Injury Prevention Making Playgrounds Fun and Safe

Grace Saulsbury

Child Care Health Consultant

Lexington-Fayette County Health Department

Objectives Learn about the benefits of safe, fun, and age

appropriate outdoor play and play equipment that facilitates physical, emotional, social, and intellectual development of children.

Identify common playground hazards.

Become familiar with proper documentation for playground walk-throughs and injuries

What KY Child Care Regulations Say

922 KAR 2:120. Child-child care center health and safety standards.

Section 4. Premises Requirements

Resources

ASTM F2373 is the Standard for Consumer Safety Performance Specifications for Public use Play Equipment for children 6 months to 23 months

Outdoor Play Should be Fun!

Outdoor Play is Healthy Children should play outdoors daily when weather

and environmental conditions do not pose a significant health or safety risk.

Infants 0-12months 2-3 times per day as tolerated Toddlers 12-36 months 90 minutes each 8 hr day Preschoolers 90-120 minutes per 8 hr day

CDC: Children Lack Places to Play and Exercise

Playgrounds Should Encourage Physical Development

Children are developmentally different in size and ability. Outdoor play areas can facilitate physical development

Playgrounds Should Encourage Positive Emotional Development

Well-designed play areas can help create positive emotional development for children.

Playgrounds Should Encourage Social Development

Outdoor play areas may be one of the first social experiences for some children. Good play areas offer children opportunities to play alone or with other children. The playground should allow younger children to easily manipulate items, explore spaces, and begin to interact with others

Playgrounds Should Encourage Intellectual Development

Playgrounds are a fun way for children to develop intellectually. Playgrounds offer opportunities to learn problem solving skills, to explore, and to manipulate items.

Outdoor Play Should be Safe

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Statistics There are 56 million children in the US through age 12.

Of this age group, 220,000 are hurt on playgrounds annually.

76% of injuries occur on public playgrounds with 10% in commercial child care centers.

24% of injuries occur on residential playgrounds. While all children who use playgrounds are at risk for

injury, males account for 54% of the reported incidents where gender is recorded

A recent survey of children brought to emergency rooms found that kids hurt in playground falls were more likely than kids in car accidents to have moderate to severe injuries.

Injuries and Fatalities

FALLS are major cause of injuries on playgrounds.

ENTANGLEMENT is the major cause of deaths and debilitating injuries on playgrounds.

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More statistics Forty Deaths were associated

with playground equipment between 2001-2008. Average age was 6 years; median age was 4 years.

27 deaths were the result of hangings or other asphyxiations

7 deaths were the result of head or neck injuries

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More statistics Young children sustain the most injuries of any age

group. They are physically different from older children. They don’t have as much strength and their center of gravity is different. Reported incidents with known ages, the 0-4 age group accounts for 54% of the data

Approximately 15% of the injuries were classified as severe, with 3% requiring hospitalization. The most prevalent diagnoses were fractures (39%), lacerations (22%), contusions/abrasions (20%), strains/sprains (11%), Internal/ Organs- 5%Concussions- 2%, Other- 3%

Most injuries occur between 11AM and 4PM.

Kentucky’s Record

Why all the Fuss?

It is morally the right thing to do and we know it

It is backed by KY child care regulations

Negligence could result in liability

Playground accidents result in litigation on average 2-4 years before settling out of court.

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Liability

Playground accidents result in litigation on average 2-4 years before settling out of court.

*See Playground Safety Checklist

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CostAccording to the Center for Disease Control and Prevention (CDC), playground related injuries among children in the US ages 14 and younger cost an estimated 1.2 billon dollars a year.

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You can bet on it! Children will try to use

play equipment in ways it was never intended to be used.

What you think can’t happen to children on a playground can happen.

Children are more likely to be hurt on a playground when they are not closely supervised.

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Play Equipment: What’s on their playground?

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Climbing Equipment This is the most dangerous play equipment on the

playground. It is associated with 53% of all injuries Climbing equipment for toddlers should be no more than

32”high. Children on climbing equipment can slip and lose their grip. Climbers can create an entrapment hazard for an older

child if openings are between 17 -28”. Use tape measure. They can also fall through onto the climber, another piece

of equipment or the ground. See CPSC Playground Safety Handbook for age

appropriate guidelines.

