Why playground injuries are on the rise

Safety measures, including installing soft surfaces beneath play areas, have reduced the number of severe head and neck injuries as well as deaths on playgrounds, but a new report reveals that traumatic brain injuries (TBIs) on playgrounds are still rising.

From 2005 to 2013, the number of children treated for TBIs related to playground injuries climbed from 23 per 100,000 children to 48 per 100,000 children, according to the report.

Swings and monkey bars are the top culprits in playground TBIs and concussions, and researchers recommend continued efforts in the construction and inspection of playgrounds to try and further reduce the number of these injuries.

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The study reviewed the injuries of more than 21,000 children treated in emergency departments (EDs) for playground injuries. The ED visit rate for boys was 39.7 per 100,000 and 53.5 for children aged 5 to 9 years in general. Most of the children studied-95.6%-were treated and released, but the report noted that ED visits involving TBIs increased significantly from 2005 to 2013.

As far as how the injuries occurred, researchers found that 33.5% of playground-related injuries occurred at a sports or recreation center, and 32.5% at schools. Monkey bars and playground gyms were associated with 28.3% of injuries, and swings were associated with 28.1%.

According to the report, an estimated 213,000 playground injuries and more than 16,000 ED visits resulting from TBI due to playground injuries occur each year. While most of these injuries result in a child being treated and released, the report authors note that even mild TBIs can have serious long-term effects on physical, cognitive, and behavioral health in children.

“Studies suggest that even children with mild TBI are at risk for disability because of psychosocial effects that require specialized resources to return to community living,” according to the report. “Therefore, understanding the epidemiology and trend of playground-related TBI is necessary to guide strategies to reduce the occurrence of this injury.”

The study authors found that most playground-related ED visits resulting in TBIs occurred in May (12.9%), followed by September (11.8%) and April (11.7%). Researchers also found that most ED visits (77.9%) related to playground injuries occurred during the weekdays.

Injuries and the related equipment associated with those injuries varied by age, according to the report. Swings were most commonly associated with TBI in ages 0 to 4 years, causing 31% of injuries, followed by slides causing 26% of injuries. In children aged 5 to 9 years, 34% of ED visits involved monkey bars of playground gyms, and 24% involved swings. The opposite occurs in children aged 10 to 14 years, with more ED visits (34%) involving swings and 29% involving monkey bars or playground gyms.

In terms of location, children aged 0 to 4 years were most often injured on playgrounds and at sports and recreation centers, whereas children aged 5 to 14 years were most often injured at school playgrounds.

Despite interventions and safety measures, the study notes that playground-related injuries rose significantly from 2005 to 2013, citing a Centers for Disease and Control Prevention (CDC) report that estimated a 57% increase in TBIs from 2001 to 2009, with most of those occurring as a result of playground injuries.

This rise may be attributed to increased awareness about TBI and concussions, prompting parents to seek medical care more often than in the past, according to the report. Healthcare providers may also be more apt to consider a TBI diagnosis after a head injury, according to the report.

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While injuries may be more frequent, they don’t appear to be more severe, according to the report. The study authors notes that more than 90% of ED visits related to playground injuries result in the child being treated and released.

Some of the variation in injury type by age group is easily explained, according to the report. Injuries increase as children age and engage in more challenging play, and injuries on school playgrounds increase as children enter grade school. This also explains the high incidence of injuries during the school week, according to the report.

“Although caregiver supervision can play an important role in child injury prevention, not all risks can be addressed by this strategy,” according to the report. “Methods to reduce a child’s risky play on playgrounds may also help lessen the burden of these injuries. Supervision to ensure proper use of equipment and modification of childhood behavior, however, need to be augmented by environmental modifications.”

Although industry standards, such as replacing hard surfaces like asphalt with softer materials like mulch or rubber, have contributed to a decrease in severe head injuries and skull fractures, additional design and maintenance measures could improve safety even further, according to the report.

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The report notes that standards for safe playground surfaced outlined by the American Society for Testing and Materials appear to be working, with few deaths from head and neck injuries over the last several years. However, the study authors note that playground construction and surfacing safety standards should be reviewed and updated annually, and playgrounds should be inspected annually for safety hazards.

The study authors also support appropriate supervision and child behavior modification, particularly for children aged 5 to 9 years, who have the highest rates of injury.

Lead author Tabitha Cheng, MD, of UCLA Emergency Medicine in Los Angeles, California, says the study highlights the importance of continue efforts to improve playground safety, and stresses the fact that sports are not the only important cause of concussions and TBIs in children.

“Many pediatricians treat patients for playground-related injuries, and as medical professionals, we are often asked to give advice to parents or guardians on how to prevent these type of injuries,” Cheng says. “Additional studies are needed to determine what specific risk behaviors lead to TBIs on the playground or why ED visits have increased.”

Cheng does, however, share some advice that pediatricians can pass along to patients and their caregivers. Those include checking that playgrounds have a soft material under them, such as wood chips, sand, or mulch; and reading playground signs to determine whether the playground equipment is suitable for the child’s age group. Caregivers should also be sure playground equipment is in good shape, with appropriate guardrails to prevent falls. Watch out for items around the playground that might cause harm, too, such as a tree root or stump that a child could trip over. Cheng says other safety tips for playground safety and traumatic head injury are available from the CDC.