Play is an essential component of healthy development in children, and playgrounds provide an opportunity for children to develop motor, cognitive, perceptual and social skills. All too often, however, playgrounds are the site of unintentional injuries.

The leading cause of playground equipment-related fatalities is strangulation and the majority of these deaths occur on home playgrounds. This is contrasted with nonfatal playground equipment-related injuries which are most often due to falls. The majority of these nonfatal injuries take place on public playgrounds, including school, day care and park playgrounds. In a 1998 survey, U.S. playgrounds received an overall grade of C- when rated on physical hazards and behavioral elements, including supervision and age-appropriate design.

It is the responsibility of adults to create play environments that are challenging for children, but that are also reasonably safe. Utilizing age-appropriate equipment, following a regular maintenance schedule, limiting equipment height and maintaining adequate surfacing, combined with adult supervision, can greatly reduce the incidence and severity of such injuries.

PLAYGROUND DEATHS AND INJURIES

— Each year, nearly 20 children ages 14 and under die from playground equipment-related injuries.

— In 1998, more than 230,000 children ages 14 and under were treated in hospital emergency rooms for playground equipment-related injuries. Children ages 5 to 14 accounted for more than 70 percent of these injuries,

WHEN AND WHERE PLAYGROUND DEATHS AND INJURIES OCCUR

— It is estimated that one-third of playground equipment-related deaths and 70 percent of playground equipment-related injuries occur on public playgrounds.

— Playground injuries are the leading cause of injury to children in the day care setting and to children ages 5 to 14 in the school environment.

— Lack of supervision is associated with 40 percent of playground injuries. A recent study found that children play without adult supervision more often on school playgrounds (32 percent of the time) than on playgrounds in parks (22 percent) or child care centers (5 percent).

— Strangulation resulting from entanglement and entrapment is the primary cause of playground equipment-related fatalities, accounting for nearly half of the deaths. Falls to the surface are responsible for an additional 24 percent of the deaths.

— More than 70 percent of playground equipment-related injuries involve falls to the surface and 9 percent involve falls onto equipment.

— Falls account for 90 percent of the most severe playground equipment-related injuries (mostly head injuries and fractures). Head injuries are involved in 75 percent of all fall-related deaths associated Nvith playground equipment.

— Nearly 4O percent of playground injuries occur during the months of May, June and September.

— Swings, climbing equipment and slides combined account for more than 85 percent of playground-related injuries.

WHO IS AT RISK

— Male children account for 62 percent of playground-related deaths and are at a slightly higher risk of non fatal playground equipment-related injury compared with females.

— Children ages 4 and under are more likely to suffer injuries to the face and head while children ages 5 to 14 are more likely to suffer injuries to the arm and hand.

— A young child is at increased risk of injury when playing on equipment designed for older children. Only 42 percent of U.S playgrounds have separate play areas for children ages 2 to 5 and children ages 5 to 12, and only 9 percent have signs indicating the age appropriateness of equipment.

— The risk of injury is four times greater if a child falls from playground equipment that is more than 1.5 meters (approximately 5 feet) high than from equipment that is less than 1.5 meters high.

— The risk of being injured in a fall onto a non-impact absorbing surface such as asphalt or concrete is more than twice that of falling onto an impact-absorbing surface. Only 62 percent of U.S. playgrounds have six feet zones of appropriate impact-absorbing surfacing around stationary equipment.

PLAYGROUND INJURY PREVENTION EFFECTIVENESS

Protective surfacing under and around playground equipment can reduce the severity of and even prevent playground fall-related injuries.

PLAYGROUND LAWS AND REGULATIONS

— Playground equipment guidelines and standards have been developed by the U.S. Consumer Product Safety Commission (CPSC), the American Society for Testing and Materials (ASTM), and the Consumer Federation of America. However, these are voluntary recommendations and are not federally mandated or regulated. At least four states — California, Michigan, North Carolina and Texas — have enacted playground safety legislation mandating many of these guidelines.

— The CPSC has issued voluntary guidelines for drawstrings on children’s clothing to prevent children from strangling or getting entangled in the neck and waist drawstrings of outerwear garments, such as jackets and sweatshirts. Children are at risk for strangulation when drawstrings on clothing become entangled in playground equipment.

PREVENTION TIPS

— Avoid asphalt, concrete, grass and soil surfaces under playground equipment. Acceptable loose-fill materials include hardwood fiber mulch or chips, pea gravel, fine sand and shredded rubber. Surfacing should be maintained at a depth of 12 inches and should extend a minimum of 6 feet in all directions around stationary equipment.

— Ensure that a comprehensive inspection of all playgrounds is conducted by qualified personnel. Abide by daily, monthly and annual playground maintenance schedules.

— Ensure that schools and child care centers have age-appropriate equipment, and that trained supervisors are present at all times when children are on the playground.

— Report any playground safety hazards to the organization responsible for the site (e.g., school, park authority, city council).

— Always supervise children when using playground equipment. Maintain visual and auditory contact. Prevent unsafe behaviors like pushing, shoving, crowding and inappropriate use of equipment.

— Ensure that children use age-appropriate playground equipment. Maintain separate play areas for children under age 5.

— Remove hood and neck drawstrirgs from all children’s outerwear. Never allow children to wear necklaces, purses, scarves or clothing with drawstrings while on playgrounds.