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Objective: Infants introduced to indoor heated swimming pools in the first year of life show an association with progressive adolescent idiopathic scoliosis (AIS). Similarly control children exposed in this way show an association with vertical spinous process asymmetry. A new method of assessment was used on these controls who were standing in an upright position. Overall, our evidence suggests that indoor heated swimming pools contain a risk factor that predisposes some infants to develop spinal asymmetries years later – progressive AIS in a few and off-vertical spinous process asymmetry in the many. What the risk factor may be and its possible portal of entry into the infant’s body are unknown and possibilities are examined. A subsequent new group of control children confirms the association of indoor heated swimming pools and vertical spinal asymmetry.

Risk factors: An irritant gas trichloramine (nitrogen trichloride) has been found to contaminate the air of indoor-chlorinated pools which Bernard et al link to asthma and chronic airway inflammation. Besides the lungs the skin in infants may provide another portal of entry of any chemical risk factors for spinal asymmetries. In connection with a chemical risk factor Nachemson anecdotally noted the development of scoliosis in salmon fry at a fish farm who were exposed to water contaminated after the re-painting of a water regulating dam.

Environmental epigenomics and disease susceptibility: Barker and his colleagues and others have shown that the origins of important chronic diseases of adult life may lie in foetal responses to the intrauterine environment and in infants to early postnatal life. Currently, there are British and US medical research projects to gather information on how human genes and environment interact over the years to cause disease; the British project is called Biobank. Another aspect concerns disease susceptibility by spotting gene variants in people who already have specific diseases. Do the suspected risk factors of indoor-chlorinated pools for spinal asymmetries need to be included in such studies? Is there potential for prevention?

In our earlier study we found 61% of the controls taken swimming in the first year of life had vertical spinous process asymmetry. In the subsequent smaller study the incidence even higher (83%).


  1. The evidence reported in our earlier paper suggests that infants introduced to indoor heated swimming pools in the first year of life show an association with spinal asymmetries including progressive AIS and in controls vertical spinous process asymmetry.

  2. Subject to confirmation of our observations consideration should be given to chemical risk factors, possible portals of entry, environmental epigenomics and disease susceptibility to altered spinal development.

  3. Subsequent controls confirm that the introduction to indoor heated swimming pools in the first year of life is associated with the development of spinal asymmetries.

Correspondence should be addressed to Jeremy C T Fairbank at The Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX7 7LD, UK