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Slides Slides are associated with17%of all injuries. A

2009 study found a relationship between shinbone (tibia) fractures and young children going down a slide on the lap of an adult. In many of these cases, the child's leg became stuck, but the adult and child could not stop moving down the slide. In other cases, the child's leg became twisted during the ride down.

Slides create an opportunity for falls, burns, cuts, and strangulation caused by entanglement

See CPSC Public Playground Safety Handbook for age appropriate guidelines. Use tape measure and angle measurement.

Slope of Slide

No portion of the slope of bedway of slide should be >50 degrees.

CPSC Public Playground Safety Handbook for age appropriate guidelines for slides.

In the News In June of 2010, an 18-month-old girl

suffered second-degree burns to her hands, knees and stomach after going down a hot plastic slide at a Des Moines playground. The slide's surface temperature was measured at 163 degrees on an 80 degree day.

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Swings Swings are associated with

19% of all injuries Single axis: to -fro swings for

older children Multi axis: tire swing for older

children Full bucket swings for toddlers Animal Swings have been

ordered by CPSC removed from most playgrounds.

See CPSC Public Playground Safety Handbook for age appropriate guidelines.

You will use tape measure. You will check hardware: S- hooks and chains

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The Dirty Dozen Checklist

12 Leading Causesof Injuries on Playgrounds

#1 Improper Protective Surfacing

Over 79% of all injuries on the playground are caused by falls to the surface.

The severity of a fall depends on two major factors: the height of the fall and the resistance of the landing surface.

Improper surfacing such as dirt, concrete, cement, grass, asphalt, or any hard packed surface, including frozen ground or snow contribute to injuries .

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Approved Protective Surfacing The study in Accident Analysis and Prevention found that

more than 80 percent of kids severely injured in falls on playgrounds landed on a so-called "safe" surface.

Protective surfacing should be around all equipment that is 18” in Ht or more. Protective surface must be maintained at a depth of 12” and free of debris and standing water. Approved surfacing includes hardwood wooded fiber mulch, shredded rubber, sand, pea gravel (only for children over 3), manufactured /synthetic surface that meet 1292 Standard, mats, or poured in place rubber surface.

You will determine surface depth with a shovel and a ruler.

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#2 Inadequate Use Zone

Use Zone is what we used to refer to as “Fall Zone”

The use zone is the surface under and around the equipment where the child might be expected to land if they fall.

A use zone should be covered with protective surfacing material and should extend a minimum 6’ in all directions from the edge of stationary equipment.

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Use Zone for Slides For slides 6’ and less in Ht, the use

zone at the bottom exit should extend a minimum of 6’ from the end of the slide.

For slides between 6’ and 8’, the use zone at the exit is equal to the Ht of the platform or entrance to the slide.

The maximum exit use zone, regardless of Ht, is 8’.

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Use Zone for Swings Swings require a much greater area for the use zone. For school age kids to-fro swings, use zones should

extend 2 times the Ht of the pivot or swing hanger in front of, and behind the swing seat surface. The use zone should also extend 6’ to the side of the support structure.

Tire swings use zones should be equal to 6’plus the distance from the pivot point to top of seat front back and around the support structure.

Toddler swings (fully enclosed) requires less of a use zone. Measure the vertical distance from the bottom of the seat to the pivot point or swing hanger and multiply by 2 for the use zone in both front and back of swing.

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#3 Protrusion and Entanglement Hazard A protrusion is a component or piece of

hardware capable of impaling or cutting. It may enter a child’s skull or eye socket, damage internal organs or cause severe lacerations.

Some protrusions are also capable of catching strings or straps on clothing causing entanglement resulting in strangulation.

Examples: bolt ends that extend more than 2 threads beyond face of nut, open S-hooks, rungs or handholds that protrude outward.

Test with Projection Gauges, testing smallest gauges first and moving to largest.

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#3 Protrusion and Entanglement Hazard

Entanglement is the #1 cause of fatalities out of all accidents on playground.

A gap between pieces of equipment can catch a draw string, strap, or loose piece of clothing and cause a child to hang or strangle. Children should never wear bike helmets on playground equipment.

Test gaps with a .04”gap gauge, feeler gauge or dime.

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#4 Entrapment Hazards Entrapment can be caused by openings at top of

slide, openings between platforms, openings on climbers, or partially bounded openings. Also entrapment can occur where there is an opening formed by flexible or moving climbing components

Head entrapment exists when openings measure between 3 ½” to 9”.

