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Special Study: Injuries and Deaths Involving Children Under Age 2 Associated with Playground Equipment  

Special Study: Injuries and Deaths Involving Children Under 
Age 2 Associated with Playground Equipment

Joyce McDonald 
Michael Greene 
Directorate for Epidemiology 
U.S. Consumer Product Safety Commission

Washington, D.C. 20207

 

2

Executive Summary

This special study was conducted by the U.S. Consumer Product Safety 
Commission’s Directorate for Epidemiology staff to address an inquiry from ASTM 
International on playground equipment-related injury and death scenarios involving 
children under the age of 2. The injury data is based on a study of playground-related 
injuries treated in U.S. hospital emergency rooms from October 2000 to September 2001. 
Playground-related fatalities reported to CPSC from January 1990 to August 2002 were 
also reviewed.

During the special study period, there were an estimated 8,250 children (95 percent 
confidence interval: 6,390-10,110) under the age of 2 treated in U.S. hospital 
emergency rooms for injuries associated with playground equipment.

Ninety-five percent of the injured were 12-23 months of age. Five percent of the 
injured were 11 months or younger. The youngest child in the sample was 3 months 
and the oldest was 23 months.

Lacerations, contusions and abrasions were the most commonly reported injuries (52 
percent). Seventy-eight percent of those relatively minor injuries were to the head or 
facial region. Fractures, sprains and strains were the second most often reported 
injuries, accounting for 30 percent of the total.

The head and facial region of the body was involved in 53 percent of all the injuries. 
The types of injuries incurred were mainly contusions, abrasions and lacerations. 
Nineteen percent of the head/facial injuries were of a more severe nature such as 
fractures, concussions or internal injuries. The leg/foot was the second most often 
reported region of the body injured with 34 percent of the injuries. Sixty-five percent 
of the leg/foot injuries were fractures, sprains or strains.

Forty-one percent (3,390) of the estimated injuries involved public playground 
equipment and 33 percent (2,730) involved home use equipment. Additionally, 26 
percent (2,120) of the injuries involved equipment that was not specified as either 
public or home playground equipment. None of the estimated injuries specified that 
homemade equipment was involved.

Sixty percent of the injuries that were related to public playground equipment 
occurred in a public park. Sixty-three percent of those injuries were related to slides.

Three percent of the injuries that occurred with home use equipment were in the yard 
of a residential daycare facility. Of the injuries that occurred with home equipment, 
38 percent involved slides.

The most common injury scenario was a fall, accounting for 50 percent of the total 
injuries. The lowest height from which a child fell in the study sample group was 1 
inch and the maximum height was 10 feet.

 

3

The second most common injury scenario was impact (colliding with or being struck 
by playground equipment) with 22 percent of the injuries.

The third most common injury scenario involved children getting a leg or foot twisted 
while going down a slide. The resulting injuries were often fractures or sprains. This 
scenario resulted in 1,090 or 13 percent of the estimated injuries.

Entrapments were involved in 270 estimated injuries and pinching was involved in 20 
estimated injuries. None of the entrapments were head or neck-related.

Protective surfacing on playgrounds is recommended for reducing the risk of serious 
head injuries. In this study the most common type of protective surfacing was wood 
chips, associated with 12 percent of the injuries. The most prevalent surfacing overall 
was grass (a non-protective surface), which was associated with 17 percent of the 
injuries.

From January 1990 to August 2002, CPSC received 6 reports of children under 2 
dying in an incident involving playground equipment. The latest death of a child 
under the age of 2 that was reported to CPSC occurred in April of 1995.

Safety efforts involving the under-2 population of playground equipment users should 
take into account the nature of the incidents in which these children are involved. 
Overall, slides were responsible for about half the playground equipment-related 
injuries to children under 2, regardless of hazard pattern.

 

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TABLE OF CONTENTS

PAGE

EXECUTIVE SUMMARY

I. BACKGROUND 5

II. METHODOLOGY 7

Injuries 7

Deaths 7

III. DATA ANALYSIS 8

A. GENERAL DISCUSSION OF INJURY DATA 8

Hazard Scenarios 
Slide-Related Leg Injuries 
Human Factors Analysis

Other Topics of Interest 
Falls 
Portable Playground Equipment 
Indoor Versus Outdoor Location

Witness to Injury Incident and Caregiver Identification 
General Information About the Equipment 
Surfacing 
Other Factors 
B. PUBLIC EQUIPMENT- RELATED INJURIES 19

Specific Location and the Type of Equipment 
Hazard Pattern by Type of Equipment 
Falls 
Twisted Leg/Foot with Slides

Impact-Related Injuries  
Entrapment or Pinching-Related Injuries 
C. HOME EQUIPMENT-RELATED INJURIES 22

Specific Location and the Type of Equipment 
Hazard Pattern by the Type of Equipment 
Falls 
Impact-Related Injuries

Entrapment-Related Injuries 
Twisted Leg/Foot with Slides

D. DEATHS 24

IV. CONCLUSIONS AND RECOMMENDATIONS 25

APPENDICES 27

 

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I. BACKGROUND

Each year, over 200,000 people are treated in U.S. hospital emergency  
rooms for playground equipment-related injuries. A majority of these injuries involve 
children under age 15. The youngest victims of playground equipment-related injuries 
are under 2 years old. Over a recent five-year period (1997 to 2001) an estimated 
average of 9,920 children under 2 years old were treated annually in hospital emergency 
rooms for injuries associated with playground equipment. A previous analysis

1 of fatality

data by CPSC staff showed that reports of deaths in this age group involving playground 
equipment are rare.

The impetus for this special study was a request from an ASTM International 
2

subcommittee that is currently working on a safety standard for public playground 
equipment for children under 2 (ASTM 15.44). The subcommittee asked CPSC to 
determine the heights from which children under 2 fall from playground equipment. 
There was a particular interest in the types of injuries incurred from heights of less than 
12 inches and whether serious injuries can occur from falls from those heights.

CPSC staff concluded that a special study was the best way to obtain information 
on fall heights since specific questions could be posed during a telephone interview with 
regard to the cases in the survey sample. Additionally, staff considered it worthwhile to 
expand the scope of the study to all playground-related injury scenarios involving 
children under 2 for comparison purposes.

There are a number of issues with the under-2 age group related to playground 
equipment that are currently of concern. Fall height under 12 inches is one issue and 
more specifically, how it relates to injury severity. Many questions have arisen regarding 
the equipment itself versus its location and the type of surfacing in place. This is of 
particular interest for portable equipment. There is also an additional issue as to what 
hazards exist with equipment installed indoors versus outdoor equipment.

This study is not limited to public playground equipment. Staff also analyzed 
data associated with injuries and deaths with home use equipment to present the broader 
scope of playground-related incidents involving children under 2. It should be noted that 
portable equipment is found in both home and public locations.  The following describes 
most of the general categories of playground equipment in use today:

Public Playground Equipment is usually located in schoolyards, public parks, amusement 
parks, commercial/institutional day care, apartment complexes and other public recreation 
areas. Increasingly, at these locations multi-use structures are becoming the norm. ASTM 
F1487 is the voluntary standard for public equipment.

Preschool or Toddler Playground Equipment is generally public equipment that is 
intended for children 2 to 5 years of age. It is usually located at commercial/institutional day 
                                                         

1 That analysis was Special Study: Injuries and Deaths Associated with Children’s Playground Equipment from April

of 2001. The 2001 study was a NEISS-based study, providing information on injuries and deaths to children 0-14 years 
of age that involved playground equipment.
 
2
ASTM International, formerly known as the American Society for Testing and Materials, provides standards used in

research, development, product testing, quality systems and commercial transactions worldwide.

 

6

care facilities, preschools or at public playgrounds in areas separated from standard size 
equipment. This equipment can also include multi-use structures. ASTM F1487 is the 
voluntary standard for public equipment encompassing users as young as a 5
 
th
percentile 2

year old.

Home Playground Equipment is usually found outdoors at private residences. This 
category would also include the equipment installed at residential daycare. Usually, this 
equipment is of lighter construction than public equipment, but once again, heavier multi-use 
structures are being seen in home settings. ASTM F1148 is the voluntary standard for this 
type of equipment.

Portable Playground Equipment is unique in that by its very nature it can be used indoors 
or outdoors. It is generally constructed of lighter weight molded plastic and the most likely 
users are children from just under 1 year of age to age 3. Portables are seen not only at 
private residences, but also at commercial and residential day care facilities and preschools. 
Currently, there are no voluntary or mandatory standards that specifically address this type of 
equipment.

