim when sick with diarrhea (even with swim diapers, which aren’t foolproof).
• Wash up. Shower with soap and water before and after you swim.

Sunburn

Avoiding sunburn is key to staying safe in the summer. The sun can damage your skin in as little as 15 minutes, according to the CDC. Ultraviolet B rays cause sunburn; ultraviolet A rays tan and age your skin. Both contribute to skin cancer, the most common form of cancer in the U.S.

How to Prevent It
• Apply sunscreen early and often.
Put sunscreen on at least 15 minutes before you go outside. Shake it before you use it, and reapply regularly—at least every 2 hours and anytime after you’ve been swimming or sweating.
• Seek shade. Try to stay in the shade during the sunniest part of the day if you can, from 10 a.m. to 4 p.m.
• Cover up. Sunscreen is just one part of a sun-protection strategy, says Nichole Steffens, aquatic product manager for the American Red Cross. Wear a hat, and periodically put on clothing that covers your skin.

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Drowning

In 2017 the USA Swimming Foundation reported a 5 to 10 percent improvement in overall swimming ability among U.S. children since its last report in 2010. But it’s still important to note that 64 percent of African American children, 45 percent of Hispanic children, and 40 percent of Caucasian children can’t swim or can’t swim well.

“Swimming lessons alone do not prevent drowning,” says Candice Dye, M.D., an assistant professor in the department of pediatrics at the University of Alabama at Birmingham.

Taking swimming lessons can reduce the risk of drowning, but it doesn’t eliminate it. Anyone can become overwhelmed or exhausted in the water.

And drowning is quick and quiet, according to the Centers for Disease Control and Prevention. There’s usually no splashing or yelling like in the movies.

That means parents and caregivers need to pay careful attention when kids are swimming. But that’s becoming more difficult with the prevalence of distractions like smartphones, says William Ramos, Ph.D., a professor in the School of Public Health and director of the Aquatic Institute at Indiana University in Bloomington.

Drowning kills about 10 people each day in the U.S. and is a leading cause of death among young children, according to the CDC.

How to Prevent It
• Stay close.
 Children, as well as people who can’t swim and those who are weak swimmers, should be within an arm’s reach of an adult in case something goes wrong. And even strong swimmers and adults shouldn’t swim alone, says Nichole Steffens, aquatic product manager at the American Red Cross.
• Learn CPR. Anyone watching over swimmers—parents, grandparents, babysitters, neighbors—should know how to perform CPR. (You can find a CPR certification class near you here.)
• Wear a life jacket. Weak swimmers or people who can’t swim should wear a U.S. Coast Guard-approved life jacket in or around water. Arm floaties for kids and floating pool toys aren’t sufficient, Steffens says. And anyone who goes boating should wear a life vest.
• Fence it in. Do you have a swimming pool in your backyard? You should install a fence to separate it from the house and the rest of the yard so that children can’t get into it when you’re not watching. The gate should lock or latch automatically.
• Don’t fight a rip current. If you’re swimming at a beach and find yourself caught in a rip current, don’t swim directly toward the shore, or you’ll risk exhausting yourself. The National Ocean Service advises swimming parallel to the shore until you’re out of the current, then swimming back to the shore at an angle. 

Swimmer's Ear

This ear infection is distinct from a typical middle-ear infection. It’s an outer-ear infection that’s triggered by contaminated water trapped in the ear canal. Swimming “produces this great environment for bacteria to have a heyday,” Dye says.

Symptoms include itchiness inside the ear, redness or swelling, pain if the ear is tugged or pressed on, and pus that drains from the ear. (If you or your child gets it, go to your doctor, who might prescribe antibiotic eardrops.)

How to Prevent It
• Protect your ears.
Keep ears dry if you can, using a swim cap or silicone earplugs (not wax).
• Remove water after a swim. Dry your ears with a towel after swimming. If you have water in an ear, tilt your head downward and pull your ear in different directions to coax water out.
• Try ear drops. Over-the-counter eardrops meant to dry out your ears can also help, Dye says. Ask your doctor to recommend a brand.

Concerns About Pool Chemicals

A study published last month in the CDC’s Morbidity and Mortality Weekly Report found that injuries due to contact with pool chemicals, mostly at private homes, were responsible for more than 13,500 emergency room visits between 2015 and 2017 in the U.S.

About a third of the cases were labeled as poisoning, and incidents were usually caused by the inhalation of fumes or dust (especially while opening containers of chemicals), swimming too soon after chemicals were added to pool water, or not keeping chemicals stored out of the reach of children.

Another potential problem with pool chemicals is eye, nose, or throat irritation. When the chlorine used to disinfect pool water comes into contact with waste or other substances that wash off swimmers’ bodies—including skin cells, makeup and other personal care products, dirt, sweat, urine, and fecal matter—it can create substances called chloramines. When chloramines are inhaled, they can cause coughing and wheezing, and even trigger asthma.

How to Prevent It
• Store chemicals safely. If you have a pool in your backyard, ensure that pool chemicals are kept securely out of the reach of children. If you opt for do-it-yourself pool maintenance at home, wear appropriate safety equipment, such as a mask, gloves, and goggles.
• Keep pool water clean. Showering before and after swimming can help keep chloramines from forming. Wearing a swim cap can help, too.
• Take breaks. Parents should take kids for bathroom breaks every hour to avoid accidents in the pool.
• Give it the smell test. You can tell that chloramines are present if you notice a chemical or chlorine smell in the pool area; well-maintained pools don’t have a strong chemical smell. If the pool has a strong smell, consider skipping your swim.
 

A Rare Danger: Naegleria Amoeba

Each year it’s common to see one or two headlines about people who contract the brain-eating amoeba Naegleria fowleri, which can grow in warm freshwater bodies, such as lakes, ponds, hot springs, and poorly maintained swimming pools. The amoeba can cause a disease of the central nervous system called primary amebic meningoencephalitis, which is almost always fatal.

The good news is that Naegleria infections are rare. Between 2006 and 2015, there were only 37 reported cases in the U.S., according to the CDC. And the amoeba won’t harm you if you swallow contaminated water; it’s dangerous only if you get it up your nose.

Naegleria infections are so uncommon that scientists haven’t been able to make definitive research-based recommendations about how to avoid it. Still, the CDC offers some commonsense tips for reducing the likelihood that you’ll expose yourself to Naegleria.

How to Prevent It
• Keep your head up.
Avoid putting your head underwater in bodies of warm fresh water, such as a lake or hot spring.
• Plug your nose. If you jump in or swim underwater, pinch your nose or use a nose clip.
• Stay out of the mud. Try not to stir or dig up sediment in warm freshwater areas.