Injuries from falls on playgrounds. Effects of day care center regulation and enforcement.

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.