Monday, June 3, 2013

The safety risks of backyard trampolines

- Jennifer Middleton, MD, MPH

I've been watching trampolines sprout up in backyards all over our neighborhood this spring, and seeing them has resurrected some memories from residency.  Like many family physicians, I spent time in a children's emergency department (ED) as a resident.

What I saw during my rotation made me wonder about the safety of these bouncy backyard devices.  I saw an injury related to backyard trampolines during nearly every shift that summer.  These children typically either fell off the trampoline onto the ground or got caught in the gap between the mat and the metal support.  Some of these injuries were just contusions and sprains, but I also helped evaluate several broken bones and a couple of head injuries.

It turns out that my ED experiences were not atypical.  The American Academy of Pediatrics (AAP) has been advising against recreational backyard trampoline use since 1977, with their most recent update last fall. (1)  Similarly, the American Academy of Orthopedic Surgeons also has a position statement against backyard trampoline use. (2) Despite these recommendations, trampoline use and trampoline injuries in the US are on the rise, from an average of about 41,000/year in the early 1990s to about 88,000/year in the early 2000s. (3) More children are injured directly on the mat, though around a third of injuries are from falls to the ground. (4,5)

I could find no rigorous evidence base to demonstrate that counseling against backyard trampoline use reduces injuries, but at least one literature review suggests that physician counseling about other childhood safety issues does reduce injuries. (6)  And, here's a recent AFP article about unintentional childhood injury prevention:  

My suspicion is that many parents remain unaware of these dangers (perhaps like this mother was), and a brief question about trampoline use would be a simple addition to our safety counseling at well child visits.

Is this topic worth discussing with families in the office?  I welcome your thoughts.

(1) Trampoline Safety in Childhood and Adolescence.  Council on Sports Medicine and Fitness.  Pediatrics; originally published online September 24, 2012.
(3) Linakis et al. Emergency department visits for pediatric trampoline-related injuries: an update. Acad Emerg Med. 2007 Jun;14(6):539-44. Epub 2007 Apr 20.
(4) Black and Amadeo. Orthopedic injuries associated with trampoline use in children. Can J Surg2003 June; 46(3): 199–201.
(5) McDermitt, Quinlin, Kelly. Trampoline injuries in children. J Bone Joint Surg Br. 2006 Jun;88(6):796-8.
(6) Bass et al. Childhood injury prevention counseling in primary care settings: a critical review of the literature. Pediatrics. 1993 Oct;92(4):544-50.