Hot tubs and their bubbly, soothing streams of water are a magnet for young children, but they can pose significant safety risks -- including the risk of drowning. Also, small bodies can quickly overheat in the hot water, and hot tubs -- or spas -- can also be a source of infection and injury. According to the American Academy of Pediatrics, children under 5 should not use hot tubs, but parents and caregivers should employ safe practices to keep older children safe.
Hot tubs are every bit as dangerous as swimming pools -- a place where unsupervised children can drown. In fact, drowning is the most common hot tub injury in children under the age of 6. Children should not use hot tubs until they are tall enough to stand in the center and still keep their head above the water. Even if your child is older or can swim, drowning can occur from overheating or after a bump on the head. Children should be supervised at all times when in the vicinity of a pool or hot tub -- young children within an arm's reach of a supervising adult. Also, when not in use, the spa should have a rigid, lockable cover or be surrounded by a locked fence that is at least 4 feet high.
Long hair, loose clothing or jewelry can get caught or sucked into the grate or suction fitting that covers the hot tub drain, trapping a person under water where drowning can occur. Current safety standards require that existing public hot tubs and all newly constructed hot tubs have dual drains, which can prevent this dangerous suction, and drain covers that minimize the risk of injury. However some home spas may have older or damaged drain covers, so it's important to have a professional inspect and service home hot tubs to ensure that drain covers meet the new standards and are securely in place. If you have a home spa, also be sure all users know how to turn off the pump, in case of an emergency.
Overheating from hot tub use is a risk for children of all ages. Young children are more likely to overheat quickly, due to their thin skin and small bodies, however older children and teens are more likely to stay in the hot spa water longer, which also risks overheating. High water temperatures can lead to drowsiness, a loss of consciousness which can lead to drowning, and can increase the risk of heat stroke -- which can also be fatal. If your child is old enough to be in a hot tub, take steps to prevent overheating by keeping the temperatures at least below 104 degrees Fahrenheit, or below 100 if you plan to allow younger children in the hot tub. Limit time to 10 to 15 minutes or less, and make sure spa users drink water regularly, to prevent overheating and dehydration.
Other Water Hazards
The most common hot tub injury in children 6 to 12 years old is related to diving or jumping into these mini-pools, so children should be instructed to avoid these activities when using a hot tub. Infections can also be transmitted due to untreated or improperly treated spa water. Fecal contamination of hot tub water -- which can occur if infants, toddlers or anyone with diarrhea uses the spa, can infect the water with Escherichia coli bacteria, Cryptosporidium organisms and Giardia parasites -- which can all cause illness. Hot tub users may also experience outer ear infections -- or swimmer's ear -- or sensitivities or rashes from the water.
If you have a hot tub at home, be sure the equipment is properly maintained, the water is treated correctly, and that the spa is fenced in and securely covered. Instruct children on the safe use of hot tubs to prevent injury and illness, and have a designated adult supervising children at all times. Do not allow children under the age of 5, or anyone with recent diarrhea, to use the hot tub, and require all users to shower prior to entering the water. If you have any questions about hot tub safety, speak with your child's pediatrician.
Reviewed by Kay Peck, MPH RD