Soft-Contained Playground Equipment is generally located in fast food restaurants, “payfor-play” facilities, shopping malls and amusement parks. Typical construction uses plastic 
crawl tubes and slides, climbing nets, ball pits and other padded climbing apparatus. Usually, 
the entire structure is surrounded by netting to minimize falls. ASTM F1918 is the voluntary 
standard for this type of equipment.

.

 

7

II. METHODOLOGY

Injuries

The injury incidents included in this special study were collected through the 
National Electronic Injury Surveillance System (NEISS). NEISS is a statistically 
selected sample of about 100 hospital emergency rooms throughout the United States that 
report product-related injuries to CPSC.  These hospitals are stratified by size and type 
(such as large, small, children’s, etc.) and are assigned statistical weights that CPSC uses 
to create national estimates of product-related injuries.

  From October 1, 2000 through September 30, 2001 every playground equipmentrelated injury reported through NEISS that involved a child under 2 was assigned for a 
telephone investigation to obtain additional information about the circumstances, injury 
and equipment involved. The telephone investigations were conducted by persons under 
contract to CPSC, using a questionnaire developed by CPSC staff. Open-ended and 
multiple choice questions were posed to the respondent to determine the details 
surrounding the hazard scenario that resulted in the injury. 

A total of 374 investigations 
3
were assigned for this study, of which 306 cases

were in scope. 
4
Those 306 cases are the basis of this study. Generally, a case was

considered to be out-of-scope if the victim’s age was more than 23 months or the incident 
was not playground equipment-related.

Deaths

CPSC obtains reports of fatalities from a number of sources, including death 
certificates, medical examiner and coroner reports, correspondence from the public, 
newspaper clippings and emergency room records. These reports are often assigned by 
CPSC staff for investigation to obtain additional details about the hazard scenario and the 
product(s) involved.

A search was conducted of the In-depth Investigation file (INDP), the Injury and 
Potential Injury Incident file (IPII), the Death Certificate file (DTHS) and the National 
Electronic Injury Surveillance System (NEISS) for playground-related deaths involving 
children under 2 reported to CPSC from January 1, 1990 to August 15, 2002. The 
resulting data were reviewed for inclusion in this study.

   

  
                                                         

3   There were 269 telephone investigations completed by the contractor (of which 219 were in scope). The completed

cases represent a response rate of 72% for this study.  
4
  Included among the in-scope cases were cases where no contact was made or the respondent refused to participate.

However, if there was information in the original case narrative and coding submitted by the NEISS hospital, 
describing the scenario, injury, etc., staff used the information in the study.

 

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III. DATA ANALYSIS

A. General Discussion of Injury Data 
5

During the study period, there were an estimated 8,250 
6
injuries treated in U.S.

hospital emergency rooms associated with playground equipment involving children 
under age 2. Ninety-eight percent of the injured victims were treated and released from 
the hospital. One percent of the injured were hospitalized, about 0.2 percent left the 
emergency room without seeing a physician and about 0.9 percent were treated and 
transferred to another hospital.

The victims in this special study were children under 24 months of age. Ninetyfive percent of the estimated total injuries treated in hospital emergency rooms were to 
children 12 to 23 months old, and five percent were to children 11 months old or 
younger. The age range of victims in the study sample was 3 to 23 months. Fifty-eight 
percent of the injured victims were male.

Table 1 gives a breakdown of the estimated injuries by type of equipment (public, 
home, homemade or unknown).
 
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Table 1: Estimates of Emergency Room Treated Injuries Involving Children Under Age 2 by Type of 
Playground Equipment

Equipment Type Percentage of 
Injuries Based on 
Estimate

Estimated Injuries

Total 100% 8,250

Public Equipment 41% 3,390

Home Equipment 33% 2,730

Homemade ---

8 0

Unknown 26% 2,120

      Source: National Electronic Injury Surveillance System (NEISS), Special Study 
10/1/00- 9/30/01 
      Estimates may not add to the totals due to rounding.

In 26 percent of the injuries it was unknown whether the equipment involved was 
public or home use equipment, even if the location was specified. Hence, the estimates 
for public and home equipment are minimum numbers.

                                                         

5 In this report, injury estimates derived from NEISS are rounded to the nearest 10 injuries, but percentages are based

on unrounded estimates. 
6
The coefficient of variation for this estimate is 11.5 percent. There is a 95% confidence interval associated with the

estimate (6,390-10,110). 
7
A number of different analyses are presented in this report for different variables of interest (such as type of

equipment or location of the incident). Some of the estimates are based on small sample sizes with relatively large 
amounts of associated variability. Interpretation of these estimates should be made with caution.
 
8
There were no injuries involving homemade equipment that fell within the scope of the study.

 

9

This study showed that 25 percent of the injuries happened in public parks 
followed by 24 percent of the injuries in the yard of a home. Table 2 shows a breakdown 
of the injuries by age of the victim and the specific location of the incident.

Table 2: Estimates of Playground Equipment-Related Injuries Involving Children Under 
Age 2 for Age of Victim by Location of Accident

Location of the Incident

Age of 
Victim Total
Public

Park

Yard of 
Home

Apt. 
Complex

Day Care Fast Food 
Rest. 
Other
 
9
Unknown

Total 8,250 2,040 1,950 280 620 200 1,150 2000

12-23 
months 7,860 2,000 1,870 280 620 70 1,080 1,940

0-11 
months 390 40 70 0 0 140 70 70

  Source: National Electronic Injury Surveillance System (NEISS), 10/1/00 through 9/30/01, Special Study 
Estimates may not add to the totals due to rounding.

 Table 3 (on the following page) provides estimates of playground equipmentrelated injury diagnoses for the under-2 age group by the region of the body that was 
injured.

Overall, injuries to the head and facial region were most common (53 percent or 
4,400 of the total injuries).  Seventy-five percent of the total head and facial region 
injuries were lacerations, contusions and abrasions.  Nineteen percent of the head/face 
injuries were of a potentially more serious nature (fracture, concussion, or internal 
injury

10).

Leg/foot region injuries were the second most common injury incurred by 
children under 2 with 34 percent of the total injuries (2,800). Fractures, sprains and 
strains accounted for over half (65 percent) of the total leg and foot region injuries. 
Contusions and abrasions were associated with 19 percent of these leg/foot region 
injuries.

Injuries to the arm and hand were the third most common with 9 percent of the 
total injuries. Eighty-five percent of those arm/hand injuries were of a more serious 
nature with the child suffering a dislocation, fracture or sprain/strain. Almost half of the 
arm/hand injuries were fractures (48 percent).

                                                         

9 The Other category for this table includes the following locations: schoolyards, commercial settings not otherwise

specified, and various other locations. 
10
The diagnosis of internal head injury is sometimes given for an injury as minor as a bump to the head, but this

diagnosis can represent a severe injury.

 

10

Table 3: Estimates of Playground Equipment-Related Injuries Involving Children Under 
Age 2 
Diagnosis by Body Part

Area of the Body Injured

Diagnosis

Total

Head & 
Face

Leg & 
Foot

Arm & 
Hand

Other 

Unk
 
11

Total 8,250 4,400 2,800 710 350

Laceration 2,330 2,230 80 20 0

Contus/Abras 1,930 1,090 530 70 240

Fracture 1,360 90 890 340 40

Strain/Sprain 1,090 0 940 140 10

Internal Injury 510 510 0 0 0

Concussion 230 230 0 0 0

Dislocation 190 0 70 120 10

Other or Unk 
12

620 250 300 10 60

Source: National Electronic Injury Surveillance System (NEISS), 10/1/009/30/01 Special Study 
Estimates may not add to the totals due to rounding.

Table 4 (on the following page) presents estimates for injury diagnosis by region 
of the body injured for children 0-11 months and 12-23 months to determine if there were 
any differences in the types of injuries incurred between the two age groups. Children 
12-23 months were involved in an estimated 95 percent (7,860) of the total playground 
equipment-related injuries to children under age 2. However, it is important to note that, 
the older age group is more mobile with more developed motor skills and probably is 
exposed to playground equipment more frequently than the younger group. Also, the 
estimates for the younger children are highly variable due to a small sample size.

                                                         

11 The Other and Unknown category for the area of the body that was injured includes: neck, shoulder, upper trunk,

lower trunk, pubic region, 25%-50% of the body suffering the injury, all parts of the body suffering the injury, and 
unspecified part of the body.
 
12
The category of Other and Unknown for diagnosis includes those diagnoses that are not commonly associated with

or occur infrequently with playground injuries, such as, anoxia, aspirated foreign object, burns of all types, electric 
shock, poisoning, nerve damage, submersion, crushing, puncture, etc.

