Playground Safety -- United States, 1998-1999

Each year approximately 211,000 U.S. children receive emergency department care for injuries sustained on playground equipment (1), making the use of this equipment the leading cause of injuries to children in school and child care environments (2,3). In response to the problem, the National Program for Playground Safety (NPPS) at the University of Northern Iowa (UNI) developed a national action plan (4) that focuses on four areas of playground injury prevention: supervision, age-appropriateness of equipment, suitable fall surfaces, and equipment maintenance. During 1998-1999, NPPS surveyed a sample of the nation's child care, elementary school, and park playgrounds. This report summarizes the survey results, which indicate that playground injuries could be reduced by measures such as resilient surfacing below equipment, better equipment maintenance, improved supervision, and use of age-appropriate equipment.

To monitor progress in achieving the national plan, UNI developed and tested a questionnaire in 1997, and during 1998, universities and colleges with leisure and recreation service departments in each of the 50 states were solicited by phone and letter to administer the survey. Once an institution agreed to participate, a contact person received a manual with instructions for selecting the sample and conducting the survey. Eighty percent of the surveys were conducted by university professors, the remainder by undergraduate and graduate students.

Playgrounds were selected using multistage sampling. First, communities in each state were stratified by population: less than 25,000; 25,000-75,000; and greater than 75,000. Parks, schools, and child care centers in three communities from each stratum then were selected randomly, resulting in 27 survey sites. Next, a list of elementary schools in that community was drawn from local directories (i.e., state departments of public education, chambers of commerce, and telephone directories). From this list, elementary schools were selected using a table of random numbers provided in the instruction manual. The same process was repeated for parks and child care centers. A total of 1353 playgrounds in 31 states (average: 44 per state) were surveyed.

Most playgrounds comprised stand-alone and composite equipment; the two most common pieces were slides (89% of playgrounds) and swings (73% of playgrounds) (Table_1). Although a wide age range of children used the playgrounds, 42% of playgrounds had a clear separation of equipment intended for ages 2-5 years and ages 5-12 years. In addition, 9% of playgrounds had signs to indicate the age group for which the equipment was designed. While 31% of the surveys were being conducted, children were playing on the equipment. In 23% of these instances, they were playing without adult supervision; 14% of the playgrounds had posted rules emphasizing the importance of supervision.

Appropriate surface materials were found in 75% of the playgrounds; however, 56% had insufficient depths of materials to protect from serious head injury, 38% had failed to provide material in adequate use zones around the equipment, and 20% had exposed concrete footings. Of the playgrounds surveyed, one out of four playgrounds had equipment with missing or broken parts or had equipment that was rusted (37%), splintered (36%), or cracked (11%).

Reported by: MG Mack, PhD, SD Hudson, PhD, D Thompson, PhD, National Program for Playground Safety, Univ of Northern Iowa, Cedar Falls, Iowa. Home and Leisure Team, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: Although greater than 80% of the playground equipment surveyed was installed in 1981 or after, and therefore should comply with standards set by the U.S. Consumer Product Safety Commission (CPSC) (5), survey results indicated that school, child care, and park playgrounds are deficient in supervision, age-appropriateness of equipment, suitable fall surfaces, and equipment maintenance. Inadequate supervision contributes to playground injuries (6); children need the attention of an adult as they play. CPSC advises that children ages 2-5 and 5-12 years are safer when equipment is separated and grouped for each age category (7). Children who play on equipment inappropriate for their size, strength, and decision-making ability increase their injury risk. Because 70% of playground injuries involves falls to the ground (8), the amount of area covered beneath equipment, and the type and depth of the surface material, are critical. Hard surfaces, such as asphalt, concrete, dirt, and grass, should be replaced by shock-absorbent surfaces, such as sand, wood chips, small round gravel, and rubber. Once an adequate zone of material is installed, it must be maintained at a sufficient depth to cushion a child's fall (7,8). Poor equipment maintenance also contributes to playground injuries (6). Continual inspection and regular maintenance and repair of all equipment and surfaces are essential to playground safety. The NPPS plan outlines strategies at local, state, and federal levels for achieving improvements in all of these areas (4).

These survey results should be interpreted cautiously because of at least four limitations. First, interrater reliability is unknown. Second, a single assessment may not reflect accurately seasonal or time-of-day differences in safety. Third, observation of the playground does not measure maintenance and supervision policies, although it does reflect actual practice. However, in a number of schools and child care centers, researchers were not permitted to be in the playground while children were present. Thus, the data on supervision may not reflect true practices. Finally, the sample size is small relative to the total number of playgrounds in the United States.

To provide a safer play environment, playgrounds must have adequate supervision, be maintained continually, and be equipped with age-appropriate equipment and resilient surfaces. Further information about the survey and safer playgrounds is available from the National Program for Playground Safety, telephone (800) 554-7529 or on the World-Wide Web at *.

References

1. Mack MG, Thompson D, Hudson S. Playground injuries in the 90s. Parks & Rec 1998;33:88-95.

2. US Congress, Office of Technology Assessment. Risks to students in school. Washington, DC: Office of Technology Assessment, 1995.

