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The first steps in keeping your kids safe when swimming are adult supervision and an age appropriate flotation device.

Because of the increase over the past decade in the number of outbreaks of illness associated with swimming, you should also be aware of the spread of recreational water illnesses (RWIs) and how to prevent them.

Healthy Swimming behaviors are needed to protect you and your kids from RWIs and will help stop germs from getting in the pool in the first place.

Here are six "PLEAs" that promote Healthy Swimming:

Three "PLEAs" For All Swimmers

Please don't swim when you have diarrhea... this is especially important for kids in diapers. You can spread the germs into the water and make other people sick.

Please don't swallow the pool water. In fact, try your best to avoid even having water get in your mouth.

Please practice good hygiene. Take a shower before swimming and wash your hands after using the toilets or changing diapers. Germs on your body end up in the water.

Three "PLEAs" For Parents with Young Kids

Follow these "PLEAs" to protect your child and others from getting sick and to help keep RWIs out of your community:

Please take your kids on bathroom breaks or check diapers often. Waiting to hear "I have to go" may mean that it's too late.

Please change diapers in a bathroom and not at poolside. Germs can spread to surfaces and objects in and around the pool and spread illness.

Please wash your child thoroughly (especially the rear end) with soap and water before swimming. We all have invisible amounts of fecal matter on our bottoms that end up in the pool.

What are recreational water illnesses (RWIs)?

RWIs are illnesses that are spread by swallowing, breathing, or having contact with contaminated water from swimming pools, spas, lakes, rivers, or oceans. Recreational water illnesses can cause a wide variety of symptoms, including skin, ear, respiratory, eye, and wound infections. The most commonly reported RWI is diarrhea. Diarrheal illnesses can be caused by germs such as Crypto, short for Cryptosporidium, Giardia, Shigella, and E. coli O157:H7.

How are RWIs spread?

Keep in mind that you share the water with everyone else in the pool, lake, or ocean.

Diarrheal Illnesses

If swimmers are ill with diarrhea, the germs that they carry can contaminate the water if they have an "accident" in the pool. On average people have about 0.14 grams of feces on their bottoms which, when rinsed off, can contaminate recreational water. When people are ill with diarrhea, their stool can contain millions of germs. Therefore, swimming when ill with diarrhea can easily contaminate large pools or waterparks.

In addition, lakes, rivers, and the ocean can be contaminated by sewage spills, animal waste and water runoff following rainfall. Some common germs can also live for long periods of time in salt water.

So, if someone swallows water that has been contaminated with feces, he/she may become sick. Many of these diarrhea-causing germs do not have to be swallowed in large amounts to cause illness.

Other RWIs

Many other RWIs (eye, skin, ear , and respiratory infections) are caused by germs that live naturally in the environment (water, soil). In the pool or hot tub, if disinfectant is not maintained at the appropriate levels, these germs can increase to the point where they can cause illness when swimmers breathe or have contact with water containing these germs.

Why doesn't chlorine kill these RWI germs?

Chlorine in swimming pools does kill the germs that may make people sick, but it takes time. Chlorine in properly disinfected pools kills most germs that can cause RWIs in less than an hour. Chlorine takes longer to kill some germs such as Crypto, which can survive for days in even a properly disinfected pool. This means that without your help, illness can spread even in well-maintained pools.

Healthy swimming behaviors are needed to protect you and your family from RWIs and will help stop germs from getting in the pool.

Where are RWIs found?

In addition to swimming pools, swimming in contaminated hot tubs, oceans, lakes, rivers, and playing in decorative water fountains can also spread RWIs.

Hot tubs
Skin infections like "hot tub rash" are the most common RWIs spread through hot tubs and spas. Chlorine and other disinfectant levels evaporate more quickly because of the higher temperature of the water in the tubs. It is important to check disinfectant levels even more regularly than in swimming pools. "Hot tub rash" can also occur in pools and at the lake or beach.

Decorative Water Fountains
Not all decorative or interactive fountains are chlorinated or filtered. Therefore, when people, especially diaper-aged children, play in the water, they can contaminate the water with fecal matter. Swallowing this contaminated water can then cause diarrheal illness.

Lakes, Rivers, and Oceans
Lakes, rivers, and oceans can become contaminated with germs from sewage, animal waste, water runoff following rainfall, fecal accidents, and germs rinsed off the bottoms of swimmers. It is important to avoid swallowing the water because natural recreational water is not disinfected. Avoid swimming after rainfalls or in areas identified as unsafe by health departments. Contact your state or local health department for results of water testing in your area or go to EPA's beach site or their National Health Protection Survey of Beaches .

Who is most likely to get ill from an RWI?

Children, pregnant women, and people with compromised immune systems (such as those living with AIDS, those who have received an organ transplant, or those receiving certain types of chemotherapy) can suffer from more severe illness if infected. People with compromised immune systems should be aware that recreational water might be contaminated with human or animal waste that contains Cryptosporidium (or Crypto), which can be life threatening in persons with weakened immune systems. People with a compromised immune system should consult their health care provider before participating in behaviors that place them at risk for illness.

Important disclaimer: The information on keepkidshealthy.com is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.