 

11

Table 4: Estimates of Playground Equipment-Related Injuries Involving Children 
Under Age 2 
Diagnosis and Body Part by Age

Age of the Victim

0-11 Months

Area of the Body Injured

12-23 Months 
Area of the Body Injured

Diagnosis Total Head

& Face

Leg & 
Foot

Arm & 
Hand

Other Total Head

& Face

Leg & 
Foot

Arm & 
Hand

Other

Total 390 140 260 0 0 7,860 4,260 2,540 710 350

Laceration 10 10 0 0 0 2,310 2,210 80 20 0

Contus/Abras 140 70 70 0 0 1,790 1,020 460 70 240

Fracture 150 0 150 0 0 1,210 90 740 340 40

Strain/Sprain 20 0 20 0 0 1,080 0 920 140 10

Internal Injury 40 40 0 0 0 470 470 0 0 0

Concussion 0 0 0 0 0 230 230 0 0 0

Dislocation 0 0 0 0 0 190 0 70 120 10

Other or Unk 40 10 30 0 0 580 240 270 10 60

Source: National Electronic Injury Surveillance System (NEISS), Special Study, 10/1/00 through 9/30/01  
Estimates may not add to the totals due to rounding.

Hazard Scenarios

Falls, impact, twisted leg/foot injuries with slides, entrapments or getting pinched 
by equipment can occur with public or home equipment, depending on the specific type 
of equipment. Table 5 (on the following page) presents the hazard scenarios by the 
general type of equipment (public, home or unknown) involved in the injuries.

 

12

Table 5: Estimates of Playground Related Injuries to Children Under Age 2 
Hazard Scenario by General Type of Equipment
 
13

General Type of Equipment

Hazard Scenario

Total Public Home Unknown

Total 8,250 3,390 2,730 2,120

Falls 4,090 1500 1,450 1,140

Hit or Struck by Equipment 1,830 510 780 540

Twisted Leg/Foot Injuries 
with Slides

1,090 910 70 110

Entrapment 270 20 210 40

Pinched or Caught by 
Equipment

20 20 0 10

Other Hazards 290 90 200 10

Unknown 660 350 20 290

Source: National Injury Surveillance System (NEISS), Special Study, 10/1/2000- 9/30/2001 
Estimates may not add to the totals due to rounding.

The most common hazard pattern was falls, associated with 50 percent of the 
injuries. The occurrence of fall-related injuries was almost equal between public and 
home equipment. The second most common hazard pattern related to the injuries (22 
percent) was incidents where the child collided with the equipment or was struck by it 
(impact).

The third most common hazard pattern related to 13 percent of the injuries 
involved leg/foot injuries where children slid down a slide and got their leg twisted. The 
specific mechanisms of these particular injuries are discussed in the next section titled 
Slide-Related Leg Injuries.
 

Entrapments accounted for 3 percent of the injuries and most occurred with home 
equipment. The entrapments that occurred with these children involved legs and feet. 
There were no head or neck entrapments. Injuries where the child got a finger (or other 
body part) pinched in the equipment were rare. Three percent of the injuries were related 
to various other hazard patterns. In 8 percent of the estimated injuries there was not 
enough information to determine the specific hazard pattern involved.

                                                         

13 Table 5 does not present numbers for homemade equipment, because there were no in-scope injury cases in the

study sample that occurred with homemade playground equipment.

 

13

Table 6 presents an overview of the injuries for the specific types of equipment by 
the hazard pattern involved regardless of the general type of equipment (public, home or 
unknown).

Table 6: Estimates of Playground-Related Injuries Involving Children Under Age 2 
by Specific Type of Equipment and Hazard Pattern

Hazard Pattern Specific Type of 
Equipment
 
Total Fall Hit or

Struck

Twisted 
Leg/Foot 
with 
Slides

Entrap Pinch Other Unk

Total 8,250 4,090 1,830 1,090 270 20 290 660

Slides 4,160 2,140 340 990 120 0 80 490

Swings 1,970 760 1,040 0 70 0 100 10

Climbers 390 380 0 0 10 0 10 0

Play Gyms 240 170 70 0 0 0 0 0

Sandboxes 180 0 70 0 0 0 100 0

Gliders 160 0 160 0 0 10 0 0

Tubes or Tunnels 140 0 0 0 70 0 0 70

Tube Slides 110 0 0 100 0 0 0 10

See Saws/Teeter Totters 100 70 20 0 0 0 0 0

Merry-Go-Rounds 80 70 0 0 0 20 0 0

Swing Set Structures 10 10 0 0 0 0 0 0

Ball Pits 10 0 0 0 0 0 0 10

Other 390 320 70 0 0 0 0 0

Unknown 320 170 70 0 0 0 0 80

Source: National Electronic Injury Surveillance System (NEISS), Special Study, 10/1/00–9/30/01 
Estimates may not add to the totals due to rounding.

Overall, slides were associated with more injuries than any other type of 
equipment (52 percent of the injuries, including tube slides). Falls accounted for the 
greatest number of injuries (50 percent) associated with slides. Twenty-four percent of 
the injuries involved swings. The most common injury (53 percent) that occurred with a 
swing was colliding with or being struck by a swing (82 percent or about 850 of these 
injuries occurred when the swing struck the child).

In the sections of this document titled Public Equipment-Related Injuries and 
Home Equipment-Related Injuries
there is more information on the hazard patterns 
associated with specific equipment.

Slide-Related Leg Injuries

Of the total estimated slide-related injuries (4,270), 52 percent (2,230) resulted in 
an injury to the leg or foot. There were several scenarios that appeared in the data 
involving a child’s foot or leg becoming twisted on a slide. One hazard scenario involved 
a child’s shoe (often a sneaker) contacting the slide’s surface or sidewall, causing the 
child’s foot to become “stuck” or “caught’ on the surface or sidewall. The child’s

 

14

leg/foot often became bent in the process. Resulting injuries in the study’s sample cases 
were primarily fractures and sprains.

There was another scenario related to the previous one, where a child went down 
a slide with an older person and the child’s leg/foot ended up under that person or was 
trapped between that person and the side of the slide. Theoretically, this may also be the 
result of the child’s shoe contacting the slide’s surface (deck) or sidewall, causing a 
braking action in the child’s forward motion.

The slide injury scenarios described above resulted in an estimated 1,090 injuries 
with public, home or unknown type of equipment, which was 26 percent of the total 
slide-related leg/foot injuries
 
14
and 13 percent of all playground equipment-related

injuries suffered by children under 2. An analysis was done by Human Factors staff to 
determine how and why these types of incidents are occurring with this particular age 
group (Appendix B).

Human Factors Analysis

In a memorandum titled Children’s Leg Injuries on Slides, Human Factors staff 
presents a behavioral analysis of the general injury mechanism associated with the slide 
injuries that involve the twisting of legs or feet.  Human Factors staff notes that although 
it would seem that a ride down a slide takes no skill, it requires balance, a slight 
backwards lean of the child’s torso, anticipation of momentum, stiffened legs to lift the 
heel off the slide deck and advance preparation for the dismount.

Many of the slide incident reports in this study described shoes (and, in at least 
one instance, bare feet) grabbing or catching on the slide surface, twisting the leg 
backwards. These incidents appear to occur, because rubber soled shoes (sneakers, for 
instance) and even bare skin can grip a slide surface (the deck or sidewall of the slide’s 
chute) and because smaller feet can contact the sidewall of the slide with the full width of 
the foot. A larger foot would be more likely to hit the rim of the sidewall and glance over 
it instead of grabbing securely like a smaller foot. In addition, a small child’s shorter legs 
are given ample room by most slides to freely bend backwards.

15

Younger children who don’t have much experience sliding and may not anticipate 
the downward plunge that occurs once they are on the slide. Older children who have 
experience on a slide will use the skills necessary to successfully slide down. In addition, 
if a child is on another person’s lap they may be more relaxed and let their legs drag 
loosely. The downward momentum, when on a larger person’s lap, is enough to twist a 
child’s leg into a potentially injurious position.

                                                         

14 Two of these incidents were hip injuries, but they are included here, because the mechanism involved was virtually

the same, involving the leg or foot. In one incident the child was on his father’s lap and his sneaker “caught” on the 
slide, dislocating the child’s hip joint. In the other incident the child was pushed down the slide by his cousin and got 
his leg bent behind him, causing a slight hip fracture.
 
