Injuries from falls on playgrounds. Effects of day care center regulation and enforcement
P. A. Briss, J. J. Sacks, D. G. Addiss, M. J. Kresnow and J. O'Neil
National Center for Injury Prevention and Control, Preventive Medicine Residency Program, Atlanta, Ga., USA.
OBJECTIVES: To measure the incidence of playground fall injuries among
children attending licensed US day care centers and to evaluate how injury
incidence varies with center characteristics and with the regulatory and
enforcement climate in which centers operate. DESIGN: Telephone surveys of
directors of day care centers and enforcement agencies and review of
written day care regulations. SETTING: Probability sample of licensed day
care centers in 50 states and the District of Columbia. PARTICIPANTS:
Children attending day care centers with playgrounds. MAIN OUTCOME
MEASURES: Medically attended playground fall injuries. RESULTS: Among the
1740 day care centers studied, a weighted total of 89.2 injuries occurred
during the 2-month study period (0.25/100,000 child-hours in day care). The
most important risk factor for injury was height of the tallest piece of
climbing equipment on the playground in both bivariate (P = .01) and
multivariate (P = .02) analyses. Neither regulations addressing playground
safety or playground surfaces nor enforcement patterns were associated with
lower injury rates. CONCLUSIONS: Additional effort is needed to develop and
evaluate regulations and enforcement that reduce injury risks for children
while minimizing burden on day care centers. In the meantime, limiting
climbing equipment heights may reduce playground injury rates.
