What Injuries Occur ? Head Injury

P lay for children has never been more important, particularly as we now know how vital exercise is in promoting health and preventing obesity, both in childhood and also into adult life. Play is also important in establishing social patterns of behaviour that allow children to react to their peers. Public playgrounds form a significant part of the play opportunities for children. It is not surprising therefore that those involved in children’s play have been anxious that playgrounds are as popular and provide as many challenges as possible. Going along with the drive to make public playgrounds as interesting as possible, there was also a drive to make them as safe as possible. This started with concern regarding playground injuries and deaths in the 1970s, particularly following an analysis in Sheffield led by the late Cynthia Illingworth. This movement led to the introduction of safety features such as impact absorbing surfaces (IAS), changes in equipment entrapment avoidance, height restrictions and guardrails, and changes in materials used in construction of equipment, and design. These changes led to introduction of standards in Britain, Europe (EN 1176 and 1177), and Australia. In the United States, the drive towards safety has been led by the Consumer Product Safety Commission. It is not surprising however, that the drive for more children’s play, and the drive for more safety have been seen to be in conflict and perhaps incompatible. This debate has been heightened by a recent review by Ball, for the Health and Safety Executive in the UK, suggesting that expensive safety modifications have minimal effect and are not cost effective in terms of reducing injury episodes to children. This article will attempt to answer this dilemma: what evidence is there to suggest that playground safety features work, and are they worthwhile in preventing serious injuries? We also would like to review the research agenda to improve playground safety. Much of the literature on injuries to children in playgrounds has included minor injuries such as abrasions and lacerations; however, the main injuries of concern are limb fracture and head injury. We will pay particular consideration to them.