Confessionals and Closures

I was driving back from the Malvern Hills and was settling down to what was due to be a five to six-hour motorway experience.

I had been enjoying a late birthday present, driving a Morgan sports car around the hills followed by a guided tour around the Morgan factory where they still handcraft these wonderful British cars. What a sensation to drive these classic, non-power, assisted sports cars. It took me back to my earliest driving days. A reminder to me how things have changed and how remote we are these days from roads we drive upon, in our cossetted, air conditioned boxes. The radio was on and it was Simon Mayo confessions.

He told a tale of a young mother who with her baby had gone swimming in an unidentified public pool more than 12 years ago. The event had obviously been very memorable to have recalled it so vividly. With her baby in the pool enjoying the bonding experience, baby without warning threw up, depositing breakfast in the pool and down mum. She spoke of the embarrassment of having cornflakes down her cleavage. Rapidly exiting the pool she was spotted by the eagle-eyed lifeguard who, after making sure all was alright, given the extent of the “soiling” sent for the manager. With cornflakes and other substances, spreading throughout the pool, and dripping down her legs, forming pools around her feet, the manager asked her when baby had last been fed. Now what possessed the manager to ask such a question implies to me that the individual concerned had had some pool technical training. I can’t think that they include baby vomit awareness in lifeguard training.

Baby was by now perfectly recovered as babies do. Throwing up after a feed is part of life’s routine. Mum thinking on her bare, corn flake encrusted feet, replied that baby had been fed some hour or more before hand. She knew that it is common knowledge, a courtesy and common sense that no one should go swimming just after eating, for whatever reason. It’s part of the folk law of swimming pools. Not wanting to show herself up as inconsiderate, non-caring mother she was certainly not going to let on that baby had only been fed just prior to entering the pool. Little did she know that on this occasion this was entirely the wrong thing to say and her embarrassment was set to get much worse.

The manager probably knew that it’s normal for babies to bring up a little milk during or just after a feed. This is called possetting, regurgitation or reflux. It can be caused by the hole in your baby’s teat being too big. Drinking milk too quickly can make your baby sick. It’s not dangerous but vomit, be it just regurgitated food, is not a attractive pool water addition. Often, vomiting results from swallowing too much water, meaning that the vomit is probably not infectious. However, if the contents of the stomach are vomited, it is important to act immediately.

What is the evidence?

The medical advice on swimming immediately after eating is that’s it’s not dangerous, but it could result in uncomfortable stomach cramps. Parents have long advised children to wait at least 30 minutes after eating before going back into the water. You may have been told that’s because swimming with a full stomach can cause severe cramps and lead to drowning. But there’s little evidence to support such a warning.

The causes of are cramp still aren’t fully understood. There’s no evidence to suggest that exercising after eating gives you cramp, but what we do know is that vigorous exercise directs blood flow away from the digestive area to the skin and to the muscles in your arms, legs and skin.

So, if your food is still half-digested this could make you nauseous. It’s the same reason that extreme fear makes you feel sick. The fight-or-flight response abandons less-urgent processes like digestion, diverting blood flow to the muscles so that you can defend yourself physically, or run faster than you ever have before.

But these studies on cramp involved athletes taking part in long-distance running or even triathlons – involving a lot more vigour and endurance than the kinds of splashing about kids are more likely to do having fun in a pool. Professional swimmers are careful not to race on a full stomach, but they do ensure that they have eaten enough to provide the fuel needed for them to perform at their best. When endurance swimmers undertake very long distances they even consume food during the race. If they do experience cramp, it’s more a result of overexertion, it doesn’t seem to be related to food.

Using common sense

The American Red Cross recommends using common sense when it comes to swimming after eating. Wait until your child is comfortable before letting them go back in the water.

Engaging in strenuous activity right after eating can lead to cramps, nausea, and vomiting. And if they’re sluggish or tired after feeding, it won’t hurt to let him rest first.

The manager in this pool knew though that there are other causes of vomiting in a pool. It was probably in deference to the time lapse and a potential infection cause that the manager took the big decision to close the pool. The mum was horrified to learn that she had caused the closure of the pool for the day. The little white lie had resulted in loss of the pool to probably hundreds of bathers later in the day and right then to many happy young swimmers, now staring accusingly at the vomit covered mother. Hence the confessional.

The PWTAG guidance on vomit is something all pool managers should be familiar with. It is not unusual for swimmers to vomit slightly. It often results from swallowing too much water, or over-exertion, and so is very unlikely to present a threat through infection. But if the contents of the stomach are vomited into a pool, the bather may be suffering from a gastrointestinal infection. And if that is cryptosporidiosis, infective, chlorine resistant Cryptosporidium oocysts are likely to be present. This is a rather theoretical, unevaluated risk, and there is some disagreement about how it should be dealt with.

PWTAG recommends that vomit in the pool should be treated as if it were blood. See Swimming Pool Water for the detail. In the US, the Centers for Disease Control and Prevention suggests treating vomit in the pool like solid stool, which amounts to the same thing. But the World Health Organisation currently recommends responding as if it were diarrhoea (potentially closing the pool for six turnovers etc).

Pool operators need to decide what their response will be, and have written procedures in place. If they follow PWTAG guidelines, vomiting would result in temporarily clearing the pool of people, scooping up vomit where possible and allowing the pollution to disperse and any infective particles to be neutralised by the residual disinfectant. Operators need to confirm that disinfectant residuals and pH values are within the recommended ranges; bathing can then resume.

The lesson from this confessional is make an informed decision. Read Swimming Pool Water, attend a PWTAG technical training course or come along to a PWTAG seminar.

Ralph Riley 27 March 2018

(Ralph Riley is the Vice Chairman of PWTAG, former Chief Exec of ISRM and provider and operator of many public swimming pools. He heads up the UK BSI representation on European and World sports standards. This blog represents Ralph’s views and not necessarily those of PWTAG.)