Water Quality (for Health Professionals)

Water can become contaminated directly (e.g., a chemical is dumped in a river, in groundwater, etc.), or indirectly (e.g., the water travels through pipes with lead in them).

There are many different types of water contaminants from a wide range of sources, including industrial/agricultural pollution, sewage spills or leaking septic systems, fuel tanks or landfills leaking underground, aging infrastructure, harmful algal blooms in both fresh and salt water. Naturally-occurring contaminants, such as arsenic, copper, iron, lithium, manganese, radon, or uranium present in various geological rock formations, can also contaminate the groundwater in aquifers.

Natural disasters, such as floods, hurricanes, wildfires, earthquakes, or tsunamis pose an immediate threat to sources of drinking water: municipal water systems can be disrupted and private wells can be breached. In such circumstances, safe drinking water may not be accessible to families for days or weeks.

Chemicals or sewage can spread or spill from industrial areas or farms into local drinking water sources. Aging water pipes in need of replacement can contain lead. Water in ponds, lakes, rivers, and oceans, often places where people swim, can also be contaminated with certain chemicals or fecal matter. Algal blooms (an overgrowth of algae and cyanobacteria) can also occur in freshwater or saltwater sources, particularly if the water is warm and/or slow moving,and make people and animals sick.

• Examples of bacteria in water include: Cryptosporidium, E. coli, Giardia, Hepatitis A virus, Legionella, Norovirus, Rotavirus, Salmonella, Shigella.
• Examples of chemicals in water include: arsenic, copper, lead, lithium, manganese, nitrate, perfluoroalkyl substances (PFAS), radon, uranium.
• Improperly discarded antibiotics, hormonal products, and other pharmaceuticals also can contaminate sources of drinking water

Effects vary based on the contaminant.

Algal Blooms- Mild symptoms can include stomach pain, rash, headache, coughing, watery eyes, nose irritation, or sore throat. More advanced symptoms may present as seizures, liver damage, and/or irregular heartbeat.

Chemicals- Chronic exposure to uranium in drinking water has been linked to renal dysfunction, kidney failure, and kidney cancer in adults. Breathing radon gas released from water or from the contamination of indoor air can cause lung cancer in adults, especially in tobacco smokers. Chronic exposure to water contaminated by elevated levels of arsenic has been associated with miscarriage in pregnancy, skin lesions, neuropathy and cognitive declines, diabetes, stroke, peripheral vascular disease, and cancer. Manganese poses neurological risks; in chronic exposures, Parkinsonian-like symptoms and other neurological deficits may develop.

Bacteria- such as Eschericia coli and viruses such as Vibrio cholerae cause severe gastrointestinal symptoms including nausea and vomiting, anorexia, severe watery diarrhea, and dehydration.

Lead- Children may present with nonspecific symptoms that progress with increasing blood lead levels (BLL). Symptoms may include headaches, abdominal pain, loss of appetite or constipation, signs of clumsiness, agitation, or decreased activity and drowsiness, vomiting, stupor, and convulsions. Subtle symptoms, such as irritability, disrupted sleep, anorexia or abdominal discomfort, may occur in some children even at relatively low BLLs. For more information on lead, visit our Lead for Health Professionals page.

Perfluoroalkyl Substances (PFAS) – PFAS are not metabolized but bind to serum proteins and accumulate in the serum, liver and kidney. They are excreted mainly in urine but also feces. Not all health effects of PFAS are known, but effects on multiple body systems have been described. PFAS exposure is associated with increases in cholesterol levels, decreases in birth weight, lower antibody response to vaccines, kidney and testicular cancer, pregnancy-induced hypertension, preeclampsia, and changes in liver enzymes. Read more here about PFAS from the Agency of Toxic Substances and Disease Registry.

Municipal Water: Families should consult their child’s health professional if they receive a notification by local water authorities of specific contaminants in municipal water. They may need to switch to an alternate safe source of water, which may include bottled water, for cooking and drinking until the municipal water source is remediated.

Well Water: Advise patients to take extra precautions if their water source is from a private well. The American Academy of Pediatrics recommends that families should test the water annually for nitrates, pH, total solids, and coliform bacteria. Test every three years for other contaminants, and test every 5 years for an expanded list of organic chemicals, or follow guidance from local water authorities. They should also test their water if there is a newborn at home, if the well cap has been damaged, if the well has been reconditioned or is new, if several family members are ill at the same time, especially with GI complaints, if neighbors report a problem with their water, after flooding or other natural disasters, and if water changes in appearance or odor.

Families installing point-of-entry filtering systems or reverse osmosis or other equipment or point-of-use filters (e.g., in the refrigerator or on the tap or under the sink) should be sure to change to new filters periodically according to the manufacturer’s recommendations.

Families living in flood-prone areas should be advised to store adequate supplies of bottled drinking water (e.g., 3-days worth if evacuating; 2 weeks worth if remaining in place) in the home for an emergency. FEMA recommends 1 gallon of water per person per day.