Current Trends
Playground-Related Injuries in Preschool-Aged Children --
United States, 1983-1987
From 1983 to 1987, nearly 6.72 million emergency room visits in
the
United States were for product-related injuries among preschool
children 1-4 years old.* Approximately 305,000 (4.5%) of these
injuries
involved playground equipment. These playground equipment-related
injuries occurred most frequently at home (38.3%), in sports or
recreation settings (29.4%), or at school (8.9%) (Table 1). Of the
82,108 injuries in preschool-aged children attending day care
(coded as
occurring at school), 27,232 (33.2%) were related to playground
equipment (Table 1).
Most preschool-aged children with injuries involving school
playground
equipment were 3 or 4 years old and male (Table 2). A higher
proportion
of playground- related injuries occurred in the spring than at
other
times of the year (Table 2). Forty percent of playground-related
injuries were associated with climbing apparatus, and two thirds of
injuries were to the head and neck (Table 2).
Lacerations (38.5%), contusions or abrasions (26.8%), fractures
(16.8%), strains or sprains (4.4%), and concussions (1.7%) were
most
commonly reported (Table 2). Head and neck injuries were primarily
lacerations (55.7%) and contusions or abrasions (23.7%). Injury to
the
extremities and trunk included mostly fractures, contusions or
abrasions, and strains or sprains (upper extremity--62.4%, 22.2%,
and
12.2%; lower extremity--31.4%, 42.2%, and 15.4%; trunk--27.7%,
51.2%,
and 9.2%, respectively). Approximately 5.3% of preschool-aged
children
treated in emergency rooms for playground-related injuries required
hospitalization.
Reported by: Div of Injury Epidemiology and Control, Center for
Environmental Health and Injury Control, CDC.
Editorial Note
Editorial Note: By 1984, more than 11 million children attended
day-care facilities (1). The potential injury hazards of organized
day
care and day-care playgrounds have been documented (2-5). The NEISS
data suggest that further improvements in playground safety are
needed
to reduce playground-related injuries.
NEISS provides a data base for estimating injuries associated with
playground equipment in young children in day-care facilities.
However,
these data are limited in that, by using *P*school*P' as the
location
to represent day-care playgrounds, they exclude children injured in
day
care at a home, church, or building other than a school.
Conversely,
some injuries that reportedly took place at school possibly
occurred to
children using a school playground but not attending day care.
Interpreting these data is also difficult because the type, size,
and
cost of equipment at a school playground differ from those used in
homes, churches, or private day care. Thus, the distribution by
type of
equipment in the overall day-care environment may vary considerably
from that described here.
A CPSC-sponsored hazard analysis showed that falls to the ground
surface account for 60% of playground equipment-related injuries
(6). A
1-foot fall directly on the head onto concrete or asphalt or a
4-foot
fall onto packed earth can be fatal (7-9). In contrast, surfaces
made
of energy-absorbing mats or loose materials such as wood chips or
sand
may reduce the likelihood of head injury even from falls of 8 feet
(7,8). Yet over 48% of day-care playground equipment is not
installed
over impact- absorbing surfaces (2,3). Although in some cases the
Occupational Safety and Health Administration requires that guard
rails
be installed to protect workers as low as 4 feet above ground
level, no
such protective legislation exists for children on playground
equipment, some of which is more than 10 feet above the ground (8).
Injury control programs should address the safety aspects of
public
and other playgrounds for all ages. According to NEISS data,
994,678
injuries in all age groups from 1983 to 1987 were associated with
playground equipment; 243,807 (24.5%) of these injuries occurred at
schools, and 257,070 (25.8%), at places of recreation.
Recommendations
to improve playground safety include installing playground
equipment
over energy-absorbing surfaces, locating the equipment away from
obstructions, properly anchoring the equipment, checking the
integrity
of the equipment frequently, covering protrusions, removing broken
equipment promptly, and instructing and supervising children in
proper
playground use (10,11). If wood chips or sand are used as
surfacing,
they should be well maintained and not allowed to compact or fall
below an adequate depth. Limiting the height of playground
equipment
may also be helpful. Parents should consider the safety aspects of
playgrounds in day-care centers, schools, and public areas before
allowing their children to use them.
References
The Child Day Care Infectious Disease Study Group. Public
health
considerations of infectious diseases in child day care centers. J
Pediatr 1984;105:683-701.
O'Connor MA, Boyle WE Jr, O'Connor GT, Letellier R. Injury
prevention practices in daycare centers. Presented at the 115th
annual
meeting of the American Public Health Association, New Orleans,
Louisiana, October 18-22, 1987.
Davis WS, McCarthy PL. Safety in day-care centers (Abstract). Am
J
Dis Child 1988;142:386.
Aronson SS. Injuries in child care. Young Child 1983;38:19-20.
Landman PF, Landman GB. Accidental injuries in children in
day-care
centers. Am J Dis Child 1987;141:292-3.
Rutherford GW Jr. Injuries associated with public playground
equipment. Washington, DC: US Consumer Product Safety Commission,
1978.
Mahajan BM, Beine WB. Impact attenuation performance of surfaces
installed under playground equipment: report to the Consumer
Product
Safety Commission. Washington, DC: US Department of Commerce,
National
Bureau of Standards, Feb. 1979; publication no. NBSIR 79-1707.
Reichelderfer TE, Overbach A, Greensher J. Unsafe playgrounds
(Letter). Pediatrics 1979; 64:962-3.
US Consumer Product Safety Commission. A handbook for public
playground safety: general guidelines for new and existing
playgrounds.
Vol I. Washington, DC: US Consumer Product Safety Commission, 1986.
US Consumer Product Safety Commission. Play happy, play safely:
playground equipment guide for teachers, park and recreation
directors,
parents, youth leaders, and other concerned adults. Washington, DC:
US
Consumer Product Safety Commission, 1979.
*This estimate is based on data from the National Electronic Injury
Surveillance System (NEISS) of the U.S. Consumer Product Safety
Commission (CPSC). Sixty-two hospitals with emergency rooms located
throughout the United States contribute to this data base. When
weighted, the reports from NEISS reflect national estimates of
persons
with product-related injuries treated in hospital emergency rooms.
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