15
The voluntary standard for public playground equipment has a requirement that the deck of the slide (slidebed

surface) be at least 12 inches wide when intended for use by 2-5 year olds and at least 16 inches wide when intended 
for 5-12 year olds.

 

15

Other Topics of Interest

The following discussion addresses some of the issues that have surfaced with 
regard to playground-related injuries involving children under 2.

Falls

Fall height from equipment has been a specific interest of the ASTM 
subcommittee members with regard to the specified age group, especially in the types of 
injuries incurred from falls under 12 inches in height. In this study sample, children fell 
from a wide range of playground equipment and its components, such as slides, 
platforms, ladders, swings and climbers.

The lowest height 
16
from which a child in the study sample group fell was 1 inch

(described below) and the maximum height was 10 feet. 
17
Of the 175 fall-related cases in

the study sample, 8 were reported to have involved a fall that was from a height of less 
than 12 inches. These cases, ranging from a 1-inch fall to an 8-inch fall, were: 
   

An 18-month-old male fell 1 inch at the end of a slide onto gravel outside at 
an apartment complex after being bumped by another child. He received 
scratches to his head.

A 23-month-old female was on a swing set swing in the yard of a home and 
let go of the chains as she swung, falling backwards 6 inches. She hit her 
head on the ground (dirt and grass), lacerating it.

A 15-month-old female was on a slide inside her home and fell backwards
inches
from the first step, hitting her head on the carpeted floor. She had the 
wind knocked out of her, but no head injury.

A 15-month-old male was on the first step of a combination structure’s 
platform outside at school and fell 6 inches onto shredded tires as he went off 
the step, twisting his foot. He fractured his tibia.

A 21-month-old female was in the yard of a home, walking down a slide of a 
combination structure. When she got to the bottom she fell off the slide
inches
to the grass, contusing her foot.

A 22-month-old female was swinging on a swing set outside at home. She 
was swinging on her stomach and fell forward over the swing 2 inches to the 
dirt. She cut her gum and loosened a tooth.
 
A 20-month-old male was standing on a merry-go-round platform at a city

park and let go of the bar, slipping off the equipment. He fell 8 inches
landing on the gravel surface below. He lacerated his forehead.

                                                         

16 The fall heights are based on information the telephone interviewer obtained from the person interviewed

concerning the incident. It is possible that some of the heights may not be exact since the respondents may be basing 
their answers on memory and not a specific measurement.
 
17
The latter incident involved a 21-month-old male who fell from a platform of multi-use structure (consisting of a fort

with a slide, swings and rope). He tried to reach a rope to slide down and missed, loosing his balance. The victim 
suffered a contusion to his head as a result of the 10-foot fall to the dirt surface.

 

16

A 19-month-old female was on a toddler slide in her backyard, going down 
too fast. She hit her face on the concrete sidewalk at the bottom, falling
inches
. Her face was bruised.

Three of the 8 cases mentioned the presence of protective surfacing (2 cases 
involved gravel and 1 involved shredded tires). In the remaining cases, the children fell 
onto dirt, grass, carpeted flooring or concrete. In the two cases involving concrete and 
the carpeted floor, it appears from the information provided that the equipment may be 
portable play equipment.

Portable Playground Equipment

Also of particular interest has been portable playground equipment that can be 
used indoors or outdoors and in a public or home location. The surfacing on which 
portable equipment is placed is of concern since this type of play equipment can be used 
on a non-protective surface by virtue of the fact it can be moved from place to place. 
This type of equipment is popular in home and daycare locations.

Portable playground equipment is not easily identified in the data without the 
manufacturer’s identification and/or pictures. Since this study did not use on-site 
investigations for the analysis there were no pictures available for examination. 
However, there were some descriptive indicators that helped in identifying these products 
for analysis.

18

Out of the study sample there were 36 cases that appeared to involve portable 
playground equipment. The children involved in these incidents ranged in age from 12 to 
23 months and more than half of the incidents (23) involved females. Over half of these 
incidents (22) occurred indoors and all but 2 of the incidents involved a fall from 
equipment. The fall height ranged from 6 inches to 4 feet.  The 2 injury incidents that 
were not fall-related involved a child getting her leg caught in a tunnel of a play set and a 
child who was struck when a plastic jungle gym tipped over.

Many of the fall-related injury incidents (20) mentioned a carpeted floor (11) or 
grass (9) as the surface the child fell to. Other surfaces mentioned in the fall-related 
incidents were a slate patio, a foam mat, floors, wood chips and concrete (outside).

Among the types of injuries that were received in these cases were concussions 
and a closed head injury,
 
19
dislocations, fractures, sprains, contusions, abrasions and

lacerations. Appendix A provides additional details on each of the 36 incidents.

                                                         

18 These cases were identified by the known characteristics of portable equipment such as, type of materials used in

the manufacturing process, size, location of use, or the specified manufacturer of the product.  
19
There were 3 incidents that resulted in concussions (two of them described as mild). They all involved

children falling from portable slides. Two of these incidents occurred indoors with one child falling onto 
carpeted floor and the other falling to an unknown type of surface. The third incident occurred outdoors 
and the child fell to a slate patio. The closed head injury occurred inside and the child fell to a tile floor 
from a plastic slide.

 

17

Indoor versus Outdoor Location of Injury Incidents

As stated in the Background section of this study, there is interest in the injuries 
that have occurred in an indoor versus outdoor location. Sixty-six percent (5,410) of the 
total injuries occurred outdoors with 2,040 occurring in a public park and 1,950 in the 
yard of a home. Ten percent (800) of the injuries occurred indoors and twenty-five 
percent (2,040) occurred at an unknown location.  Of the injuries occurring indoors, 23 
percent occurred in various types of commercial settings, including daycare. Falls were a 
common hazard scenario no matter where the equipment was located. Table 7 presents a 
breakdown of the injuries according to specific location and whether the injury occurred 
indoors or outdoors.

Table 7: Estimates of Playground Equipment-Related Injuries to Children Under 2 by 
Specific Location of the Incident and Whether an Indoor or Outdoor Occurrence

Location of  
Injury Incident Total Outside Inside Unknown

Total 8,250 5,410 800 2,040

Public Park 2,040 2,040 0 0

Yard of Home 1,950 1,950 0 0

Institutional/Commercial Daycare 530 370 150 10

Apartment Complex 280 280 0 0

Schoolyard 260 260 0 0

Fast Food Restaurant 200 20 20 160

Yard of Daycare Setting 100 100 0 0

Other Commercial Setting 
20
20 10 10 0

Other 
21
870 200 600 80

Unknown Location 2,000 200 10 1,790

Source: National Electronic Injury Surveillance System, Special Study, 10/1/00-9/30/01  
Estimates may not add to the totals due to rounding.

Examples of the types of equipment used indoors in the study sample cases were 
slides, play sets, combination structures, a teeter-totter, and a climbing gym (many of 
which were plastic). Most of those were in homes and the surfacing was often flooring 
(carpeted or tile). A few of the locations were “pay-for-play” or restaurants and among 
the surfacing for this equipment was manufactured mats or a padded floor.

Witness to Injury Incident and Caregiver Identification

In 31 percent of the injuries, the person responding to the study questionnaire 
witnessed the events that led to the injury. Thirty-eight percent of the respondents did not 
see the incident happen (but that does not mean that no one witnessed the incident).

                                                         

20 “Pay-for-play” establishments are included in Other Commercial setting category.

21 It is in this category that injuries occurring inside a home or inside home daycare would be found.

 

18

Forty-seven percent of the victim’s caregivers were their parents, followed by 
daycare providers (7 percent). An estimated 66 percent of children injured had at least 
one caregiver supervising the child at the time of the incident, although this does not 
mean they actually saw the incident as it happened. An estimated 100 injuries occurred 
with no adult supervising.

General Information about the Equipment 
22

Thirty-three percent of the injuries were associated with play equipment 
(regardless of the type) that was obtained new, while 7 percent of the injuries were 
related to used equipment.
 
23
The type of material used in the construction of the play

equipment associated with the most injuries was plastic (33 percent), followed by metal 
(12 percent) and equipment constructed of both metal and plastic (11 percent). In 54 
percent of the injuries associated with home equipment, the equipment was constructed 
of plastic, followed by wooden equipment (8 percent). Most of the injuries (61 percent) 
that involved public equipment occurred on equipment made from plastic, metal or a 
combination of both.

Twenty-one percent of the injuries were associated with play equipment that was 
less than 5 years old and 29 percent of the injuries involved equipment under 10 years 
old. An estimated 10 injuries occurred with equipment 20 years or older. Seventy percent 
of the injuries were associated with equipment of unknown age. The equipment in the 
study sample cases ranged from brand new to 50 years at the oldest. The oldest 
equipment associated with the injuries was found at schoolyards and the newest 
equipment (under 5 years old) was in the yards of homes.

