How the combination of diapers and splash pads led to 10K illnesses

Emma Vaquera, 3, of Pomona, plays in the splash pad at Monte Vista Park in Chino, Calif. on Aug. 30, 2022. (Watchara Phomicinda / The Orange County Register via AP)

New research is raising concerns about the safety of splash pads, which can be ground zero for germs and greatly increase the risk of spreading disease.

Although they are designed to be safer than pools for young children to play in, the water playgrounds may result in waterborne-disease outbreaks, a multi-decade U.S. study published on Thursday suggests.

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Since young children are often not potty-trained and don’t have good hygiene skills, disease can spread while they play at splash pads, according to the Morbidity and Mortality Weekly Report by the U.S. Centers for Disease Control and Prevention (CDC).

"Because children typically ingest more recreational water than adults and have been commonly observed to place their open mouths on sprayed or jetted water, children are at increased risk for exposure to pathogens in contaminated splash pad water," researchers wrote.

Splash pads typically are used by children aged five or younger and reduce the risk of drowning with a design that allows them to splash around with fountains and spray pads rather than swim in a pool, according to the study.

Results of study

Public health officials from 23 states and Puerto Rico reported 60 waterborne disease outbreaks connected with splash pads from 1997 to 2022, the study found. No deaths were reported from the outbreaks, but they resulted in 10,611 cases, 152 hospitalizations and 99 emergency department visits.

The parasite Cryptosporidium (or crypto) was the main reason behind the illnesses, with 40 outbreaks that resulted in 9,622 cases and 123 hospitalizations.

The gastrointestinal illness resulting from a parasite can cause watery diarrhea, fever, nausea, vomiting, dehydration and stomach cramps or pain, according to Public Health Agency of Canada (PHAC).

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Cryptosporidium infections can become serious, chronic and even fatal. Cryptosporidiosis, a nationally notifiable disease, is reported by all provinces and territories. 

Health Canada said it publishes recreational water quality guidelines, but the management and maintenance of splashpads are not federal responsibilities. Provinces may have different protocols when regulating safety issues at splash pads.

For instance, Ontario’s Ministry of Health sets guidelines requiring local public health units to assess the conditions of splash pads and other regulated recreational water facilities to ensure the water quality is safe.

To eliminate potential hazards, a public health inspector may issue a verbal or written order to the owner or operator to take immediate action, a Toronto Public Health spokesperson said in an email to CTVNews.ca on Friday.

Under Ontario’s Health Protection and Promotion Act, the order may require facility users to leave the site and close the facility for a period of time. If the facility owner or operator doesn’t comply, they may face “enforcement action.”

Drinking sufficient fluids, antidiarrheal medications and anti-parasitic medication are among the treatments, according to health officials.

Meanwhile, norovirus from splash pads was suspected to cause two outbreaks that led to 72 emergency department visits. Norovirus is an extremely contagious virus that causes diarrhea, nausea, stomach pain and cramps, and vomiting, according to PHAC.

"Waterborne pathogens that cause acute gastrointestinal illness can be transmitted by ingesting water contaminated with feces from infected persons," according to the CDC study.

How illnesses spread

Infected young children who aren't potty-trained can spread diseases by sitting or standing on top of water jets with their diapers while playing at splash pads, according to the study.

Researchers said swim diapers don't prevent fecal contamination and children can carry as much as 10 grams of feces.

Researchers said chlorine is the main way to prevent the spread of illnesses in splash pad water, but it's not effective for Cryptosporidium.

Additionally, maintaining an adequate concentration of the chemical disinfectant can be difficult in splash pads because of the spraying of water, they added.

In some cases, the water in splash pads is drained into a tank, filtered and disinfected before it is recirculated again. For other splash pads, water circulates through the plumbing once before draining into the sewer.

"Because splash pads do not have standing water in areas accessible to users, they might be exempt from public health regulations in certain jurisdictions," according to the study.

Prevention

To prevent disease outbreaks, researchers recommend improving the design, construction, operation and management of facilities. As well, they advise children not to stand or sit above the splash pad jets. They said children shouldn't get in the water if they have diarrhea until two weeks after it has stopped and they shouldn`t swallow the water. They recommend taking young children on bathroom breaks or checking diapers or swim diapers every hour, as well as changing diapers away from the water.