Swimming and Splashing with Complex Medical Conditions
Most kids love to splash in the water during the summer months, but water play can be very challenging for children with certain medical conditions or medical devices. In most cases, kids can experience water play in one way or another.
This article will discuss swimming and splashing with a variety of medical devices, including feeding tubes and pumps, central lines, tracheostomies, ostomies and drainage bags, and oxygen. It will also provide some suggestions for swimming with children who need physical supports in the pool.
Gastrostomies, Feeding Tubes, and Pumps
Most children with gastrostomies or other types of feeding tubes are able to swim and splash in the water without too many restrictions. There is one exception to this rule: children with brand new stomas that are less than two months old should not swim.
In general, most doctors recommend sticking to chlorinated pools and oceans when swimming, as lakes and rivers may have unsafe water quality. If you do want your child to swim in a lake or river, it is best to first check the water quality of the body of water, and then ask your child’s doctor. The CDC’s Healthy Swimming website is a good place to start to learn about water quality.
If at all possible, unhook your child from the feeding while swimming, and remove the extension set if applicable. Clamp long tubes or NG tubes and secure them so they do not get caught while swimming. If you will be in a sandy area, you may want to cover the entire tube site and feeding tube with a clear, protective dressing, such as AquaGuard or Tegaderm. Press and Seal plastic wrap and waterproof tape can also be used.
Children hooked up to feeding pumps should not submerge the pump in the water. The Moog Infinity pump is designed to be somewhat waterproof, so it can be worn while splashing, though you may still want to place it in a plastic zipper bag for greater protection. Children with the Kangaroo Joey pump should avoid both splashing and swimming while the pump is in use. Some children have used extra long extension tubing to allow swimming while keeping the pump far away and dry, but this must be done with extreme caution, and only with children who understand the limitations of their tubing.
If a child cannot be disconnected from the feeding pump to swim, a dry suit may be another option. This type of suit forms a complete seal, allowing a child to wear the feeding pump while swimming. Unfortunately, dry suits must be custom fit and are quite expensive.
Children with compromised immune systems or other unique feeding tube issues should consult their physicians before swimming.
Central Lines and IV Pumps
There are mixed opinions as to whether children with central lines should swim. Most physicians agree that children with unaccessed ports may swim, as long as the port site has healed. On the other hand, any child with a new line (less than 30 days old) or a compromised immune system should not swim. Swimming for other children is on a case-by-case basis, depending on the child’s condition and the physician’s preference.
Children with central lines should only swim in clean bodies of water, such as chlorinated pools or regulated ocean beaches. Swimming in rivers and lakes should only be considered if the water quality can be verified as safe.
If at all possible, children should be disconnected from IV medications, fluids, or nutrition while swimming. The cap or valve of the line should be wrapped with plastic wrap, covering the connection to the line, and secured with type. The entire site, including the external portion of the line, should be covered with a clear, plastic dressing such as AquaGuard or Tegaderm. Children with PICC lines can also use commercial inflatable PICC protector devices that cover the line site and form a complete seal around it.
Immediately after swimming, the central line dressing should be changed using standard protocol, and the cap or valve should be changed as well.
IV pumps should not be submerged or splashed. If a child cannot be disconnected from the pump, a dry suit that forms a complete seal around the torso is the best alternative. The child can wear the IV pump under the dry suit.
Tracheostomies and Ventilators
Children with tracheostomies cannot fully submerge, because water would enter directly into the airway through the tracheostomy. Most, however, can splash, and some can swim without submersion. Always consult your child’s doctor before swimming or splashing with a trach.
Children with new tracheostomies (less than two months since placement) should not swim. In addition, children with immune system problems should not swim. Children who are healthy and have well-healed stomas may splash or partially swim on a case-by-case basis, depending on health and physician preference. Always choose clean water sources, such as chlorinated pools or monitored ocean beaches.
Children who use a trach alone should cap the trach before swimming, if possible. There are swimming devices for tracheostomies, but most of these are too complex for children to use.
Swimming should only be considered for children who are developmentally mature enough to know not to go under the water. Swimming may also be considered for children with limited or no mobility who are accompanied by a trained adult or hydrotherapist at all times. If partial swimming is being considered, make sure that the other children in the pool will not endanger the child with a trach by splashing or pushing him or her under the water. Shallow pools are the best option, though the use of head flotation systems may allow children with trachs to swim in deeper water.
Most importantly, a trained one-on-one adult should always be with a child who has a trach while swimming or splashing.
Ventilators, humidifiers, and other electrical devices should not be submerged in water or splashed under any circumstances. Children who cannot be disconnected from these devices may be able to sit in a small kiddie pool and splash a little bit, as long as the ventilator or other device is kept as far away as possible, covered with plastic, and the splashing is minimal.
Ostomies and Drainage Bags
Children with ostomies are also able to swim, as long as the ostomy site is healed and protected. Children should wait about two months after a new ostomy is placed before swimming. Once again, try to stick to safe water sources, such as chlorinated pools or the ocean.
Care should be taken to secure the ostomy pouch as well as possible before swimming. The pouch should be put in place several hours before swimming to ensure the adhesive will form a good seal. An ostomy belt or undergarment may also be worn for greater securement, and waterproof tape can be used to reinforce the adhesive. Commercial inflatable ostomy protectors, which provide a complete seal around the ostomy site, may also be an option. Obviously, emptying the pouch before swimming and refraining from eating right before swimming will slow the pouch from filling up.
Children with other types of drainage catheters or bags may or may not be able to swim. Those with gastric or urinary drainage systems should be able to swim as long as long as the bag is waterproof and forms a closed collection system. Some children with vesicostomies or other urostomies may be able to swim; others may not. Always ask your child’s physician before taking him or her swimming, especially if he or she has immune system issues.
Splashing is an option for most children with ostomies and drainage bags. Ostomy and other drainage systems are designed to get wet, and should be able to be splashed without a problem.
Children on oxygen are able to swim and splash, but it can be challenging to do so when hooked up to an oxygen tank. In general, use 50 foot extension tubing to allow the child as much distance as possible from the oxygen source.
Some children are able to submerge their heads without getting water in the nasal cannula, but others may find this more challenging. Securing the cannula tightly can help keep it free of water. Children should be monitored carefully to ensure they are continuing to receive the necessary amount of oxygen while swimming.
Children who have mobility challenges may have additional needs for support in a pool or ocean beyond commercially available personal flotation devices. There are a wide variety of products now available, including everything from head flotation devices to full body flotation devices, to make swimming possible for almost all children.
Children without full head control should always wear a flotation device with a head support. While these are available commercially in small sizes, older children will likely require a specialized head float. Children may also use a sectional float with constant one-to-one adult assistance, which supports the entire body. Danmar makes an entire line of specialized swimming devices for children with a range of needs.
Get Your Kid Splashing!
If you haven’t taken your child with medical issues swimming before, it can be very scary the first time. Make sure you check with your physician and then get splashing!
For children who are allowed to swim, trying hydrotherapy or adapted swim lessons first may help you to feel more comfortable having your child in the water. Hydrotherapy is available at many larger rehabilitation facilities, and is typically provided by an OT or PT. It is often covered by insurance and Medicaid.
Adapted swim lessons are beginning to be offered at many swim schools and centers. Most YMCAs offer the Goldfish program, which is a small-group class designed for children with disabilities.
Enjoy the water!