Two Safety Issues With Children

by Jeff Cersonsky, MD, FAAP

“I’m thinking of buying a trampoline — any suggestions?”

This is a tough question because jumping is so much fun. However, I strongly advise against buying home trampolines because injury and permanent disability are NOT fun. Home trampolines are responsible for over 50,000 injuries requiring a trip to the emergency room, many of them serious. Neck fractures and brain injury are the most severe while compound limb fractures requiring surgery are common. A proportion of the injuries required admission to the hospital, many of them needing surgery.

The American Academy of Pediatrics recommends that (1) Trampolines should never be used at home, (2) Trampolines should not be part of routine physical education classes, (3) Trampolines should never be on playgrounds or considered “play equipment.”

We don’t want to take fun away from the children, but we do want that fun to be safe and in an appropriate setting.

The only approved usage of trampolines is in supervised training programs for gymnastics and diving. Even then, (1) The trampoline should be properly maintained, (2) The surface surrounding the trampoline should be an impact-absorbing safety material, (3) Springs should be covered with padding, (4) People trained in trampoline safety and a competent spotter should always be present, (5) One person on the trampoline at a time, and (6) The American Academy of Pediatrics and the Consumer Product Safety Commission advise that no child under age six should use a trampoline. This caution is appropriate. However, my five-year-old has attended parties that involve a trampoline in a padded area in a professional gymnastics facility closely supervised by trained gymnasts and one-to-one supervision by a parent. Only seat jumps were done, again under strict professional supervision.

I remember when the first trampoline came to our neighborhood and everyone wanted to try it. I’m very glad no one was seriously hurt (as far as I know) on that trampoline. However, knowing what I know now, I know we were just lucky. When I recently made a house call, one of my patients was very proud to show me the flip he could do on a trampoline on his driveway without a spotter, with clearly exposed springs, and with a hard surface surrounding the trampoline. I hope that his parents will take my advice and find a safer backyard activity for him to be proud of.

“My child is now (finally) 40 pounds. Is a booster seat really necessary in the car?”

The AAP recommends use of an appropriate car seat until a child reaches 40 pounds. Note that this recommendation is in pounds, not the four-year limit as many state laws use. Many four-to-six year olds are too small not to be in a car seat.

However, at 40-60 pounds, the recommendation is to use a recommended booster seat. A seat belt and shoulder strap do not provide optimal protection for children in this size range. Children even seven and eight years old have died when they submarined under an adult seat belt in high-speed collisions. A booster seat prevents a child from submarining under a seat belt during a high-speed accident and prevents the shoulder strap from impacting the neck during an accident. Of course, a seat belt can save lives if no booster is available but the booster seat is the way to go. A booster also raises the child up to give them more of a view and a more pleasant ride.