Preschoolers tend to enter openings feet first. Their feet and body may go through an opening, but their head may not. If they are off the ground when entrapment occurs, they may hang themselves.The CPSC issued a warning in 1999 about the danger of entrapment and entanglement when 2 children died that year from strangulation after getting their head caught in an opening in equipment while wearing a bike helmet.

Using the Probes to Test Entrapment

Any opening that allows the small torso probe to pass through, but does not allow the large head probe to pass through fails and is a hazard.

Any opening that does not allow the small torso probe to pass through or allows both the small and large head probe to pass through passes and is not a hazard.

An exception is when the ground acts as the lowest border.

You would test with the Torso Probe first and then the Head Probe inserted at least 4”. Partially bounded openings would be tested with the Fish Wedge.

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#5 Insufficient Equipment Spacing Causes overcrowding of play area A "use zone" should be established around each piece of

equipment, with adequate space for entering and exiting. Equipment less than 30” in Ht may overlap use zones.

Equipment greater than 30” in Ht must be a minimum of 9’ between each structure.

Zones for popular activities should be separate to avoid overcrowding.

Swings need a large use zone and should be apart from all other equipment. See CPSC Playground Safety Handbook

Test with tape measure

Clearance Dimensions for Swings

To prevent collision, there should be adequate clearance between swings, see page 37 of CPSC Public Playground Safety Handbook

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#6 Trip Hazards

Trip Hazards are created by play structure components or items on the playground.

This could include, parts of equipment that stick out into the flow of traffic, exposed concrete footing, abrupt changes in surface elevation, tree roots, tree stumps or rocks.

Trip Hazard

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#7 Lack of Supervision

Close supervision by a responsible adult may be the most important factor in preventing playground injuries.

40% of all playground injuries are due to lack of supervision.

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Good Supervision is… Sight lines in all playground areas should be

clear to allow proper adult supervision. Positoning yourself so you can see the children and they can see you

Making sure preschoolers are playing away from areas where older, more active children play and preventing them from playing on equipment inappropriate for their age

Supervising near high use or potentially dangerous areas. If more than one teacher, swap positions at least once during play periods

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Reviewing playground safety rules with children and remind them while they are playing

Intervening when unsafe behavior occurs Insuring safe clothing for children, including

shoes Don’t let children play on broken equipment.

If broken, report it and fix it or remove it. Make sure children use playground

equipment as intended. Children will always find other creative and dangerous ways to play on equipment.

“Who’s watching me?”

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#8 Age Appropriate Equipment and Activities

It is recommended that areas for preschool children (2-5) be separate from areas intended for school age children (5-12).

Before 1991, there were no guidelines for children under the age of 5.

Age 6 months - 23 months

Play areas for children 6 months through 23 months should offer places where children can have space to move explore. Appropriate play areas for this group should provide places to pull up, crawl, stand, and walk.

Appropriate outside equipment for this age group could include, low climbing equipment under 32 inches, low ramps, spring rockers and swings with full bucket seats.

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Age 2-5 years

Preschoolers are smaller, weaker, and less coordinated than older children.

They have a higher center of gravity which make them more likely to fall on their head.

Equipment should have smaller steps and crawl spaces.

Equipment should have smaller grips and lower handrails.

Equipment should be lower to the ground.

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Toddlers and babies should use only full-bucket swings, not half-bucket swings. Their play equipment should be in a separate area away from older children.

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What’s Appropriate for Children 2 to 5 ?Recommended

Activity panels Full bucket tot swings Lower platforms Spring rockers Sand/water tables Crawl tunnels Playhouses Slides no taller than 4 ft. See CPSC Playground

Handbook for a breakdown in age groups

Not Recommended

Free standing arch climbers. Free standing flexible climbers

Long spiral slides (over 360+) Chain and cable walks,

fulcrum seesaws Log rolls and Overhead rings Track rides Vertical sliding poles Parallel bars Swinging gates Trampolines

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What’s Appropriate for Children 5-12? They have increased upper body

strength. They are learning socializing and

problem-solving skills. Appropriate equipment includes to- fro

swings, tire swings, spiral slides, chain and net climbers, free standing arch climbers, sliding poles, merry-go-rounds, see-saws.

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#9 Lack of Maintenance

In order for all playgrounds to be safe, there has to be someone to maintain it.

There should be no missing, broken or worn out components.