Twenty-two percent of the injuries occurred on part of a multi-use/combination 
structure.
 
24
Twenty percent of the injuries with this multi-use equipment were associated

with equipment designed for home use and 72 percent were with public equipment.

Overall, in 53 percent of the injuries that occurred, the equipment was 
characterized as being in good or excellent condition. Eleven percent of the injuries were 
associated with equipment in poor or fair condition.
 
25
Seventy-seven percent of the

injuries were related to home equipment in excellent or good condition and 4 percent of 
the injuries occurred with home equipment in fair or poor condition. In 50
percent of the 
injuries that occurred with public equipment, the condition of the equipment was 
described as good or excellent and in 21 percent of the injuries with public equipment the 
condition was fair or poor.

                                                         

22 It is important to note that respondents were not able to provide as much general information about public

playground equipment as home equipment in terms of whether it was new or used or the age of the equipment. 
23
In 60 percent of the estimated injury incidents, it was not stated whether the equipment was obtained new or used.

24 Swing sets are not considered to be a multi-use structure.

25 Respondents reported rust and abuse among the reasons for the poor or fair condition of the equipment.

 

19

  
Surfacing

Protective surfacing under and around play equipment is recommended to reduce 
the risk of serious head injuries. The most prevalent type of protective surfacing used 
under the play equipment, involved in 12 percent of the injuries, was wood chips. The 
most prevalent non-protective surfacing was grass, associated with 17 percent of the 
injuries (overall more injuries occurred where a grass surface was present than any other 
type of surfacing). More injuries occurred with public equipment (25 percent) where 
wood chips were installed than any other type of surfacing, followed by injuries where 
sand was the surface (13 percent). Grass was the most common surfacing associated with 
the home use equipment-related injuries (45 percent).

The thickness of the surfacing associated with the injury cases in the study sample 
ranged from .25 inches to 48 inches.
 
26
However, the surface thickness information may

not be entirely accurate given the fact that the measurements were obtained during phone 
interviews and probably were not based on an actual measurement, but more likely the 
respondent was relying on memory.

Other Factors

More of the children (41 percent) were injured in the afternoon and early evening 
(between 12:01 p.m. and 6:00 p.m.) than any other time of day. The involvement of 
other children in the injury incident occurred with 18 percent of the injuries. Nine 
percent of the injuries were associated with equipment that had warnings and/or 
instructions that came with the equipment, or were posted on it. In 2 percent of the 
injuries there were signs or warnings concerning the use of equipment posted in the play 
area.

B. Public Equipment-Related Injuries

Forty-one percent of the overall playground equipment-related injuries occurred 
with public playground equipment. In general, public playground equipment is usually of 
heavier construction than home equipment, but portable equipment can be found in some 
public locations, such as daycare facilities. 

Specific Location and Type of Equipment 
 
Table 8 (on the following page) details the estimated injuries for each specific

public location by the type of equipment associated with the injury. It is important to 
note that even if the injury was associated with a particular piece of equipment such as a 
slide or climber, it might have been part of a larger structure (multi-use structure, swing

                                                         

26 The 4 foot thickness of sand associated with this case was supposedly verified according to the interviewer.

However, generally speaking the range of thickness was .25 inches to 12-18 inches. The 4 foot thickness is very 
unusual and seems to be related to the fact that the surfacing at the base of the equipment also served as a sandbox.

 

20

set, etc.). Thirty-eight percent of the injuries that occurred with public playground 
equipment were associated with a multi-use or combination structure.
 
27

Table 8: Estimates of Playground Equipment-Related Injuries to Children Under 2 by Type 
of Equipment and the Specific Public Location

Equipment 
28
Specific Public Location

Total

Public 
Park

Apartment 
Complex

School 
(Outside) 
Fast Food Daycare Other 
Com-

mercial 
29

Other Unk

Total 3,390 2,020 280 250 200 60 20 170 400

Slides 2,300 1,320 260 150 130 40 10 150 240

Swings 490 300 20 0 0 20 0 20 130

Climbers 230 200 0 10 0 0 0 0 20

Merry-Go-Rounds 80 80 0 0 0 0 0 0 0

Tubes/Tunnels 70 0 0 0 70 0 0 0 0

Swing Set 
Structure

10 10 0 0 0 0 0 0 0

Ball Pits 10 0 0 0 10 0 0 0 0

Other 130 30 0 90 0 0 10 0 0

Unknown 70 70 0 0 0 0 0 0 10

Source: National Electronic Injury Surveillance System, Special Study, 10/1/00-9/30/01 
Estimates may not add to the totals due to rounding.

Sixty percent of the injuries related to public equipment occurred at public parks. 
More injuries (63 percent) were associated with slides in public parks than any other type 
of equipment in a public setting, followed by 9 percent of the injuries on swings or swing 
set structures in public parks and 8 percent of the injuries on slides at apartment 
complexes. 
 
Hazard Pattern by Type of Equipment

Table 9 (on the following page) presents a breakdown of the types of public 
equipment associated with the injuries by hazard pattern.

                                                         

27 Multi-use structures do not include swing sets.

28 If a particular type of public equipment (gliders or seesaws, for instance) had no injuries associated with it, then it

was not included in Table 8. 
29
“Pay-for-play” establishments are included in the Other Commercial setting category.

 

21

Table 9: Estimates of Playground Equipment-Related Injuries to Children Under 2  
Type of Public Equipment by Hazard Pattern

Type Equipment Hazard Pattern

Total Fall

Twisted 
Leg/Foot 
with 
Slides

Hit or 
Struck Entrap Pinch Other Unk

Total 3,390 1,500 910 510 20 20 90 350

Slides (All Types) 2,300 830 910 190 20 0 70 270

Swings 490 230 0 250 0 0 10 0

Climbers 230 230 0 0 0 0 10 0

Merry-Go-Rounds 80 70 0 0 0 20 0 0

Tubes or Tunnels 70 0 0 0 0 0 0 70

Ball Pits 10 0 0 0 0 0 0 10

Swing Set Structures 10 10 0 0 0 0 0 0

Other 130 130 0 0 0 0 0 0

Unknown 70 10 0 70 0 0 0 0

Source: National Electronic Injury Surveillance System (NEISS), Special Study, 10/1/2000- 9/30/2001 
Estimates may not add to the totals due to rounding.

Falls Associated with Public Playground Equipment

Fall-related injuries accounted for 44 percent of all the injuries that occurred with 
public equipment. More of those fall-related injuries occurred on slides than any other 
type of equipment, followed by swings and climbers.

Twenty percent of the fall-related injuries were from a height of less than 36 
inches, 24 percent occurred from heights of 36 inches or greater. In 56 percent of the 
fall-related injuries the distance the child fell was unknown. The greatest height a child 
fell from on a piece of equipment in a public setting was 7 feet from a freestanding slide.

 The most frequently reported cause of the falls associated with the injuries 
involving public equipment was the victim slipping or tripping and falling on or from the 
equipment (48 percent of the injuries).

The most common types of surfacing the children fell on (accounting for 50 
percent of the public equipment fall-related injuries) were mulch, wood chips, sand, 
gravel, manufactured mats and shredded tires, all protective surfacing. In only 3 percent 
of the injuries with public equipment did the children fall on non-protective surfacing 
(grass, concrete, asphalt and dirt).

Twisted Leg/Foot with Slides (Public Equipment)

Twenty-seven percent of the injuries that occurred involving public equipment 
were the result of a child getting his/her leg or foot twisted on a slide. For more

 

22

information on this hazard pattern refer to the General Discussion section of this 
document.

Impact-Related Injuries with Public Equipment

Fifteen percent of all the injuries incurred with public equipment involved impact. 
These impact-related injuries involved incidents where either the child collided with 
stationary or moving equipment, or
the equipment struck the child. Eighty-seven percent 
of the impact-related injuries involved slides and swings.

Entrapment or Pinching-Related Injuries with Public Equipment

One percent of the injuries with public equipment involved body part entrapment 
or children getting body parts pinched in the equipment.
 
The injury estimate was based on

only 2 cases from the study sample 
30
. An entrapment injury occurred with a slide and a

pinch injury occurred with a merry-go-round (non-amusement ride). 

