It seems obvious that car crashes can be especially dangerous for children, but according to a new study published in this week's issue of Ambulatory Pediatrics, playgrounds, too, pose a serious threat. "Most injuries are minor, but a higher proportion of playground injuries [reviewed in the study] were moderate to severe compared to injuries due to motor vehicles, bicycles or all falls," explains lead author Kieran Phelan of the Children's Hospital Medical Center of Cincinnati.

Phelan's team analyzed statistical information gathered by the National Center for Health Statistics on how many children and adolescents visited U.S. emergency rooms between 1992 and 1997. Falling accidents in general made up a quarter of all injury-related E.R. visits, the largest proportion from a single cause. And of those falls, 5.3 percent, or approximately 153,000 cases, occurred on playgrounds. About 40 percent took place on school playgrounds, whereas another 25 percent happened at home, and about 9 percent occurred in public parks or recreation areas.

Although the number of playground injuries is decreasingfrom 187,000 in 1992 to 98,000 in 1997Phelan hopes that prevention efforts aimed at middle-school-age children can reduce the number even further. "Children in the five- to nine-year age group had significantly higher rates of emergency visits from playground falls," he says. "They were three times as likely to have an emergency visit as children 10 to 14 years old." Noting that most of these injuries happen at school and at day-care centers, he adds that "if you are going look into improving the situation, those are the places where you want to focus your efforts."

Despite the findings, Phelan is not asking parents to keep their children inside. "Playgrounds provide obvious benefits for children," he says, "but they should be engineered to provide safety from falls, including rubberized or other soft surfaces to absorb the impact.