Hot Tub Therapy for Children
Warm water works wonders for certain childhood conditions.
By Debra Maurer
Warm water has been shown to improve many health conditions — including arthritis, diabetes, sleep problems and muscle tension. But these problems typically affect adults.
Is hot tub therapy helping children? Yes — in more ways than you might think.
A hot tub can provide therapy for kids with certain health conditions, such as physical and mental limitations, respiratory problems and birth defects, allowing them to strengthen certain necessary skills better than on land. In fact, hospitals and therapy centers across the country use hot tubs for treatment of various health conditions in children.
Among them: Children's Healthcare of Atlanta, which uses water therapy to treat about 50 children a month at three outpatient centers — many by physical therapist Kristin Cooley. Although children with conditions aided by hot tub and other hydrotherapy should always be treated by trained professionals, Cooley says adjunct at-home care can be done by parents (under a therapist's guidance).
Juvenile Rheumatoid Arthritis
For kids with JRA — the most common form of arthritis in children, characterized by joint inflammation and muscle weakness — hot tubs help in several ways: The buoyancy of the water helps increase range of motion activities, says Cooley, while its resistance offers the opportunity to strengthen muscles. "When you turn on the jets to create some turbulence, this translates into helping them achieve better balance on land when going about everyday activities." In addition, kids can increase their endurance when doing aerobic activities in the water.
At home, parents need to be aware of protecting the child's joints and conserving the child's energy. "If your child is experiencing a severe JRA flare-up, you want to be gentler," advises Cooley, "while if he's doing really great, you might be able to engage him in a little more activity." Of course, warm water has also been shown to help those with osteoarthritis, which is more common in adults than in children.
Cystic Fibrosis and Asthma
"From a respiratory standpoint, the most beneficial thing about water — either warm or cool — is the hydrostatic pressure," says Cooley. "This is the pressure that the water has on the chest. You can use it to strengthen muscles in the diaphragm, which aid in breathing. In the long run, this can help with increased lung capacity, breath control and rib mobility."
However, you want to keep close tabs on the proximity of your child's face to the water's surface. When the nose and mouth are 18 inches or closer to the surface, "that's where the chemicals are evaporating from the water." Cooley recommends that children with respiratory problems spend about 10 minutes at the 18 inches-to-surface level, then another 10 minutes in waist-deep water so they are out of the range of the chemical evaporation zone.
Cerebral Palsy
Again, the buoyancy of water improves the ability to stand, walk and keep their balance on land in children with cerebral palsy, a disorder that causes uncontrolled reflex movements and muscle tightness on one side or the entire body. The jets and warmer water also help to loosen muscles. "Especially in children with cerebral palsy, if they're in cold water, sometimes their muscles tighten up even more and that can cause pain. If we get the children to relax, that decreases their pain perception," says Cooley.
Brittle Bones
Using the buoyancy of the water, kids with osteogenesis imperfecta (OI) can exercise with less risk of injury and fractures than on land. With OI, which affects up to 50,000 Americans, bones break easily, often from little or no apparent cause (such as coughing). Water movements strengthen their muscles and improve mobility and motor skills, says Cooley.
Scoliosis
Water's buoyancy and resistance strengthens the muscles on the other side of the curved spine resulting from scoliosis, and works on the body's alignment.
Autism & Sensory Integration Dysfunction
Water puts constant tactile input on the body and increases hydrostatic pressure, providing the physical sensation that autistic children often seek. "Having something constantly touching every part of the body can be really calming," says Cooley. "Even the echoes in an indoor water environment are escalated so you get a lot more auditory input. You also have lots of visual input; sometimes just the light reflecting off the water is beneficial."
The sensory input also helps children with Sensory Integration Dysfunction (SID, also called sensory processing disorder), a neurological disorder causing difficulties with processing information involving the senses of sight, hearing, touch, smell and taste; as well as movement. SID often affects those with autism, attention-deficit disorder (ADD), dyslexia, Tourette's Syndrome, multiple sclerosis and speech problems.
Spina Bifida
An aquatic setting helps kids suffering from spina bifida — a birth defect resulting in malformed or undeveloped vertebrae, which, depending on the type and severity, can lead to nerve damage — with their upper body strengthening to assist with their transfers or their wheelchair propulsion. If they have lost some of the muscle tone in their lower extremities, their center of gravity is different from if they had more muscle tone. "Just becoming familiar in the water, being able to orient themselves, is really beneficial to kids with spina bifida," explains Cooley.
Photo courtesy of Coleman Spas
Age-to-Time and Temperature Ratio
Although doctors typically recommend that adults soak in 104-degree F water for no longer than 15 minutes, a different set of rules applies when it comes to children.
The ideal temperature for water therapy with children should be between 90 and 94 degrees F, says Cooley. "It's much safer for kids because it prevents them from being fatigued. We generally don't recommend raising the temperature, especially for younger children. If you have older kids, they can be in 100- to 102-degree water, but only up to their pelvis or waist."
As far as soaking time, here's the general rule of thumb: Kids can be in 90- to 94-degree temperature water for 10 minutes for every year of age. This is based on how quickly a child will lose his core temperature, which is normally 98.6 degrees F. For example, the body temperature of a two-year-old will start dropping after 20 minutes, while a 10-year-old is able to stay in that 90- to 94-degree water for an hour and 40 minutes before his temperature starts to go down.