Skip to main content
SpringerLink
Log in

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

  • Systematic Review
  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

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.

Résumé

Objectifs

Les principaux objectifs de l’étude consistaient : 1) à dresser la liste des facteurs de risque et/ou de protection associés aux blessures sur les terrains de jeux chez les enfants de moins de 18 ans et 2) à dresser la liste des interventions, des programmes ou des politiques visant à prévenir les blessures sur les terrains de jeux chez les enfants de moins de 18 ans. Le résumé des données en phase avec les normes en vigueur pour les terrains de jeux était un objectif secondaire.

Méthode

Pour les objectifs principaux, nous avons systématiquement interrogé 4 bases de données et 12 ressources en ligne pour repérer les études observationnelles et expérimentales portant sur les facteurs de risque et/ou de protection associés aux blessures sur les terrains de jeux (p. ex., les comportements dangereux sur les terrains de jeux), sur les interventions ou sur les résultats des blessures sur les terrains de jeux. Nous avons extrait les données sur le protocole d’étude, les participants, le résultat, l’exposition ou l’intervention, l’analyse de données et les estimations des effets. La qualité des données probantes de chaque étude a été évaluée selon les critères de Downs et Black.

Résultats

Les études de cette revue étaient de qualité moyenne; elles ont mis au jour des facteurs de risque de blessures sur les terrains de jeux et des interventions efficaces. Les facteurs de risque étaient l’absence de mains courantes et de garde-corps sur les équipements de jeu, les surfaces n’absorbant pas les impacts, ainsi que les hauteurs de chute critiques. Les interventions efficaces consistaient à modifier la surface des terrains de jeux et de réduire la hauteur des équipements à moins de 1,5 m.

Conclusion

Les terrains de jeux qui comportent des équipements et des structures devraient être conformes aux normes pour les terrains de jeux afin de réduire les risques de blessures graves. Les organismes chargés de l’installation et de l’entretien des terrains de jeux devraient envisager des aires de jeu différentes qui permettent aux enfants de jouer à l’extérieur, dans un milieu naturel propice à leur développement sain et à l’activité physique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2011). Caring for our children: national health and safety performance standards; guidelines for early care and education programs, 3rd edn. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association.

  • (CDC), Centers for Disease Control and Prevention. (1999). Playground safety—United States, 1998-1999. MMWR Recomm Rep, 48(16), 329–332.

    Google Scholar 

  • Acik, Y., Gulbayrak, C., & Turaci, C. G. (2004). Investigation of the level of safety and appropriateness of playgrounds in Elazig city in Turkey. Int J Environ Health Res, 14(1), 75–82.

    Article  PubMed  Google Scholar 

  • Allen, E. M., Hill, A. L., Tranter, E., & Sheehan, K. M. (2013). Playground safety and quality in Chicago. Pediatrics, 131(2), 233–241.

    Article  PubMed  Google Scholar 

  • Brussoni, M., Gibbons, R., Gray, C., et al. (2015). What is the relationship between risky outdoor play and health in children? A systematic review. Int J Environ Res Public Health, 12(6), 6423–6454.

    Article  PubMed  PubMed Central  Google Scholar 

  • Canadian Standards Association (2015). CAN/CSA-Z614-14. Children’s playspaces and equipment.

  • Chalmers, D. J., Marshall, S. W., Langley, J. D., et al. (1996). Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study. Inj Prev, 2(2), 98–104.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chalmers, D. J., Parry, M. L., Crawford, A. I., & Wright, C. S. (2001). Compliance of Dunedin school playground equipment with the New Zealand playground standard. Aust N Z J Public Health, 25(3), 253–255.

    Article  CAS  PubMed  Google Scholar 

  • Chelvakumar, G., Sheehan, K., Hill, A. L., Lowe, D., Mandich, N., & Schwebel, D. C. (2010). The stamp-in-safety programme, an intervention to promote better supervision of children on childcare centre playgrounds: an evaluation in an urban setting. Inj Prev, 16(5), 352–354.

    Article  PubMed  Google Scholar 

  • Cradock, A., O'Donnell, E., Benjamin, S. E., Walker, E., & Slining, M. (2010). A review of state regulations to promote physical activity and safety on playgrounds in child care centers and family child care homes. J Phys Act Health, 7(Suppl 1), S108–S119.

    Article  PubMed  Google Scholar 

  • Downs, S. H., & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health, 52(6), 377–384.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fiissel, D., Pattison, G., & Howard, A. (2005). Severity of playground fractures: play equipment versus standing height falls. Inj Prev, 11(6), 337–339.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fisher, L., Harris, V. G., VanBuren, J., Quinn, J., & DeMaio, A. (1980). Assessment of a pilot child playground injury prevention project in New York State. Am J Public Health, 70(9), 1000–1002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fuselli, P., & Yanchar, N. L. (2012). Preventing playground injuries. Paediatr Child Health, 17(6), 328.

