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    Matthew Rank, M.D.

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Question

Infant swimming: Do indoor pools pose an asthma risk?

I've heard that infant swimming in chlorinated, indoor pools might cause childhood asthma. Is it safe for my 5-month-old to swim indoors?

Answer

from Matthew Rank, M.D.

There isn't enough information linking infant swimming and asthma to warrant keeping your baby out of indoor pools.

Researchers began looking at a possible connection between infant swimming and asthma to explain why asthma is on the rise among children. Some researchers theorize that chlorine — a common disinfectant used to keep pools clean — binds with swimmers' sweat and urine to create byproducts in the water and air that may harm an infant's lungs and put him or her at risk of developing asthma. Indoor pools have higher concentrations of these byproducts than do outdoor pools. Babies are thought to be at particular risk because their lungs are still developing and they tend to swallow irritant-laden water while swimming.

Studies examining the relationship between infant swimming and asthma, however, have produced conflicting results. A 2008 Norwegian study found that infants who swam at age 6 months had a greater risk of having an episode of chest congestion or wheezing in the chest up to age 18 months — if their mothers had a history of allergies. But a 2008 German study found that infants who didn't swim before age 1 had a greater risk of being diagnosed with asthma at age 6.

If your baby participates in infant swimming in indoor pools and you're concerned about asthma, opt for a well-ventilated facility. Ideally, staff members will open doors and windows in the pool area and use fans to boost air flow over the surface of the pool when it's crowded. Also, be sure to rinse yourself and your baby in the shower before entering the pool to reduce the formation of irritants in the water.

Next question
Wheezing in children: Could it be asthma?
References
  1. Irritants (chloramines) and indoor pool air quality. Centers for Disease Control and Prevention. http://www.cdc.gov/healthyswimming/irritants.htm. Accessed Jan. 30, 2009.
  2. Uyan ZS, et al. Swimming pool, respiratory health and childhood asthma: Should we change our beliefs? Pediatric Pulmonology. 2009;44:31.
  3. Bernard A, et al. Infant swimming practice, pulmonary epithelium integrity, and the risk of allergic and respiratory diseases later in childhood. Pediatrics. 2007;119:1095.
  4. American Academy of Pediatrics Committee on Sports Medicine and Fitness and Committee on Injury and Poison Prevention. Swimming programs for infants and toddlers. Pediatrics. 2000;105:868.
  5. Bernard A, et al. Chlorinated pool attendance, atopy and the risk of asthma during childhood. Environmental Health Perspectives. 2006;114:1567.
  6. Nystad W, et al. Baby swimming and respiratory health. Acta Paediatrica. 2008;97:657.
  7. Schoefer Y, et al. Health risks of early swimming pool attendance. International Journal of Hygiene and Environmental Health. 2008;211:367.
  8. Rank MA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 13, 2009.

AN01976

May 30, 2009

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