All hardware should be secure.

The wood metal or plastic should not show signs of fatigue or deterioration. Check for splinters, rust or chipped paint.

All parts should be stable.

Surfacing material must be maintained.

Check for signs of vandalism.

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Daily Inspections

The playground should be inspected every time prior to children going out to play

Adequate surfacing depth Trash and broken glass Insect nests under equipment Foreign materials Vandalism Broken equipment Surface temperature of equipment Animal waste Standing water

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Monthly Inspections

Corrosion of hardware

Broken swing seats

Swing hangers and chains

Broken support anchors

Cement support footing

Sharp edges and points

Protrusions

Loose hardware

Chipped paint

Damaged wood and splinters

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#10 Pinch, Crush, Shearing, and Sharp Edge Hazards

Components on the playground should be inspected to make sure there are no sharp edges or points that can penetrate the skin.

Suspension bridges, see-saws, merry-go-rounds, etc. should be checked with rubber rods in various sizes to ensure there are no moving parts that might crush a child’s finger . Do not test equipment with your finger!

Ouch! I’m bleeding!

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#11 Platforms With No Guardrails There should be guardrails or barriers on every

elevated surface, such a platforms, ramps and bridges.

Pre-school: guardrails on any elevated platforms higher than 20” and protective barriers on platforms higher than 30”

School-age: guardrails on any elevation higher than 30”and protective barriers on platforms above 48 “

See CPSC Public Playground Safety Handbook for guardrails and barrier guidelines.

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#12 Equipment NOT Recommended for Public Playgrounds

Heavy swings, such as animal swings

Free swinging ropes that may fray or form a loop

Swinging exercise ring or trapeze bars

Metal slides or any equipment than can absorb too much heat

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When buying new equipment Look for the IPEMA seal

(International Play Equipment Manufacturers’ Assoc.)

The IPEMA seal means that this piece of equipment meets the standards of the Consumer Product Safety Commission and ASTM standards.

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Encourage your center not to buy somebody else’s problems!

Don’t buy equipment from a school or other agency that is upgrading,

Enclosures Outdoor play areas should be enclosed with

a fence (that conforms with applicable building codes) or natural barriers

Fence posts should be outside the fence Enclosure should have two exits Wood in fences should be tested for

chromated copper arsenate (CCA) Play area should be secured against

inappropriate use when facility is closed The gates should have self-closing and

positive self latching closures and the securing device out of reach of children.

Openings in the fence or gate no larger than 3-1/2 inches

Alternatives to Playground Equipment

Nature walks

Playhouses, forts Tricycle tracks Large balls Picnic tables Music and art activities

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Fun in the Sun Keep infants younger than six

months out of direct sunlight. Find shade under a tree, umbrella, or the stroller canopy;

The peak sun intensity hours, when UV light is strongest, are between 10 a.m. and 3 p.m. standard time or 11 a.m. and 4 p.m. daylight savings time

Wear a hat or cap with a brim that faces forward to shield the face;

Wear child safe shatter resistant sunglasses with at least 99% UV protection;

Teach children how to identify and find good sources of shade

Apply sunscreen often

Fun in the Shade

Accessibility and Play Opportunities for All Children

The Americans with Disabilities Act of 1990 prohibits discrimination on the basis of disability in public places.

All new and renovated public playgrounds must have access for people/ children with disabilities.

Should have proper access surfacing and stable paths and ramps for wheelchairs.

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Where to find more information

US CPSC Public Playground Safety

Handbook ask for # CPSC-325 1-800-638

2772. Order up to 50 copies free of charge

National Program for Playground Safety (NPPS) website: http://www.playgroundsafety.org/

National Program for Playground Safety

www.uni.edu/playground1-800-554-PLAY

National Program Safety Institute a Program of the National Recreation and Parks Department

Sources US Consumer Product Safety Commission Public Playground Safety

Handbook #325

National Program for Playground Safety (NPPS) website: http://www.playgroundsafety.org/

Center for Disease and Prevention (CDC) website

The Dirty Dozen National Playground Safety Institute

NTI for Child Care Health Consultants: Injury Prevention Playground Safety and Outdoor Learning Environments (training module)

Caring for our Children National Health and Safety Performance Standards 3rd edition

922 KAR 2:120. Child-child care center health and safety standards

Thanks to Cindy Wilson RN, BSN, CPSI

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