    Article  PubMed  PubMed Central  Google Scholar 

  • Heck, A., Collins, J., & Peterson, L. (2001). Decreasing children’s risk taking on the playground. J Appl Behav Anal, 34(3), 349–352.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Herrington, S., & Nicholls, J. (2007). Outdoor play spaces in Canada: the safety dance of standards as policy. Critical Social Policy, 27(1), 128–138.

    Article  Google Scholar 

  • Howard, A. W., MacArthur, C., Willan, A., Rothman, L., Moses-McKeag, A., & MacPherson, A. K. (2005). The effect of safer play equipment on playground injury rates among school children. CMAJ, 172(11), 1443–1446.

    Article  PubMed  PubMed Central  Google Scholar 

  • Howard, A. W., Macarthur, C., Rothman, L., Willan, A., & Macpherson, A. K. (2009). School playground surfacing and arm fractures in children: a cluster randomized trial comparing sand to wood chip surfaces. PLoS Med, 6(12), e1000195–e1000195.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hudson, S. D., Olsen, H. M., & Thompson, D. (2008). An investigation of school playground safety practices as reported by school nurses. J Sch Nurs, 24(3), 138–144.

    Article  PubMed  Google Scholar 

  • Keays, G., & Skinner, R. (2012). Playground equipment injuries at home versus those in public settings: differences in severity. Inj Prev, 18(2), 138–141.

    Article  PubMed  Google Scholar 

  • Kotch, J. B., Hussey, J. M., & Carter, A. (2003). Evaluation of North Carolina child care safety regulations. Inj Prev, 9(3), 220–225.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Laforest, S., Robitaille, Y., Dorval, D., Lesage, D., & Pless, B. (2000). Severity of fall injuries on sand or grass in playgrounds. J Epidemiol Community Health, 54(6), 475–477.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Laforest, S., Robitaille, Y., Lesage, D., & Dorval, D. (2001). Surface characteristics, equipment height, and the occurrence and severity of playground injuries. Inj Prev, 7(1), 35–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Macarthur, C., Hu, X., Wesson, D. E., & Parkin, P. C. (2000). Risk factors for severe injuries associated with falls from playground equipment. Accid Anal Prev, 32(3), 377–382.

    Article  CAS  PubMed  Google Scholar 

  • MacKay, M. (2003). Playground injuries. Inj Prev, 9, 194.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Macpherson, A. K., Jones, J., Rothman, L., Macarthur, C., & Howard, A. W. (2010). Safety standards and socioeconomic disparities in school playground injuries: a retrospective cohort study. BMC Public Health, 10, 542–542.

    Article  PubMed  PubMed Central  Google Scholar 

  • Martin, J., & Cooper, C. D. (2005). Playground safety in south western Sydney. J Paediatr Child Health, 41(11), 587–591.

    Article  CAS  PubMed  Google Scholar 

  • Morrongiello, B. A., & House, K. (2004). Measuring parent attributes and supervision behaviors relevant to child injury risk: examining the usefulness of questionnaire measures. Inj Prev, 10(2), 114–118.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morrongiello, B. A., & Kane, A. (2015). An evaluation of the Cool 2 Be Safe program: an evidence-based community-disseminated program to positively impact children's beliefs about injury risk on playgrounds. Prev Sci, 16(1), 61–69.

    Article  PubMed  Google Scholar 

  • Morrongiello, B. A., & Mark, L. (2008). “Practice what you preach”: induced hypocrisy as an intervention strategy to reduce children’s intentions to risk take on playgrounds. J Pediatr Psychol, 33(10), 1117–1128.

    Article  PubMed  Google Scholar 

  • Morrongiello, B. A., & Matheis, S. (2007). Addressing the issue of falls off playground equipment: an empirically-based intervention to reduce fall-risk behaviors on playgrounds. J Pediatr Psychol, 32(7), 819–830.

    Article  PubMed  Google Scholar 

  • Mott, A., Evans, R., Rolfe, K., Potter, D., Kemp, K. W., & Sibert, J. R. (1994). Patterns of injuries to children on public playgrounds. Arch Dis Child, 71(4), 328–330.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mott, A., Rolfe, K., James, R., et al. (1997). Safety of surfaces and equipment for children in playgrounds. Lancet (London, England), 349(9069), 1874–1876.

