Pediatric Annals

Healthy Baby/Healthy Child 

Trampolines: What's the Harm?

M. Denise Dowd, MD, MPH

Abstract

Trampolines hold the promise of fun and enjoyment for many children, but they are associated with a significant number of orthopedic and other injuries. Injuries vary from minor to severe, and the most common are extremity injuries. Although most injuries are associated with residential (ie, backyard) trampolines, a growing number of injuries now occur in trampoline parks. Adult supervision has not been effective for prevention. Emerging data on trampoline park-related injuries indicate that caution should be exercised in these settings as well. [Pediatr Ann. 2018;47(10):e385–e387.]

Abstract

Trampolines hold the promise of fun and enjoyment for many children, but they are associated with a significant number of orthopedic and other injuries. Injuries vary from minor to severe, and the most common are extremity injuries. Although most injuries are associated with residential (ie, backyard) trampolines, a growing number of injuries now occur in trampoline parks. Adult supervision has not been effective for prevention. Emerging data on trampoline park-related injuries indicate that caution should be exercised in these settings as well. [Pediatr Ann. 2018;47(10):e385–e387.]

In 2017 there were more than 145,000 medically treated trampoline-related injuries in the United States, most among children younger than age 15 years; 3% of those treated require hospitalization.1 The Consumer Product Safety Commission, through its National Electronic Injury Surveillance System, documented a peak in injuries in 2004 with a subsequent yearly decrease since then.2 A more recent phenomenon is the growing popularity of trampoline parks, which offer many opportunities for trampoline play and exercise. These parks typically consist of wall-to-wall connected indoor trampolines, some of them angled. They often include pits filled with foam pieces or air bags for landing after a jump.

Injury Types

Extremity injuries are the most common type of trampoline-associated injury and most often occur in the lower extremities, representing nearly one-half of all injuries. Ankle injuries, the most common of which are sprains, are the most frequent type of lower extremity injury, comprising about 60% of all lower extremity injuries.3 Upper extremity injuries occur in one-quarter to one-third of all cases, and about 60% are fractures.3 Arm fractures requiring surgery are the most common reason a child with a trampoline injury is admitted to the hospital.4

The injuries that cause the most concern are head and neck injuries, which account for 10% to 17% of all trampoline injuries.5,6 Head injuries most commonly occur with a fall from the mat, whereas spine injuries typically occur on the mat as a result of failed flips.5,6 It is estimated that 0.5% of all trampoline injuries result in permanent neurologic damage.7

Risk Factors and Mechanisms

Approximately 75% of all injuries occur when multiple people use the trampoline at the same time.3,5 In such a situation, those who are of lowest weight are the most likely to be injured. One study documented that the risk to the lighter person was 14 times that of the heavier user when both are on the mat at the same time.8 Falls from the mat surface account for about one-third of all trampoline-associated injuries,9,10 with injury risk increasing if the child contacts an object on the ground.

Children with higher risk of atlantoaxial subluxation, such as children with Down syndrome, are at higher risk of cervical injury and should be advised against the use of trampolines.11

A recent study examined differences in injuries occurring in trampoline parks versus those occurring in residential settings.12 The study found that injury patterns varied significantly, with greater risk for head injuries with home trampolines but greater risk for lower extremity injury and necessity of hospital admission for injuries sustained in a trampoline park.12

Several studies have noted that adult supervision does not reduce the risk for injury when a child uses a trampoline.5,13,14

Prevention

The American Academy of Pediatrics, in its 2012 policy statement on trampoline safety, reiterated its longtime stance advising against recreational home trampoline use.15 For families who make the choice to use a home trampoline, several guidelines are offered in that policy statement. These include allowing no more than one jumper on the mat at a time, protective padding around the edge and over the springs, adult supervision, and not allowing children to do flips or somersaults (Table 1). Despite these recommendations, it is not clear that parents are aware of these precautions. A Canadian study found that although nearly one-half of all families had access to a trampoline and nearly 9% of their children had a trampoline injury, less than 10% reported knowledge of all key safety recommendations.16 Clinicians must not assume that possession of a trampoline implies awareness of child injury risk or the methods to decrease the risk of injury.16

Recommendations for Trampoline Use for Families

Table 1:

Recommendations for Trampoline Use for Families

Since 1997, netting has been available to enclose the user on the mat and prevent falls; however, there is no published evidence that such enclosures have made any difference in injury rate.17 This lack of effectiveness may have to do with the fact that so many injuries occur on the mat itself and not a fall from the mat. Pads covering trampoline frames and springs have been required by American Society for Testing and Materials standards since 1999.18

As mentioned above, trampoline parks are increasing in popularity. The industry grew from only three parks in 2009 to more than 1,000 by the end of 2017.19 With this rise in popularity, injuries in these settings have increased as well, as has the occurrence of severe injuries such as open fractures and spinal cord injuries.12 Attention to safe use and behavior in trampoline parks is important because guidelines vary from park to park. Parents should specifically inquire about park rules pertaining to limiting the number of people on the mat as well as prohibitions about flips and somersaults. Relatively recent voluntary standards aimed at reducing injuries were announced last year by the International Association of Trampoline Parks,20 but their effectiveness remains to be measured.

It is not uncommon for children to be exposed to trampolines as part of a structured training program for sports such as gymnastics, skiing, or diving. There are significant differences in trampolines and their use in these settings versus home settings. The mats tend to be bigger, there is a rim of padding around the mat, there is an additional 5- to 6-foot radius of padding on the floor, and supervision is constant.15 No studies have documented patterns or types of injuries in this fairly structured setting, so care should be taken to not extrapolate data from residential settings.