C. Home Equipment-Related Injuries

Thirty-three percent of the overall playground equipment-related injuries with the 
under 2 children occurred with home use equipment. Thirteen percent of the injuries 
occurring with home equipment involved multi-use or combination equipment. Portable 
equipment is found in the home setting both indoors and outdoors (see Appendix A for 
specific examples). Home playground equipment is generally of lighter weight 
construction (except for some of the multi-use structures).

Specific Location and the Type of Home Equipment

Sixty-five percent of all the injuries occurring with home use equipment occurred 
in the yard of a home and 3 percent of the injuries occurred in the yard of a home daycare 
provider. Most of the injuries (38 percent) with home equipment were associated with 
slides, followed by swings and swing set structures with 30 percent of the injuries.

Hazard Pattern by the Type of Home Equipment

Table 10 (on the following page) presents a breakdown of the types of equipment 
associated with the injuries in a home setting by hazard pattern.

                                                         

30 One case involved a sprained foot received when the child got a foot entrapped in part of a slide structure after

flipping over on the sliding board. The other case involved a child who nearly severed two fingers from getting them 
pinched in the center section of a merry-go-round.

 

23

Table 10: Estimates of Playground Equipment-Related Injuries to Children Under 2 
Type of Home Equipment by Hazard Pattern

Type Equipment 
31
Hazard Pattern

Total Fall

Hit or 
Struck Entrap 
Twisted 
Leg/foot

w/Slides

Pinch Other Unk

Total 2,730 1,450 780 210 70 0 200 20

Slides (Including Tube 
Slides)

1,050 820 70 70 70 0 10 20

Swings and Swing Set 
Structures

820 260 400 70 0 0 80 0

Sandboxes 170 0 70 0 0 0 100 0

Play Gyms 160 160 0 0 0 0 0 0

Gliders 160 0 160 0 0 0 0 0

See Saws or Teeter 
Totters

90 70 20 0 0 0 0 0

Tubes or Tunnels 70 0 0 70 0 0 0 0

Climbers 50 40 0 10 0 0 0 0

Other 170 100 70 0 0 0 0 0

 Source: National Electronic Injury Surveillance System, Special Study, and 10/1/00-9/30/01 
Estimates may not add to the totals due to rounding.

Fall-Related Injuries Associated with Home Equipment

Fall-related injuries accounted for 53 percent of all the injuries that occurred with 
home equipment. More of the fall-related injuries occurred on home slides than any 
other type of home use equipment, followed by injuries on swings and swing set 
structures, and play gyms.

Thirty-two percent of the fall-related injuries occurring with home equipment 
were from a height of less than 36 inches and 45 percent occurred from heights of 36 
inches or greater. In 23 percent of the injuries the distance the child fell was unknown. 
The greatest height a child fell from on a piece of equipment in a home setting was 10 
feet from a platform of a multi-use structure.

                                                         

31 If a particular type of equipment (merry-go-rounds, for instance) had no injuries associated with it, then it was not

included in Table 10.

 

24

The most frequently reported cause of falls associated with the home equipmentrelated injuries was slipping or tripping on or from the equipment, accounting for 49 
percent of the fall-related injuries.

The most common types of surfacing the children fell on with home equipment 
were grass, concrete or dirt (all non-protective surfaces), accounting for 43 percent of the 
injuries. The most common surfacing they fell on was grass with 25 percent of the 
injuries. Only 2 percent of the home equipment-related injuries occurred where 
protective surfacing was in place (wood chips, mulch, gravel and synthetic turf) and none 
of those injuries were serious head injuries.

Impact-Related Injuries Associated with Home Equipment

Twenty-nine percent of the home equipment-related injuries that these young 
children suffered involved impact. The child either collided with the equipment or was 
struck by it. Fifty-one percent of these impact injuries occurred with swings.

Entrapment-Related Injuries Associated with Home Equipment

Eight percent of the injuries that occurred with home equipment involved body 
part entrapment. The injuries occurred in equal numbers on slides, swings, and tubes or 
tunnels. The children in the study sample cases got a leg or foot entrapped (for the most 
part in gaps in the equipment’s structure). There were no reports of head or neck 
entrapment.

Twisted Leg/Foot with Slides (Home Equipment)

This particular twisted leg/foot hazard pattern was not very common with slides 
that were home use equipment. For more information on this particular hazard pattern 
refer to the General Discussion section of this document.

D. Deaths

From January 1, 1990 to August 15, 2002, CPSC has reports of 6 deaths related to 
playground equipment involving children under 2 years of age.
 
32
The last death reported

to CPSC occurred in April 1995.

These deaths do not constitute a statistical sample of known probability of 
selection and may not include all playground equipment-related deaths with children 
under 2. However, they do provide a minimum figure for deaths associated with 
playground equipment that occurred during the specified time period.

The ages of the victims were 12 to 21 months and 4 out of the 6 deceased children 
were female. Four of the fatalities involved head injuries (severe closed head injury, 
hemorrhage, skull fracture and blunt head trauma). Three of the head injury deaths
 
                                                         

32 A search was conducted of the In-depth Investigation file, the Injury and Potential Injury Incident file, the Death

Certificate file and the National Electronic Injury Surveillance System.

 

25

resulted from falls from equipment (a swing, platform and a slide). In the case of the 
closed head injury from the swing related fall, the type of surface to which the child fell 
was not stated. The child who suffered a fatal skull fracture fell from a platform leading 
to a slide and hit his head on the post supporting the platform. The blunt head trauma 
fatality occurred when the child fell from a slide onto concrete. One head injury fatality 
occurred when a homemade swing set fell over and impacted the child’s head, causing a 
hemorrhage.

There was one death that occurred when the child became entangled in a 
homemade rope swing and hung. One child died when a swing set fell on him (the type 
of injury was not specified).

Three of the fatal incidents occurred with homemade equipment (2 swing sets and 
1 rope swing). One death occurred in a public park, 4 deaths occurred in a home setting 
and one occurred at an unknown location.

Specific details of the 6 deaths involving the children under age 2 are presented in 
Appendix C.

IV. Conclusions and Recommendations

Fall-related incidents accounted for more injuries related to playground 
equipment with children under age 2 than any other hazard scenario. Slides were 
associated with more fall-related injuries than any other type of playground equipment 
for these younger children.

This study found 8 cases in the sample count that resulted in injury from a fall of 
less than 12 inches. There were no serious head injuries among the 8 cases. The most 
serious injury incurred was a fractured tibia. Since the sample count was small for falls 
less than 12 inches, any national estimate projected with regard to these cases would also 
be small and have large variability associated with it.

The second most common injury hazard scenario was where a child either 
collided with a piece of equipment or was struck by it. Swings were associated with more 
impact-related injuries than any other type of playground equipment.

Overall, slides were associated with about half of all of the playground 
equipment-related injuries to children under age 2, regardless of the hazard pattern. In 
addition to the falls, the next most prevalent hazard with slides, in terms of injury, was 
where a child twisted his/her leg or foot going down a slide (1,090 or 13 percent of all the 
injuries). The use of slides by children under 2 is an area where further study could be 
beneficial.

Portable equipment poses some challenging problems in terms of ensuring proper 
surfacing and children under 2 are frequent users.  Over half (22) of the 36 incidents 
identified in the study’s sample count occurred indoors. Indoor surfacing for portable

 

26

equipment may be simply a carpeted floor in a home (20 incidents). All but 2 of the 
incidents were fall-related.

Ten percent (800) of the total playground-related injuries occurred in an indoor 
setting, including homes, daycare, “pay-for-play”, and restaurant locations. The 
surfacing was often flooring (carpeted or tile) and among the types of surfacing reported 
in the commercial locations were manufactured mats or a padded floor. Sixty-six 
percent (5,410) of the total injuries occurred outdoors with grass being the most common 
surfacing followed by wood chips. About three-quarters of the outdoor injuries occurred 
in either a public park or in the yard of a home. Whether the injury occurred indoors or 
outdoors, falls were a prevalent hazard pattern.

Since April of 1995, CPSC has not received a report of a playground-related death 
occurring with a child under 2. Six deaths have been reported to CPSC since 1990 with 
these younger children.  Head injuries were associated with 4 of the 6 deaths and 3 of the 
deaths involved homemade equipment.

Safety efforts involving children under 2 and their use of playground equipment 
should take into account the nature of the incidents in which these children are involved. 
Overall, slides were responsible for about half of all the estimated playground equipmentrelated injuries to these children, regardless of the hazard pattern.