    Article  CAS  Google Scholar 

  • Mowat, D. L., Wang, F., Pickett, W., & Brison, R. J. (1998). A case-control study of risk factors for playground injuries among children in Kingston and area. Inj Prev, 4(1), 39–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Norton, C., Nixon, J., & Sibert, J. (2004). Playground injuries to children. Arch Dis Child, 89, 103–108.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Olsen, H., Hudson, S., & Thompson, D. (2010). Strategies for playground injury prevention: an overview of a playground project. Am J Health Educ, 41, 187–192.

    Article  Google Scholar 

  • Park, M. J., Baldwin, K., Weiss-Laxer, N., et al. (2010). Composite playground safety measure to correlate the rate of supracondylar humerus fractures with safety: an ecologic study. J Pediatr Orthop, 30(2), 101–105.

    Article  PubMed  Google Scholar 

  • Petridou, E., Sibert, J., Dedoukou, X., Skalkidis, I., & Trichopoulos, D. (2002). Injuries in public and private playgrounds: the relative contribution of structural, equipment and human factors. Acta Paediatr, 91(6), 691–697.

    Article  CAS  PubMed  Google Scholar 

  • Pickett, W., Carr, P. A., Mowat, D. L., & Chui, A. (1996). Playground equipment hazards and associated injuries in Kingston and area. Can J Public Health, 87(4), 237–239.

    CAS  PubMed  Google Scholar 

  • Roseveare, C. A., Brown, J. M., Barclay McIntosh, J., & Chalmers, D. J. (1999). An intervention to reduce playground equipment hazards. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 5(2), 124–128.

    Article  CAS  Google Scholar 

  • Sacks, J. J., Holt, K. W., Holmgreen, P., Colwell Jr., L. S., & Brown Jr., J. M. (1990). Playground hazards in Atlanta child care centers. Am J Public Health, 80(8), 986–988.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sacks, J. J., Brantley, M. D., Holmgreen, P., & Rochat, R. W. (1992). Evaluation of an intervention to reduce playground hazards in Atlanta child-care centers. Am J Public Health, 82(3), 429–431.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schwebel, D. C., Summerlin, A. L., Bounds, M. L., & Morrongiello, B. A. (2006). The stamp-in-safety program: a behavioral intervention to reduce behaviors that can lead to unintentional playground injury in a preschool setting. J Pediatr Psychol, 31(2), 152–162.

    Article  PubMed  Google Scholar 

  • Sherker, S., & Ozanne-Smith, J. (2004). Are current playground safety standards adequate for preventing arm fractures? Med J Aust, 180(11), 562–565.

    PubMed  Google Scholar 

  • Sherker, S., Ozanne-Smith, J., Rechnitzer, G., & Grzebieta, R. (2005). Out on a limb: risk factors for arm fracture in playground equipment falls. Inj Prev, 11(2), 120–124.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sherker, S., Ritchie, J., Eager, D., & Dennis, R. (2009). Soft landings: encouraging compliance with safety standards in local government authority playgrounds. Health Promot J Austr, 20(1), 31–36.

    Article  PubMed  Google Scholar 

  • Tremblay, M. S., Gray, C., Babcock, S., et al. (2015). Position statement on active outdoor play. Int J Environ Res Public Health, 12(6), 6475–6505.

    Article  PubMed  PubMed Central  Google Scholar 

  • U.S. Consumer Product Safety Commission. (2010). Public playground safety handbook.

  • Uskun, E., Kisioglu, A. N., Altay, T., Cikinlar, R., & Kocakaya, A. (2008). Assessment of the current status of playground safety in the Midwestern region of Turkey: an effort to provide a safe environment for children. Turk J Pediatr, 50(6), 559–565.

    PubMed  Google Scholar 

  • Vollman, D., Witsaman, R., Comstock, R. D., & Smith, G. A. (2009). Epidemiology of playground equipment-related injuries to children in the United States, 1996-2005. Clin Pediatr (Phila), 48(1), 66–71.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Health, Kinesiology and Health Science, York University, 339 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada

    Sarah A. Richmond, Tessa Clemens & Alison Macpherson

  2. BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, BC, Canada

    Ian Pike

Authors
  1. Sarah A. Richmond
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tessa Clemens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian Pike
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alison Macpherson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah A. Richmond.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Richmond, S.A., Clemens, T., Pike, I. et al. A systematic review of the risk factors and interventions for the prevention of playground injuries. Can J Public Health 109, 134–149 (2018). https://doi.org/10.17269/s41997-018-0035-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.17269/s41997-018-0035-8

Keywords

Mots-clés

Search

Navigation