References

  1. Consumer Product Safety Commission. NEISS Data Highlights–2017. https://www.cpsc.gov/s3fs-public/2017-Neiss-data-highlights.pdf?3i3POG9cN.rIyu2ggrsUkD1XU_zoiFRP. Accessed September 26, 2018.
  2. United States Consumer Product Safety Commission. https://www.cpsc.gov/Research--Statistics/NEISS-Injury-Data. Accessed September 26, 2018.
  3. Linakis JG, Mellow JM, Machan J, Amanullah S, Palmisciano LM. Emergency department visits for pediatric trampoline-related injuries: an update. Acad Emeg Med. 2007;14(6);539–544. doi:. doi:10.1197/j.aem.2007.01.018 [CrossRef]
  4. Sandler G, Nguyen L, Lam L, Manglick MP, Soundappan SS, Holland AJ. Trampoline trauma in children: is it preventable?Pediatr Emerg Care. 2011;27(11):1052–1056. doi:. doi:10.1097/PEC.0b013e318235e9e0 [CrossRef]
  5. Nysted M, Drogset JO. Trampoline injuries. Br J Sports Med. 2006;40(12):984–987. doi:. doi:10.1136/bjsm.2006.029009 [CrossRef]
  6. Shankar A, Williams K, Ryan M. Trampoline-related injury in children. Pediatr Emerg Care. 2006;22(9);644–646. doi:. doi:10.1097/01.pec.0000221339.26873.14 [CrossRef]
  7. Brown PG, Lee M. Trampoline injuries of the cervical spine. Pediatr Neurosurg. 2000;32(4):170–175. doi:. doi:10.1159/000028929 [CrossRef]
  8. Hurson C, Browne K, Callender O, et al. Pediatric trampoline injuries. J Pediatr Orthop. 2007;27(7):729–732. doi:. doi:10.1097/BPO.0b013e318155ab1 [CrossRef]
  9. Furnival RA, Street KA, Schunk JE. Too many pediatric trampoline injuries. Pediatrics. 1999;103(5).e57. doi:10.1542/peds.103.5.e57 [CrossRef]
  10. McDermott C, Quinlan JF, Kelly IP. Trampoline injuries in children. J Bone Joint Surg Br. 2006;88(6):796–798. doi:. doi:10.1302/0301-620X.88B6.17647 [CrossRef]
  11. Bull MJCommittee on Genetics. Health supervision for children with Down syndrome. Pediatrics.2011;128(2):393–406. doi:. doi:10.1542/peds.2011-1605 [CrossRef]
  12. Kasmire KE, Rogers SC, Sturm JJ. Trampoline park and home trampoline injuries. Pediatrics. 2016;138(3):e20161236. doi:. doi:10.1542/peds.2016-1236 [CrossRef]
  13. Wootton M, Harris D. Trampolining injuries presenting to a children's emergency department. Emerg Med J. 2009;26(10):728–731. doi:. doi:10.1136/emj.2008.069344 [CrossRef]
  14. Smith GA. Injuries to children in the United States related to trampolines, 1990–1995: a national epidemic. Pediatrics. 1998;101(3 pt 1):406–412. doi:10.1542/peds.101.3.406 [CrossRef]
  15. Briskin S, LaBotz MCouncil on Sports Medicine and FitnessAmerican Academy of Pediatrics. Trampoline safety in childhood and adolescence. Pediatrics. 2012;130(4):774–779. doi:. doi:10.1542/peds.2012-2082 [CrossRef]
  16. Beno S, Ackery A, Colaco K, Boutis K. Parental knowledge of trampoline safety in children. Acad Pediatr. 2018;18(2):166–171. doi:. doi:10.1016/j.acap.2017.03.015 [CrossRef]
  17. Alexander K, Eager D, Scarrott C, Sushinsky G. Effectiveness of pads and enclosures as safety interventions on consumer trampolines. Inj Prev. 2010;16(3):185–189. doi:. doi:10.1136/ip.2009.025494 [CrossRef]
  18. ASTM International. Standard safety specification for components, assembly, use, and labeling of consumer trampolines. https://www.astm.org/Standards/F381.htm. Accessed September 15, 2018.
  19. International Association of Trampoline Parks. International Association of Trampoline Parks (IATP) statement for the Dr. Oz show https://cdn.ymaws.com/www.indoortrampolineparks.org/resource/resmgr/docs/Dr._Oz_Statement_Final.pdf. Accessed September 26, 2018.
  20. International Association of Trampoline Parks. IATP membership pledge. https://www.indoortrampolineparks.org/page/USAPledge. Accessed September 15, 2018.

Recommendations for Trampoline Use for Families

<list-item>

Primary recommendation: no home use of trampolines

</list-item><list-item>

If there is home use of a trampoline: <list-item>

Restrict use to a single jumper

</list-item><list-item>

Adequate padding of sides/springs

</list-item><list-item>

Set at ground level if possible

</list-item><list-item>

Do not allow somersaults and flips

</list-item><list-item>

Active supervision by an adult

</list-item><list-item>

Discard/replace parts if damaged

</list-item><list-item>

Check homeowner's insurance to assure coverage

</list-item>

</list-item>
Authors

M. Denise Dowd, MD, MPH

M. Denise Dowd, MD, MPH, is the Associate Director, Office for Faculty Development, and the Medical Director, Community Programs, Department of Social Work, Children's Mercy Hospital; and a Professor of Pediatrics, University of Missouri-Kansas City School of Medicine.

Address correspondence to M. Denise Dowd, MD, MPH, via email: ddowd@cmh.edu.

Disclosure: The author has no relevant financial relationships to disclose.

10.3928/19382359-20180918-01

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