    

 

27

Appendix A

Portable Playground Equipment 
Spreadsheet

 

Appendix A  
Document 
Age/Sex 
Falls/

Hgt 
Hit Equip. or  
Struck by It 
Entrapment 
Pinched Hardware 
Other

Hazards 
Inside or  
Outside 
Narrative

1001016HEP1121 
22 MO F 
Yes, 1

ft

Inside 
On a plastic alligator teeter-totter on a  
carpeted floor in home with sister and  
sister jumped off.  Teeter totter came

down hard and victim fell sideways,  
putting her hand down to catch herself. 

She bent her wrist, fracturing it.

2001101HEP0401 
19 MO F 
Yes, 2

ft

Outside 
Going up the steps of a slide in yard of  
home, turned to look at mother and  
slipped off to the grass.  Fractured left

elbow.

3001101HEP8214 
18 MO F 
Yes, 2

ft

Inside 
Child fell off a plastic play set's slide as  
she was preparing to slide down.  Her  
foot got caught underneath her and she

fell, landing on the carpeted floor in the  
basement of residence.  Chin

laceration.

4001102HEP8213 
16 MO M 
Yes, 1

ft

Outside 
Child was playing on a plastic  
combination slide/fort/platform in the  
babysitter's backyard.  While climbing

the step of the slide she slipped and  
fell to the grass, fracturing her lower left

arm.

5001114HEP8213 
22 MO F 
Yes,

Unk

Inside 
Fell off indoor plastic slide while at  
daycare, landing on head.   
Concussion.

6001117HEP8213 
18 MO M 
Yes,

Unk

Inside 
At daycare fell off indoor play  
equipment (not specified) and broke his  
arm.

Portable Playground Equipment* 
October 1, 2000 to September 30, 2001

 

Document 
Age/Sex 
Falls/  
Hgt 
Hit Equip. or

Struck by It 
Entrapment 
Pinched Hardware 
Other

Hazards 
Inside or  
Outside 
Narrative

7001120HEP0881 
21 MO F

Yes

Inside 
Child was climbing through a tunnel on  
a slide/tunnel combo play set in her  
home.  She somehow got her right leg

caught in the equipment, causing a  
sprain.

8001121HEP8141 
19 MO F 
Yes, 3

ft

Inside 
Playing with her cousin on a play set  
slide in the grandparent's home.  Child  
climbed to the top of the slide and fell

off the side, landing on her arm on the  
carpet, fracturing her upper arm.

9001201HEP7521 
21 MO F 
Yes, 4

ft

Inside 
Climbed to the top of the slide on a  
carpet inside her home and didn't slide  
down, but tried to climb back down and

slipped.  Mild concussion.

10001208HEP1201 
13 MO M 
Yes, 3

ft

Inside 
Child was in his playroom on the  
platform of his slide and leaned over  
side too far.  He fell to the carpet,

landing on his head.  One pupil was  
dilated and he favored one side when

he crawled.

11001212HEP8141 
23 MO M 
Yes, 4

ft

Outside 
Climbing up the steps of a slide and fell  
backwards from the top step.  Hit the  
back of his head on a slate patio in

yard of home.  Mild concussion.

12010103HEP2161 
19 MO F 
Yes, 3

ft

Outside 
Child climbed to the top of a plastic  
playground set, slipped and fell, hitting  
another part of the equipment before

hitting the grass at home.  Bruised  
shoulder.

13010103HEP7681 
15 MO F 
Yes, 8

in

Inside 
Playing on slide indoors at home.  
Mother believes child tried to go up the  
slide and fell from the first step

backwards, hitting her head on the  
carpeted floor.  Stopped breathing for a

moment and hit the back of her head.  
Got wind knocked out of her and no

head injury. 

 

Document 
Age/Sex 
Falls/  
Hgt 
Hit Equip. or

Struck by It 
Entrapment 
Pinched Hardware 
Other

Hazards 
Inside or  
Outside 
Narrative

14010117HEP1201 
18 MO F 
Yes,

18 in

Inside 
Child was playing on a plastic slide on  
a rug in the livingroom.  She lost her  
balance while sitting on the slide

platform and fell to the floor, bracing  
herself by putting her left arm out. 

Dislocated left elbow.

15010117HEP5601 
14 MO M 
Yes,

12.5  
in

Inside 
Child was playing on play slide inside  
the home.  He climbing the steps up to  
the platform and caught his heel on a

piece of the structure, falling back over  
the side to the tile floor.  Bump to head.

16010120HEP6641 
12 MO F 
Yes, 3

ft

Inside 
Fell off the platform of an indoor plastic  
play set in day care center, when she  
lost her balance.  Fell on carpeted

concrete floor.  Nosebleed and swollen  
face.

17010123HEP8854 
22 MO F 
Yes, 3

ft

Outside 
Slipped of top of steps of plastic slide  
and fell to grass in her backyard,  
sustaining a contusion to her elbow.

18010124HEP1201 
21 MO F 
Yes,

18 in

Inside 
Climbing up steps of plastic slide in  
classroom at daycare and slipped,  
landing on her feet on a foam mat. 

Sprained knee.

19010207HEP6001 
18 MO F 
Yes,

Unk

Inside 
Sprained ankle falling onto carpeted  
floor from a small plastic slide at her  
day care center.

20010228HEP7601 
17 MO M 
Yes, 3

ft

Outside 
Climbing in the middle of a plastic play  
gym and fell backwards out of one of  
the holes to the grass of friend's yard. 

Contusion to head and abrasion to  
nose.

21010305HEP7681 
21 MO M 
Yes, 2

ft

Inside 
Fractured arm when he toppled over  
from the top of a small plastic sliding  
board to the floor in his home.

 

Document 
Age/Sex 
Falls/  
Hgt 
Hit Equip. or

Struck by It 
Entrapment 
Pinched Hardware 
Other

Hazards 
Inside or  
Outside 
Narrative

22010409HEP1201 
15 MO F 
Yes,

Unk

Inside 
On a toddler slide at daycare, trying to  
get in position on the platform to slide  
down and fell over the side of the slide

to the floor.  Nursemaid's elbow.

23010430HEP1121 
16 MO F 
Yes,

30 in

Inside 
Child sustained a fracture of her elbow  
when she fell from a plastic climbing  
gym onto the carpeted floor of her

livingroom.

24010529HEP7812 
17 MO F 
Yes,

Unk

Inside 
Fell off plastic slide to tile floor. Closed  
head injury.

25010601HEP8213 
15 MO F 
Yes, 2

ft

Outside 
Climbing up surface of a plastic slide,  
lost her balance and fell to the grass at  
home daycare, dislocating elbow.

26010711HEP2961 
17 MO F 
Yes, 3

ft

Inside 
Climbing the ladder of a plastic toddler  
slide and lost balance at the top.  Fell  
to carpeted floor in livingroom of home.

Contused head and back.

27010716HEP2961 
21 MO F 
Yes, 2

ft

Outside 
On a toddler's plastic play set and slid  
down the slide head first, hitting head  
on concrete in backyard of home. 

Closed head injury.

28010722HEP0321 
18 MO M 
Yes, 3

ft

Inside 
On platform of a plastic slide in  
babysitter's home and slipped, falling to  
the carpet.  Bit tongue.

29010831HEP2241 
22 MO F 
Yes, 3

ft

Inside 
In an office building on a plastic slide,  
walking down it and fell off to the tiled  
floor.  Nose contusion.

30010909HEP5601 
19 MO F 
Yes, 6

in

Outside 
On a toddler slide at her home, going  
down too fast and hit her face on the  
sidewalk at the bottom.  Bruised face.

31010912HEP8213 
15 MO M 
Yes,

30 in

Outside 
Fell from a play gym that was a  
playhouse with a slide to the grass in  
his backyard.  Fractured his right

radius.

 

Document 
Age/Sex 
Falls/  
Hgt 
Hit Equip. or

Struck by It 
Entrapment 
Pinched Hardware 
Other

Hazards 
Inside or  
Outside 
Narrative

32010918HEP7812 
17 MO F 
Struck by

equipment

Unknown 
Slide from plastic jungle gym tipped  
over onto child.  Leg contusion.

33010930HEP6985 
19 MO M 
Yes,

Unk

Outside 
On a toddler size slide in a toddler  
playground at daycare facility.  Fell to  
wood chip covered ground, lacerating

upper lip.

34011002HEP8213 
17 MO M 
Yes, 3

ft

Outside 
On a plastic portable slide at home and  
slipped off the top rung, falling to the  
grass.  Contused wrist.

35011119HEP6401 
18 MO M 
Yes, 3

ft

Inside 
On indoor plastic slide at commercial  
daycare and fell off to tile floor,  
lacerating his forehead.