3. Briss PA, Sacks JJ, Addiss DG, Kresnow M, O'Neil J. A nationwide study of the risk of injury associated with day care center attendance. Pediatrics 1994;93:364-8.

4. Thompson D, Hudson S. National action plan for the prevention of playground injuries. Cedar Falls, Iowa: National Program for Playground Safety, 1996.

5. US Consumer Product Safety Commission. Handbook for public playground safety (vol. I & II). Washington, DC: US Consumer Product Safety Commission, 1980.

6. King S. Developing a safe playground is everyone's responsibility. Presented at the Minnesota Recreation and Park Congress. Bloomington, Minnesota, 1990.

7. US Consumer Product Safety Commission. Handbook for public playground safety. Washington, DC: US Consumer Product Safety Commission, 1997.

8. Mack MG, Hudson S, Thompson D. A descriptive analysis of children's playground injuries in the United States, 1990--1994. Inj Prev 1997;3:100-3.

References to sites of nonfederal organizations on the World-Wide Web are provided solely as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites.

TABLE 1. Number and percentage of safety-related factors in playgrounds, by locale -- United States, 1998-1999
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                            Child care center (n=486)         Park (n=412)              School (n=454)            Total (n=1353)*
                            -------------------------   -----------------------    -----------------------   -------------------------
Factor                       No.     (%)    (95% CI+)   No.    (%)     (95% CI)    No.    (%)     (95% CI)    No.    (%)      (95% CI)
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Layout
  Installed 1981 or later    450    (93%)   (90%-95%)   324   (79%)   (75%-83%)    380   (84%)   (80%-87%)   1153   (85%)    (83%-87%)
  Combination
    of equipment             368    (76%)   (72%-80%)   329   (80%)   (76%-84%)    336   (74%)   (70%-78%)   1033   (76%)    (74%-79%)
  Slides present             431    (91%)   (89%-94%)   374   (91%)   (88%-94%)    378   (87%)   (83%-90%)   1178   (89%)    (88%-91%)
  Swings present             324    (69%)   (64%-73%)   361   (89%)   (85%-92%)    276   (63%)   (58%-67%)    962   (73%)    (70%-75%)

Fall surfaces
  Appropriate surface
    material present         331    (71%)   (66%-75%)   309   (75%)   (71%-79%)    353   (79%)   (76%-83%)    992   (75%)    (73%-77%)
  Inappropriate surface
    depth                    256    (56%)   (52%-61%)   223   (56%)   (51%-61%)    241   (55%)   (51%-60%)    721   (56%)    (53%-59%)
  Inadequate use zone        183    (39%)   (35%-44%)   161   (39%)   (34%-44%)    150   (34%)   (29%-38%)    495   (38%)    (35%-40%)
  Exposed concrete
    footings                  82    (20%)   (16%-24%)    85   (21%)   (17%-25%)     82   (19%)   (15%-23%)    251   (20%)    (18%-22%)

Equipment maintenance
  Missing parts               97    (21%)   (17%-24%)   116   (29%)   (24%-33%)    111   (25%)   (21%-29%)    325   (25%)    (22%-27%)
  Broken parts                98    (21%)   (17%-24%)   109   (27%)   (22%-31%)    105   (24%)   (20%-28%)    314   (24%)    (21%-26%)
  Rusted equipment           117    (33%)   (28%-38%)   157   (40%)   (35%-44%)    159   (37%)   (33%-42%)    435   (37%)    (34%-40%)
  Splinters                   87    (30%)   (25%-35%)    67   (38%)   (31%-45%)     88   (41%)   (34%-47%)    242   (36%)    (32%-39%)
  Cracked equipment           40    (10%)   ( 7%-13%)    34   (12%)   ( 8%-16%)     28   (10%)   ( 7%-14%)    102   (11%)    ( 9%-13%)

Supervision
  Children playing            96    (21%)   (17%-24%)   186   (46%)   (41%-50%)    127   (29%)   (25%-33%)    410   (31%)    (29%-34%)
  No adult supervision        12    (12%)   ( 6%-18%)    41   (22%)   (16%-28%)     42   (33%)   (25%-41%)     96   (23%)    (19%-27%)
  Supervision rules posted    46    (10%)   ( 7%-13%)    82   (20%)   (16%-24%)     56   (13%)   (10%-16%)    184   (14%)    (12%-16%)

Age-appropriateness
  Designed for ages
    2-12 years               240    (51%)   (46%-55%)   344   (84%)   (81%-88%)    198   (45%)   (40%-49%)    783   (59%)    (56%-62%)
  Separation of equipment    127    (53%)   (47%-59%)   128   (37%)   (32%-42%)     71   (37%)   (30%-44%)    326   (42%)    (38%-45%)
  Signage for age level       21    (10%)   ( 6%-14%)    20   ( 7%)   ( 4%- 9%)     16   (10%)   ( 5%-15%)     57   ( 9%)    ( 6%-11%)
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* Site was unknown for one playground; denominators vary depending on the specific factor being examined.
+ Confidence interval.
========================================================================================================================================

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