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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

  1. 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.

  2. 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.

  3. Davis WS, McCarthy PL. Safety in day-care centers (Abstract). Am J Dis Child 1988;142:386.

  4. Aronson SS. Injuries in child care. Young Child 1983;38:19-20.

  5. Landman PF, Landman GB. Accidental injuries in children in day-care centers. Am J Dis Child 1987;141:292-3.

  6. Rutherford GW Jr. Injuries associated with public playground equipment. Washington, DC: US Consumer Product Safety Commission, 1978.

  7. 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.

  8. Reichelderfer TE, Overbach A, Greensher J. Unsafe playgrounds (Letter). Pediatrics 1979; 64:962-3.

  9. Sweeney TB. X-rated playgrounds? (Letter). Pediatrics 1979;64:961.

  10. 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.

  11. 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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