36020417HEP8213 
20 MO M 
Yes,

2.5 ft

Outside 
On the platform of a small plastic slide  
in his backyard and jumped to the  
grass, sustaining a spiral fracture to his

ankle.

Total= 36 
*  Photographs of the equipment were not available.  Staff believes these cases are portable equipment based on description.

 

28

Appendix B

Children’s Leg Injuries on Slides 
Human Factors’ Analysis

 

UNITED STATES 
C
ONSUMER PRODUCT SAFETY COMMISSION 
W
ASHINGTON, DC 20207

Memorandum

CPSC Hotline: 1-800-638-CPSC (2772) + CPSC's Web Site: https://www.cpsc.gov

Date: April 7, 2003

TO : Joyce McDonald

Division of Hazard Analysis (EPHA)

THROUGH: Hugh McLaurin, Associate Executive Director 
Directorate for Engineering Sciences 
Robert B. Ochsman, Ph.D. 
Director, Division of Human Factors (ESHF)

FROM : Jonathan D. Midgett, Ph.D. 
Engineering Psychologist, ESHF

SUBJECT : Children’s Leg Injuries on Slides

Introduction

The ASTM subcommittee for public playground equipment for children under 2 requested that 
the CPSC staff review common playground injury scenarios. Within this study’s research and 
compilation of incidents, a particular scenario involving slides frequently emerged. This scenario 
involves either a child sliding alone or being taken for a ride down a slide seated on the lap of a 
caregiver. This event may lead to children breaking, spraining, bruising, or causing some other 
injury to a leg. Human Factors staff has been asked to provide a behavioral analysis of this 
general injury mechanism.

Analysis

Motivation

The motivation for giving a baby or a toddler a ride on a slide is foreseeable. Toddlers are 
commonly brought to playgrounds with older siblings and peers before they are mature enough 
to fully join in the challenges offered by most common types of playgrounds. Their attempts to 
play on equipment are generally monitored by caregivers who follow them closely and dissuade 
them from attempting difficult maneuvers and from getting in the way of older playground users. 
Some of this caregiver dissuasion will likely be frustrating to a toddler struggling to become 
masterful with motor skills and self-determination. They will want the attention and the 
challenges found on playground equipment. Not surprisingly, caregivers tend to facilitate as best 
they can those features of a playground that a toddler can safely enjoy. As caregivers look 
around for ways to make the playground fun for a toddler, it seems likely that the slide would 
seem a safe choice, as long as the child is held on the lap, or monitored on the way down with 
someone to catch them at the bottom. They may reason that the slide down will be fun for the

 

-2-

child, yet “safe,” because it requires no skill on the part of the child except to sit still. No doubt, 
many times this is the case and no injury is incurred. However, sometimes other relatively 
unexpected factors alter the outcome. These factors are discussed below.

Injury Mechanisms

Many incident reports describe the child’s shoes grabbing or catching on the slide and at least 
one incident describes the child’s bare feet grabbing. This occurrence is unexpected because 
people think of a slide as being slippery. However, many rubber-soled shoes will easily hold the 
surface of a slide, and bare skin also grips effectively. To slide down, slide users usually lift their 
feet slightly, so their shoes don’t drag on the slide. Pressing down with their feet can actually 
stop a scared slider part of the way down, depending on how clean their shoes are and how fast 
they are going. Once they have the hang of it, however, slide users stiffen their legs, hold their 
feet up completely and slide to the bottom. To observers, and to people accustomed to slides, the 
activity is not obviously one of such careful posture selection. It is so easy, that people forget 
how much is actually going on during a slide. It requires balance, a slight backward lean of the 
upper torso, anticipation of the momentum, a stiffening of the legs to lift the heel from the slide, 
and advance preparation for landing. Without these skills, a slider can roll down a slide, or shoot 
off the bottom of the slide out of control. It takes some practice.

When children have not had the experience of using a slide before, they do not know what is 
about to happen. Older children who are experienced in the use of a slide will keep their legs 
stiffened and their feet up, off of the surface. Very young children will not know to do this and in 
addition, caregivers probably do not anticipate any danger from a relaxed child. Consequently, 
the baby’s feet drag loosely on the slide, sometimes with their legs straddling a caregiver’s lap. 
Then their rubber soles catch on the surface, pulling their leg backwards. The downward 
momentum, especially with an adult or larger playmate holding them, is enough to pull a baby’s 
relaxed leg into an injurious position. This combination of the unanticipated plunge, relaxed legs, 
rubber-soled shoes, grabbing feet and adult-sized momentum can lead to injuries. It can, and has 
happened, on any kind of slide, metal or plastic, straight, tubular, or spiral.

Additionally, the likelihood of feet grabbing the sides of a slide may be slightly increased for 
smaller feet because when small feet hit the rim of a slide, they can contact with the full width of 
the foot. A larger foot hitting a slide’s rim would be more likely to glance upwards and over the 
rim, like a boat over a wave, before grabbing securely like a small foot can. A child’s short legs 
are also given ample room by most slides to freely bend backwards, whereas longer-legged 
children simply do not have enough room on the slide to bend their legs backwards without 
falling off the slide.

Injury Diagnosis

According to the reports, caregivers were not always aware that the child’s leg had even been 
stressed. Injuries varied from fractured bones, usually in the lower leg, to sprained ankles, knees, 
hips, and other bruises. Because the child may begin crying during the slide, caregivers may 
believe that she/he is just afraid or distressed by the ride, not by an injury, and may not be as 
likely to search for an injury. At least one child was in distress overnight before being taken to

 

-3-

the emergency room for x-rays. Many caregivers notice that the child is favoring one leg, or 
unable to stand, and then diagnose the injury.

Conclusion

Toddlers may lack the coordination and experience to properly use playground equipment. 
Caregivers sometimes allow toddlers or young children to use a slide or set the child on their lap 
for a ride down the slide. Unaware that the child’s feet can grab on the slide, they allow the 
child’s legs to drag. The child’s foot inadvertently grabs the slide rim or surface, pulling the leg 
hard enough to seriously injure it. Injuries range from minor bruising to serious fractures that 
take months to heal.

 

Appendix C

REPORTED DEATHS RELATED TO PLAYGROUND EQUIPMENT 
(JANUARY 1, 1990 - AUGUST 15,2002)

DOCUMENT # 
DATE 
LOCATION

AGE 
SEX 
HOMEPUB 
HAZARD PATTERNNARRATIVE

DOCUMENT #2

19108013330 
910801DENVER, CO 
12 MO 
F

HOME

FALL (SEVERE  
CLOSED HEAD  
INJURY ) 
SEATED ON SWING WHICH CAME UNHOOKED AND FELL.   
SUSTAINED SEVERE CLOSED HEAD INJURY

2930211HCC3122 
920603GRETNA, LA 
19 MO 
M

HOME

TIPOVER/COLLAP 
SE  
(HEMORRHAGE) 
STRUCK IN THE HEAD BY A HOMEMADE SWING SET AS HE  
WAS BEING PUSHED IN A SWING AND SWING SET TOPPLED

OVER

9222017202

3921001HCC2263 
920920REX, GA 
20 MO 
F

PUBLIC PARK 
FALL (HEAD;  
SKULL FX 
FELL OFF THE PLATFORM LEADING TO THE SLIDE OF A

JUNGLE GYM SET IN A PUBLIC PARK.  HIT HEAD ON THE  
POST SUPPORTING THE PLATFORM

X9290094A.  
9213038878

49312060661 
930530JACKSONVILLE, FL 
21 MO 
F

HOME

FALL (BLUNT  
HEAD TRAUMA ) 
FELL ONTO CONCRETE FROM SLIDE--BLUNT HEAD  
TRAUMA

X9376281A

5X9397587A  
930818PIMA, AZ 
12 MO 
M

UNK

TIPOVER/COLLAP 
SE

DIED FOLLOWING A FALL FROM A HOMEMADE SWINGSET  
THAT THEN FELL ON HIM

6951018HCC3007 
950423STOWELL, TX 
12 MO 
F

HOME

HANGING 
PLAYING ON A HOMEMADE ROPE SWING HANGING FROM A  
TREE BRANCH AND BECAME ENTANGLED AND DIED DUE  
TO HANGING

9548048883

Total=6 
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ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff

SOURCE:  DEATH CERTIFICATE (DCRT), REPORTED INCIDENT (IPII), NATIONAL ELECTRONIC INJURY SURVEILLANCE SYSTEM (NEISS), AND IN-DEPTH INVESTIGATION (IDI) FILES (1/1/90 - 8/15/02) 
                   U.S. CONSUMER PRODUCT SAFETY COMMISSION/EPHA

1