Elsevier

The Lancet

Volume 349, Issue 9069, 28 June 1997, Pages 1874-1876
The Lancet

Articles
Safety of surfaces and equipment for children in playgrounds

https://doi.org/10.1016/S0140-6736(96)10343-3Get rights and content

Summary

Background

The safety of playgrounds is important to protect children from injury, but studies are mostly done mainly under laboratory conditions without epidemiological data. We investigated the safety of different playground surfaces, and types and heights of equipment in public playgrounds in the City of Cardiff, UK.

Methods

We did a correlational study of 330 children aged between 0 and 14 years. All children were hurt when playing in playgrounds in Cardiff and presented to the Accident and Emergency Department in Cardiff Royal Infirmary during summer (April to September) 1992 and 1993, and the whole of 1994. We studied the children's hospital records to establish the type of injury and interviewed their parents to find out the playground and type of equipment involved. The main outcome measures were the number of children injured whilst playing, and injury rates per observed number of children on different surfaces, types, and heights of equipment.

Findings

Children sustained significantly more injuries in playgrounds with concrete surfaces than in those with bark or rubberised surfaces (p<0·001). Playgrounds with rubber surfaces had the lowest rate of injury, with a risk half that of bark and a fifth of that of concrete. Bark surfaces were not significantly more protective against arm fractures than concrete. Most injuries were equipment related. Injury risk due to falls from monkey bars (suspended parallel bars or rings between which children swing) was twice that for climbing-frames and seven times that for swings or slides. The height of the equipment correlated significantly with the number of fractures (p=0·005) from falls.

Interpretation

Rubber or bark surfacing is associated with a low rate of injuries and we support their use in all public playgrounds. Bark alone is insufficient, however, to prevent all injuries, particularly arm fractures. Rubberised impact-absorbing surfaces are safer than bark. We believe that playing on monkey bars increases the risk of injury in playgrounds and that they should generally not be installed. Safety standards should be based on physical and epidemiological data. Our data suggest that the proposed raising of the maximum fall height from 2·5 m to 3·0 m in Europe is worrying.

Introduction

Playgrounds were originally developed during the nineteenth century to offer children play opportunities in an increasingly industrialised society.1 The safety of playgrounds is important, not only for the prevention of injuries, but also to assure families that they are safe places for their children to play. Public playground provision, safety, and maintenance in the UK are largely the responsibility of the local-government councils.2 Much work has been done to develop safer equipment and surfaces and in producing acceptable saftey standards (BS 5696 and BS 7188).3 However, these standards have largely been developed in the laboratory4 and there has been little analysis of real children being injured in real playgrounds.5

Impact-absorbing surfaces are a key safety feature. These types of surface were introduced to reduce the severity of head injuries from falls6 but their effectiveness has been debated and they are costly.7 Various surfaces are available, including bark and impact-absorbing rubberised surfacing. Information on injuries that children acquire in the playground is vital for those who develop safety standards, produce equipment, and plan playgrounds. Analysis of the effectiveness of these features is particularly timely since European safety standards for playground safety are currently being developed.

In 1992, we began our research into playground injuries with the aim of investigating the correlation between accidents and specific playgrounds, equipment, and surfaces. We found that for the study to be effective we had to develop a close association with the local authority. Therefore, we developed a safety and research partnership with Cardiff City Council. The council has an active policy of playground development, maintenance, and safety.

Our first study described the pattern of injuries on different playground surfaces.8 Although bark seemed to be protective against head injury, many children sustained arm fractures after falling from playground equipment on to bark surfaces. During this study we realised that to compare risks, we needed to develop a method of measuring exposure of children to playground injuries. Our objective was to assess the effectiveness of different surfaces and equipment in prevention of injuries. We did this by relating children's injuries in public playgrounds to their exposure to injury.

Section snippets

Methods

In this collaborative study between the Department of Child Health and the Sports and Leisure Department of Cardiff County Council, we recorded the surface types of 85 playgrounds and the type and height of equipment. We investigated injuries sustained while playing on swings, slides, climbing-frames, and monkey bars (a series of parallel bars or rings suspended above the ground between which children swing). We identified children aged between 0 and 14 years who in 1994 attended the Accident

Results

There were 85 playgrounds in Cardiff in 1994, with tree bark (conforming to British Standards), impact-absorbing rubberised, or concrete or tarmac surfaces (table 1). 330 children attended the Accident and Emergency Department of the Cardiff Royal Infirmary with a playground injury. Full accident details were obtained for 301 children. The mean and median ages were both 7·4 years (range 1·2–14·9 years); 167 (55·5%) were boys. 48 (16%) children were admitted to hospital, 44 with a fracture. Only

Discussion

The importance of reliable estimates of exposure in the analysis of playground accident data cannot be overemphasised. One bark-surfaced playground had a high rate of injuries, but exposure data showed that in 1994, this playground was used at least five times more frequently than the other playgrounds with bark surfaces. Our method of measuring exposure of children to injuries relies on the observations of the people who work in the playgrounds. Results should, therefore, be reproducible and

References (12)

  • P Hesletine et al.
  • City of Cardiff Leisure and Amenities Department. Playground strategy, 1st edn. February,...
  • P Heseltine et al.

    Playground management and safety

    (1989)
  • ML Lewis et al.

    Quantification of impact attenuation of different playground surfaces under various environmental conditions using a tri-axial accelerometer

    J Trauma

    (1993)
  • JJ Sacks et al.

    Playground hazards in Atlanta child care centers

    Am J Public Health

    (1990)
  • D Ball et al.

    Playground injuries: a scientific appraisal of popular concerns

    J R Soc Health

    (1991)
There are more references available in the full text version of this article.

Cited by (92)

  • Head and neck fracture patterns associated with playground equipment use in the pediatric population

    2020, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    LaForest et al. have suggested that limiting maximum equipment height to less than 6.5 feet and also using protective material under playground equipment with a high level of resilience, such as sand, will help reduce the rate of pediatric head injuries by decreasing the rate of the head's peak deceleration [8]. Using a correlational study, Mott et al. calculated playground injury rates for children (aged 0–14 years) and found that the risk of injury in playgrounds with concrete surfaces was higher than that in playgrounds with bark and rubber surfaces [9]. A previous study by Mott et al. noted that climbing equipment such as monkey bars contribute a disproportionate amount of injuries, including a fracture rate that is twice as high as other climbing structures, when considering injuries to the entire body (preventing injuries in public playgrounds, etc.) [9].

  • Ecology of falls

    2018, Handbook of Clinical Neurology
View all citing articles on Scopus
View full text