Day Care Dangers

Pediatric injuries in child care explored in new study and playground injuries top concern

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) The need for child care outside the home has become a common fact of life in the US; unfortunately so have injuries that take place in childcare centers. The authors of a new review set out to explore just how common these injuries were.

According to the authors, unintentional childhood injuries were a big issue in the US, and with both parents at work, many of these injuries took place in childcare centers.

The review found that most injuries were minor, and most severe injuries occurred on playgrounds. The review also uncovered a trend toward more unintentional injuries in boys than in girls.

"Talk to your child about playground safety."

"Pediatric unintentional injuries are currently the leading cause of morbidity and mortality among children nationally," reported the review's authors, who were led by Andrew N. Hashikawa, MD, of the University of Michigan Medical School in Ann Arbor.

And minor injuries are also a concern, Dr. Hashikawa and team noted, as they make up the majority of incidents and therefore create the biggest burden — both financial and functional — on families and on the healthcare system.

To explore the presence of these unintentional injuries, the researchers analyzed data from 53 previous studies. 

Childcare settings were defined as a facility that cares for 13 or more children. This might include daycare centers, nurseries and preschools. 

Injuries explored in the review included any injury that led to the child's absence from child care, that led to an injury report, that school policy or state law considered reportable or that required medical treatment (either from a school nurse, a doctor or an emergency department).

Data uncovered in the team's review included an estimated 2.6 to 3.3 injuries per child and 635 to 835 medically attended injuries per year per 100,000 children.

Of the studies analyzed, 14 reported on injury rate differences between genders. Ten of these showed a higher childcare center injury rate in males than females and the other four found no difference between genders.

"Generally, there were higher rates of injury in younger children (non-infants) compared to older children; toddler (13–35 months) injury rates were typically greater than preschooler (36–59 months) injury rates," the review authors wrote.

The majority of injuries were minor and included abrasions, sprains and bites. Severe injuries reported included burns, fractures and concussions.

Most of the fractures and concussions were due to falls from playground structures. The review reported an estimated 271 to 364 childcare center playground injuries per year per 100,000 children.

The review authors noted that these rates of injury in childcare centers were comparable to injury rates published for other institutions like schools, playgrounds and summer camps.

"Unintentional injuries are a concern for both parents and daycare providers. Many severe injuries, such as fractures and concussions occur from falls on playground equipment. To minimize this risk, be sure your child is playing on age-appropriate equipment," Bridget Boyd, MD, a Pediatrician and Child Safety Expert at Loyola University Health System, told dailyRx News.

"Also, look for playgrounds with wood chips, mulch, sand, pea gravel, or mats made of safety-tested rubber or rubber-like materials.Adequate supervision is key to prevention for children of all ages," said Dr. Boyd.

"Unintentional childcare center injuries remain predictable and preventable, and further research is required because these preventable pediatric injuries remain a major health care burden in the United States, especially for poor and minority families who lack both health and work benefits to care for their injured children," Dr. Hashikawa and team concluded.

The review was published online October 3 by the Journal of Child Health Care. No conflicts of interest were reported.

Review Date: 
October 4, 2013
Last Updated:
October 8, 2013