Every month a copy of Infectious Diseases in Children mysteriously appears in my mailbox. I don’t know why it continues to show up, every month, following me wherever I move despite having never subscribed to it. But I can’t say I mind because it’s actually pretty decent as far as “throwaway journals” go.

Backyard pools: harmless Summer fun or above ground cauldrons of death and diarrhea?

Two articles in the July issue were particularly interesting to me, with both involving the risk of exposure to an infectious disease in water as well as questionable parental choices. In the first article, found in the journal’s “Outbreak News” section, we learn that nationally reported cases of infection with Cryptosporidium, a nasty and ubiquitous intestinal parasite that can cause weeks of profuse diarrhea, have increased three fold since 2004. And cases in some states have doubled, even quintupled, in recent years.

Why the increase in reported cases? Improved diagnostic technology may be playing a role rather than an actual increase in the incidence of the infection. Regardless, we now know that it is the leading cause of outbreaks of diarrhea associated with recreational swimming in aquatic facilities. The source of these outbreaks are typically young children whose parents have allowed them to enter the water while ill or too soon after recovery, and the only way to clear the water of these hardy organisms is to literally chlorinate the shit out of it. See what I did there?

Humans are not dolphins, and they probably never will be

I’ve written about the absurd practice of human mothers delivering their babies into water twice, both times laying out the many reasons why this practice is dangerous and without benefit. Adding to the pile is the second article from the July IDC. In it, we learn of two cases of Arizona newborns suffering from Legionnaire’s disease, a diagnosis which is fatal in 10% of cases, caused by exposure to contaminated water during their delivery.

An investigation by the local department of public health revealed that facilities irresponsible enough to allow women to give birth into water are not doing a great job making sure that said water is safe from infectious organisms. Shocking, I know. In one of the cases, heated water sat in the tub for a week prior to the delivery, a perfect breeding ground for the causative organism.

In response to the two cases, which thankfully were not fatal, health officials worked with waterbirthing facilities to put guidelines into place that would reduce the risk of contamination. These guidelines were based on those developed in Texas in 2014, when a baby did die from Legionellosis after a water birth. Not mentioned in the article, or in the response from health officials, is that waterbirthing has no benefit, and the much more common practice of merely laboring in water is of minimal benefit and could still result in infection from contaminated water. In my opinion, medical facilities that claim to provide quality, evidence-based care to women should do away with this ridiculous practice.

Integrative parenting?

Although written in April, I’ve only just stumbled upon Organic Life‘s treatise on the reasons why parents want natural remedies for their children (and 9 cures to try right now!). It’s chock full of the standard fallacies and false claims, and the combination of reasonable health advice with abject quackery that we’ve come to expect from the world of integrative medicine. I’ll pick out a few juicy morsels of malarkey to sink our teeth into.

What do they get right? A few things, actually. Many parents are turning to alternative therapies in addition to conventional recommendations, often basing their choice on anecdotes from friends and family members. And many of these parents are not discussing their alternative choices with their child’s pediatrician or family doctor. It’s also true that herbal remedies aren’t evaluated by the FDA, leaving many unanswered questions regarding safety and efficacy of thousands of products.

But according to the several quoted experts, such as protégé and integrative medical provider Russell Greenfield, there is still plenty of nonsense to recommend based on cherry picked studies, flawed assumptions, and appeals to overly simplistic understanding of human health. Greenfield et al are proponents of fish oil supplements for “boosting the immune system” while somehow also reducing inflammation, in order to prevent colds, ear infections, and acne. No explanation of what part of the immune system is boosted is given, or how this might result in fewer infections without more autoimmune conditions. Also there is no explanation for the contradictory effect of a boosted immune system but somehow less inflammation.

Other questionable “cures” recommended in the article range from the unlikely to those calling into question fundamental laws of reality. These include probiotic supplements for allergic conditions like eczema and asthma, essential oils for a child’s cough, yoga for asthma, acupuncture for headaches, craniosacral therapy for ear infections, and homeopathy for colds. The article has this to say on the most irrational of these recommendations:

“Homeopathy has been found to be effective for some medical conditions in well-designed studies,” says Timothy Culbert, MD, medical director of Integrative Medicine and Cultural Care at Children’s Hospitals and Clinics in Minneapolis and Saint Paul. “But we are not completely certain as to how it works. And that makes doctors nervous.”

Neither Dr. Culbert nor the authors of this article provide a link to one of these well-designed studies. There are many aspects of medicine that I am not completely certain about, but homeopathy ain’t one of them. What truly makes me nervous, however, is that Dr. Culbert has access to ill children.

The quacks who say Kneipp?

Although I had heard of hydrotherapy/hydropathy before, I don’t recall encountering the tale of Sebastian Kneipp. In the late 19th century, after discovering the healing miracle of gently applied water of varying temperatures when his tuberculosis was cured by wading in the Danube, Kneipp developed a large following and is considered a founding father of naturopathy. In addition to promoting treatments such as putting your feet in water and slowly increasing the temperature in order to treat colds and rheumatic conditions, the folks at Kneipp also sell a variety of cheap lotions and bath oils.

Alkaline water for kids!

Alkaline water is nonsense and has been discussed in various SBM articles over the years. I recently discovered this gem on the “industry-wide” recommendations for giving alkaline water to children, and it even breaks down the benefits by age. They claim that drinking comically large quantities of alkaline water, around 8 liters each day for older kids, can improve the immune system as well as mental AND emotional stamina.

They recommend less daily water in younger children, although getting a toddler to drink 2 liters of water would still be a challenge and is completely unnecessary. The claimed benefits are improved toxin elimination and faster recovery from exertion. The most concerning part of this article is when they discuss water consumption in babies down to the newborn period:

Eight to 16 ounces a day is all they should need but it is important that you give you start giving your baby some water – at least filtered water – as early as possible. Babies aren’t particularly picky and this is a good time to help your baby acquire a taste for water.

This is extremely dangerous. Newborns and young infants need exactly zero ounces of extra water on top of their breast milk or formula. That much extra free water could dilute the electrolytes in their blood, particularly sodium, and result in seizures, coma, and even death.

Just a short post this time around. See you in a couple weeks.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician practicing at Newton-Wellesley Hospital in Newton, MA, and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @skepticpedi and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey.