Jacuzzis

Dear Lisa,

I have heard that it is not good to have a child in a Jacuzzi, is this true?

“Concerned Mother in Jersey”

Dear “Concerned Mother is Jersey”,

There are definitely some health concerns with children going into Hot Tubs or Jacuzzis. First of all the temperature regulatory system in children is not mature enough to withstand extreme changes in temperature efficiently. (1) Children who stay in a Jacuzzi at a high temperature for a long period of time can overheat quickly and develop heat exhaustion.

The signs of heat exhaustion include; hot, dry skin, profuse sweating, unsteady gait, low blood pressure, incontinence, headache dizziness, abdominal pain, vomiting, diarrhea, fast heart rate, fast breathing and seizures. (2,3 ) Heat exhaustion is dangerous because it may progress to heat stroke which can be fatal. Children who develop heat stroke develop a fever up to 104.9 degrees Fahrenheit and exhibit signs of delirium which may progress to shock, coma and even death. (3) Children at risk for developing a heat related illness include those on medication such as neuroleptics or sedatives, use of alcohol, those with fever, those using supplements such as creatine or ephedrine or those engaging in excessive activity. (2)

Secondly, entrapment injuries are a concern for children who go in Jacuzzis. (4) Entrapment injuries occur when a child’s hair gets sucked into the intake suction valves in a Jacuzzi or Hot Tub. This could pose a drowning risk for children with long hair who put their head under water or near an intake valve. If the hair gets stuck, it pulls the child’s head under water which can lead to drowning. It is a good idea to be aware of the placement of the input suction valves and have children stay clear from them. In addition, before going into a spa inquire about the procedure for turning off the Jacuzzi in case of an emergency. Most hotels, spas and cruise ships will have an emergency shut off buttons with clear signage and instructions regarding emergency shut procedures.

Another very important concern about Jacuzzi use in children is the risk of Recreational Water Illnesses (RWIs). Recreational Water illness are skin, ear, eye, respiratory, neurologic and wound infections that children contract after being exposed to germs in a pool or Jacuzzi. Jacuzzis are a particular risk because Chlorine and other disinfectant levels evaporate more quickly due to the higher temperature of the water in the tubs. (5) In addition lower water volume and heavy bather loads only contribute to low disinfectant levels that allow the growth and spreading of germs. (4)

If diligent monitoring and proper disinfection of hot tubs are not maintained the levels of germs can increase to the point where they can cause illness when swimmers breathe or have contact with water containing these germs.(5) Very common Recreational Water illnesses include diarrhea caused by Crypto, short for Cryptosporidium, Giardia, Shigella, Norovirus, and E. coli O157:H7. (6) People who are a high risk for developing Recreation Water Illnesses include, children, pregnant women, people with compromised immune systems, people living with AIDS, those who have received an organ transplant, or those receiving certain types of chemotherapy. People with these conditions can suffer from more severe illness if infected.(7) Activities that children engage in such as putting their head under water and swallowing the water in the Jacuzzi puts them at risk for developing recreational water illnesses. (7)

Hot Tub Folliculitis also known as “hot tub rash” and skin infections are the most common RWI that spread through hot tubs and spas. (5) Hot Tub Folliculitis is the inflammation and abscess of hair follicles which is typically caused by the organism, Staphylcoccus aureus. (3) The symptoms include itchiness and pimple like lesions distributed on the parts of the body where a swimsuit covers. The rash typically is found on a child’s torso, buttocks and groin and usually spares the face and extremities. The rash is worse under the area of the swimsuit because the swimsuit keeps the contaminated water in contact with the skin for a longer period of time. (8) Children with Hot tub folliculitis may develop complications such as ear infections, throat infections, conjunctivitis and pneumonia.

In order to keep your child from developing complications when using a Jacuzzi a few measures should be followed. Young children, especially under 5 years old should not go in a hot tub at all. (4) Most Hotels, spas and cruise ships do not allow children under 12 in hot tubs. Children who go into a hot tub should not stay in it for more than 15 minutes. In addition, the hot tub temperature should be set so that it does not exceed 104 degrees Fahrenheit. (4)

All children who go into a hot tub should have their hair secured high on their head and should never put their head under water or swallow the water. Once a child comes out of the hot tub their swimsuit should be removed right away and not be allowed to remain on the body for any length of time. No children with skin infections, diarrhea illnesses or an altered immune system should go into a hot tub. If your child develops an illness, skin infection, skin rash, cough, eye discharge or diarrhea after spending time in a Jacuzzi, contact your Doctor for an evaluation.

If you own a Jacuzzi or hot tub it is important to carefully follow instructions regarding proper maintenance and disinfection in order to prevent RWIs. You can find instructions on how to maintain your hot tub by logging on to:

http://www.cdc.gov/healthyswimming/pdf/spa_operation.pdf


References:
(1) Bellack J, Bamford P. Nursing Assessment A multidimensional approach. Belmont, CA:Wadsworth Inc.1984:284.
(2)Dawson F. Unusual case of heat stroke in a young boy. The Clinical Advisor. 2006. Mar:50-58.
(3)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 626,1132
(4)The Centers for Disease Control. CDC fact sheet for pool staff/owner. Available at: http://www.cdc.gov/healthyswimming/pdf/spa_operation.pdf. Accessed Sept 2006.
(5) The Centers for Disease Control. Where are RWI found. Available at:
http://www.cdc.gov/healthyswimming/where.htm. Accessed Sept 2006.
(6)The Centers for Disease Control. What are recreational water illnesses (RWIs)? Available at: http://www.cdc.gov/healthyswimming/what.htm. Accessed Sept 2006.
(7)The Centers for Disease Control. Who is likely to get Ill from RWI? Available at: http://www.cdc.gov/healthyswimming/who.htm. Accessed Sept 2006.
(8)The Center’s for Disease Control. What is Hot Tub Rash? Available at: http://www.cdc.gov/healthyswimming/derm.htm. Accessed Sept 2006.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Kids Healthy