Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder, which can cause significant disruption to both children’s lives and those around them. The diagnosis is made on clear-cut criteria. These include a short attention span, difficulty in concentrating, disorganised and excessive levels of activity and impulsive behaviour. It tends to run in families and the diagnosis is usually made before the age of seven. It can affect up to 3-5% of all children, with many cases being unrecognised and untreated. Thus, it is quite likely that most swimming clubs have at least one child who needs special help. Whilst many “normal” children can, under certain circumstances, show some of these behaviours, it is the severity of the symptoms and their inappropriateness, which help in making the diagnosis. Untreated children with ADHD can fail to reach their potential with underachievement at school and in later life can get into trouble because of anti-social behaviour and delinquency.
ADHD is NOT due to bad parenting. It is a medical condition, which is treatable with a combination of medication, support and advice and a structured behaviour programme. Usually, specialist doctors based in hospitals manage it. Many children are treated with a drug called Methylphenidate (Ritalin or Concerta), which can have a marked beneficial effect on the behavioural problems of children with ADHD. Other drugs, which are sometimes used, are atomoxetine and Dexamphetamine.All these need to be taken regularly for the best effect. It is important to realise that these drugs are banned substances for doping control. All registered, competitive swimmers must notify the ASA to obtain a Therapeutic Use Exemption (T.U.E) form to prevent a doping violation. Coaches and helpers should be sympathetic to the needs of these children (and their parents). They should manage them in a fair, firm and consistent way, without discrimination, whilst being aware of the potential for disruptive behaviour. This should enable virtually all children with ADHD to participate in training sessions. Due to their short “fuse” and attention span, other children can sometimes easily provoke them. Children with ADHD can excel at competitive swimming and other sports. At least one famous and multiple Olympic swimming champion is said to have suffered from ADHD as a child. The disciplined lifestyle of the competitive swimming helps provide structure and focus for their attentions and training programmes can be a useful release for their excess energy. Additional information and advice is available from www.livingwithadhd.co.uk
Many parents are concerned about their child swimming with asthma as they are worried about the effects of asthma medicines and the risk of an asthma attack. By following these simple steps you will enable your child to participate as much as they are able and give them the confidence to achieve their full potential.
Swimming is usually an excellent form of exercise for children and young people with asthma. The warm humid air in the pool is less likely to trigger symptoms of asthma. However, this is not the case for everyone and chlorine and swimming in cold water can trigger some people’s asthma.
If swimming makes a child’s asthma worse always ensure that they use their blue inhaler immediately before they warm up. Try to avoid the things that trigger their asthma before swimming. Ensure your child always has their reliever (blue) inhaler with them by the side of the pool. If your child has asthma symptoms when they are swimming, ensure they stop, take their reliever inhaler and wait five minutes or until their feel better before starting again.
Brief voluntary or incidental submersion may be included in lessons under the guidance of the teacher and at the discretion of the accompanying adult. Neither forced nor prolonged submersions are recommended.
The forced submersion of young babies is not recommended by the ASA, a position fully supported by the Royal Society for the Prevention of Accidents (ROSPA). It has been suggested that young babies have a natural breathing reflex, which will prevent them from attempting to breathe underwater. This view point is not universally accepted within the medical profession and attempting to breathe underwater can lead to water intoxication (hyponatremia) caused by the young baby swallowing large quantities of water, the result of which can adversely affect the electrolyte levels of the baby.
Epilepsy is a common condition – 4% of the population will have a seizure at some time in their life and the prevalence of epilepsy is 0.5 – 1% of the population. Defined as a transient electrical disturbance within the brain it leads to varying disturbances in consciousness and bodily function.
Thus, most swimming teachers and coaches will have a swimmer with epilepsy in their class or squad at some time, and in the vast majority of cases fits will be very well controlled with appropriate anti-convulsant medication.
It is important that the coach:-
Be aware of the conditions
Knows what to do if a swimmer has a seizure in the water or poolside
Knows the factors which increase the likelihood of a fit happening in the pool
There is no reason why people with epilepsy can’t enjoy swimming as a hobby or compete at the highest level provided simple precautions are taken. However it is sensible for the person with epilepsy to obtain his/her doctors permission to swim, ensure that control of the fits is optimal and make the pool authorities/coach know that they have epilepsy.
There are many forms of epilepsy classified into partial (no loss of consciousness) and generalised (loss of consciousness) and some common examples are:-
Absences (petit mal) – just a transient lapse in consciousness or awareness lasting a few seconds
Generalised tonic clonic fits (grand mal) – loss of consciousness, fall, tonic (stiffening) phase, clonic (rhythmical jerking), recovery with drowsiness and confusion
Temporal lobe epilepsy – often starts with funny smells, sounds or tastes followed by convulsions
Myoclonic epilepsy – brief muscle jerks
With all there is the risk of drowning and no sufferer from the condition should ever swim alone. From a practical viewpoint this will mean training in an indoor pool with lifeguard facilities and resuscitation equipment. A bright cap in a group can aid identification and it is useful to have a third party e.g. parent on the balcony/poolside to keep and additional eye on the swimmer.
Medication must be declared to doping control
What to do if a swimmer has a fit in the water:
Reach the swimmer as soon as possible approaching from behind if generalised convulsions
Aim to keep the head above water
Once the convulsion is over remove from the water asap
Place in the coma position on poolside to complete the recovery, keeping warm
Resuscitate if breathing has stopped
Factors which increase the likelihood of a fit occurring during swimming:
Overtiredness/over training and fatigue – therefore avoid
Shimmering lights on the water surface particularly from sunlight or fluorescent lights
Cold water temperatures
Infections/fever – therefore not to swim if inter current viral illness
Hypoglycaemia (low blood glucose) – therefore use glucose replacement drinks during training
Verrucas like most warts are due to a viral infection of the growing layers of the skin.Injury of the skin is a prerequisite for the contraction of warts, hence, a predilection for the hands, knees and feet as these sites are more prone to minor injury during childhood activities, particularly barefoot activities in changing rooms, gymnasium and especially swimming pools with the plantar skin being slightly soggy together with possibly damp duckboards or foot mats. As with most infection, particularly viral, immunity to the causative occurs in time.This is possibly why such warts occur less often in adolescents and adults.
The majority of dermatologists are not in favour of treating plantar warts.Many feel that because the virus is so widespread, it could be beneficial to spread it as much as possible and as early as possible in the lives of children.Similarly, the use of devices like plastic socks should be discouraged, as like elasticated knee bandages; they can be of limited value, other than attracting attention.The use of a waterproof plaster is sufficient. The main indication for treating plantar warts is intolerable pain or tenderness to walking.This is usually because of the hard skin which accumulates around the wart.
Chemist’s shelves are full of expensive wart remedies principally because none of them work satisfactorily.Most of them work from time to time for the simple reason that all warts will eventually disappear themselves. Occasionally, symptoms may make treatment inevitable and whilst cryotherapy with liquid nitrogen is best avoided on the foot, curettage (scrapping out) under local anaesthesia is valuable in skilled hands. Except in highly skilled hands there is little difference in the disappearance rate of warts, which are treated by different methods or otherwise left untreated.