Thursday, July 28, 2011

Playground Safety: Dr. Jen's Take on the New York Times Piece

A repost from

As a pediatrician with a sub-specialty in child abuse, and a mother of two sets of twins, I read the New York Times article Can a Playground Be Too Safe? with significant concern. In this piece, John Tierney explains the history of New York City’s playgrounds and safety. Specifically, regarding a 10-foot-high jungle gym in Manhattan near his childhood home, he explained that as long as he was the parks commissioner, the monkey bars were going to remain in place. This was despite researchers at the time, who cited accident statistics and the importance of safer playgrounds. Fast forward to 2011, and this article, in accordance with Mr. Stern’s 1990’s edict - critics saying that playgrounds may “stunt emotional development, leaving children with anxieties and fears that are ultimately worse than a broken bone”.

Wow, do I disagree.

The CDC cites a 2001 study reporting over 200,000 emergency department visits each year for children ages 14 and younger related to playground-injuries . This same study highlights 147 fatalities between 1990 to 2000 related to playground injuries. Further, 45% of these injuries are severe–fractures, internal injuries, concussions, dislocations, and amputations. Public playgrounds account for 75% of these injuries. On public playgrounds, climbers account for the majority of injuries. An incredible $1.2 billion cost was estimated for 1995 by the Office of Technology Assessment related to playground-related injuries among children ages 14 and younger.

Let’s discuss the effect of intervention: A 2005 article by Dr. Andrew W. Howardpublished in the Canadian Medical Association Journal. He explained that changes to Canadian Standards Association (CSA) standards for playground equipment led to the removal of hazardous equipment from 136 elementary schools in Toronto. He compared injuries before and after equipment replacement in these schools. The rate of injury in intervention schools decreased from 2.61/1000 students (95% CI 1.93–3.29) to 1.68/1000 students – resulting in 550 less injuries in the 136 elementary schools.

And, here in the Unites States, a study by Dr. Kieran Phelan described Injury prevention efforts targeting schools and 5- to 9-year-old. Dr. Phelan found that visits to emergency rooms by children and adolescents for injuries due to falls from playground equipment were decreasing (187,000 in 1992 to 98,000 in 1997). Playground injuries were still an issue after revisions, which stresses the importance of coupling safer playgrounds with safety prevention steps parents can take.

Here are some tips, adapted from the American Academy of Pediatrics:
  1. Young children (in my opinion, up to 12 years of age) should be carefully supervised when using playground equipment.
  2. During this supervision assure children are not being rough – including shoving, pushing, or fighting.
  3. Playground surfaces should be energy absorbent. This includes safety-tested mats or loose fill materials (shredded rubber, sand, wood chips, or bark) maintained to a depth of at least 9 inches.
  4. Install the protective surface at least 6 feet (more for swings and slides) in all directions from the equipment.
  5. Swing seats should be made of something soft, not wood or metal. Children should refrain from twisting swings, swing empty seats, or walk in front of moving swings.
  6. Put home playground equipment together correctly. It should sit on a level surface and be anchored firmly to the ground.
  7. Cap all screws and bolts. Check periodically for loose nuts and bolts and broken, rusty, or sharp parts.
  8. Install playground equipment at least 6 feet from fences or walls.
  9. Be aware of hot metal surfaces on equipment which could cause burns.
  10. Ropes of any kind (jump ropes, clotheslines, or pet leashes) should never be attached to playground equipment because children can strangle on them.
  11. Teach all child care providers the same, and assure these standards apply in any day care setting.
To summarize my point of view – safety wins out.