A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population

This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.

"Children are precious cargo; we don't let them take any risks!": Hearing from adults on safety and risk in children's active play in schools: a systematic review

Background

Understanding determinants of children’s outdoor play is important for improving low physical activity levels, and schools are a key setting for both. Safety concerns shape children’s opportunity to play actively outdoors, therefore, this qualitative evidence synthesis aimed to i) examine adult (e.g., parent, teacher, yard supervisor, principal) perspectives on safety and risk in children’s active play during recess in elementary and/or middle schools, and ii) identify how safety and risk influence playground supervision and decision making in this setting.

Methods

Six electronic databases were systematically searched in March 2021, with an updated search in June 2022. Records were screened against eligibility criteria using Covidence software, and data extraction and synthesis were performed using predesigned coding forms in Microsoft Excel and NVivo. Framework synthesis methodology was employed, guided by a conceptual framework structured on the socio-ecological model (SEM) and affordance theory.

Results

From 10,370 records, 25 studies were included that represented 608 adults across 89 schools from nine countries. The synthesis identified 10 constraining and four affording factors that influenced whether school staff were risk-averse or risk tolerant during recess, and, in turn, the degree to which children’s play was managed. Constraining factors stemmed from fears for children’s physical safety, and fear of blame and liability in the event of playground injury, which shaped parent, school staff and institutional responses to risk. Interrelated factors across SEM levels combined to drive risk-averse decision making and constraining supervision. Emerging evidence suggests children’s active play in schools can be promoted by fostering a risk tolerant and play friendly culture in schools through play facilitation training (e.g., risk-reframing, conflict resolution) and engaging stakeholders in the development of school policies and rules that balance benefits of play against potential risks.

Conclusions

Findings show several socio-cultural factors limited the ability of school staff to genuinely promote active play. Future work should seek to foster risk tolerance in schools, challenge the cultural norms that shape parent attitudes and institutional responses to risk in children’s play, and explore novel methods for overcoming policy barriers and fear of liability in schools.

Trial registration

PROSPERO registration: CRD42021238719.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01344-7.

Preliminary findings of thermal safety in children's outdoor playhouses

Children are less proficient at regulating internal body temperatures, especially during physical activity, increasing the potential for heat-related illnesses during periods of elevated outdoor temperatures. Recent studies suggest that playgrounds and bounce houses create microclimates with potentially dangerous conditions elevating the risk of heat-related illnesses. The present pilot study extends the inquiry to children's outdoor playhouses to determine if the same capability of creating microclimatic conditions of elevated thermal risk exists. Air temperature (°C) and relative humidity (%) measurements were collected from inside two playhouses and the outside ambient environment over a 6-h period on a clear, warm, summer day. Measurements were used to calculate the National Weather Service (NWS) heat index for both playhouses and the outside environment. Results from a Kruskal-Wallis test demonstrated significant differences (p < 0.001) and post hoc test procedures indicated that playhouse A and playhouse B had significantly higher heat index values than the outside environment. Little is known about the thermal risks created by children's outdoor play equipment. This study adds to the preliminary work in this field, but continued research is warranted to fully understand the thermal safety of children's outdoor play equipment.

A systematic review of the risk factors and interventions for the prevention of playground injuries

OBJECTIVES

The primary objectives of this work were to (1) identify the risk and/or protective factors associated with playground injuries among children less than 18 years of age and (2) identify interventions/programs/policies aimed at preventing playground-related injuries among children less than 18 years of age. Secondary objectives include a summary of the data that reflect alignment with current playground standards.

METHODS

For the primary outcome, 4 databases and 12 online resources were systematically searched to include observational and experimental studies examining risk and/or protective factors or interventions associated with playground injury or outcomes related to playground injury (e.g., risky playground behaviour). Data extraction included study design, participants, outcome, exposure or intervention, data analysis, and effect estimates. The quality of evidence for all studies was assessed using the Downs and Black criteria.

RESULTS

This review included studies of moderate quality, revealing a number of risk factors and effective interventions for playground injury. Risk factors included absence of handrails and guardrails on playground equipment, non-impact-absorbing surfacing, and critical fall heights. Effective interventions included modifying playground surfacing and reducing equipment height to less than 1.5 m.

CONCLUSION

Equipment- and structure-based playgrounds should adhere to and maintain playground standards in order to reduce the risk of serious injury. Organizations responsible for installing and maintaining playgrounds should consider alternative play spaces that allow children to play outdoors, in a natural environment that supports healthy child development and promotes physical activity.

Head injuries in children

School nurses play a crucial role in injury prevention and initial treatment when injuries occur at school. The role of school nurses includes being knowledgeable about the management of head injuries, including assessment and initial treatment. The school nurse must be familiar with the outcomes of a head injury and know when further evaluation is indicated. Developing a head injury protocol in the school setting is one strategy to make sure that all involved are able to consistently and effectively respond to a head injury and prevent a possible negative outcome. The combination of a protocol, nursing judgment, and best practices can ensure that all means are used to take care of children when a head injury is sustained. These strategies will help to increase the safety of children at school. A systematic approach to the management of these types of injuries is essential for preventing possible complications.

Developing a playground injury prevention plan

Playgrounds are a major source of unintentional injuries in the school environment. In fact, 80% of all injuries on public playground equipment happen at school. Thus, the need for developing a playground injury prevention plan is critical to provide safe educational outdoor environments for children. The S.A.F.E.trade mark framework for injury prevention is the first step in preventing playground injuries. This article highlights suggestions that school nurses can implement in creating an effective playground injury prevention program at their schools.