More U.S. children are needing treatment for traumatic brain injuries such as concussions from injuries on the playground despite safety improvements in playground equipment — a trend Canadian doctors see too.

About 28,500 children a year in Canada need medical treatment as a result of playground injuries ranging from bruises and broken bones to serious head trauma and spinal cord injuries, according to Canadian hospital injury data.

In Monday’s issue of the journal Pediatrics, researchers from the U.S. Centers for Disease Control and Prevention used national injury data from 2001 to 2013 to focus on nonfatal traumatic brain injuries in children aged 14 and younger.

• • Head injuries in children ranked by cause
• • Can playgrounds be too safe?

About 58 per cent of the hospital visits were by boys.

Children aged five to nine accounted for nearly 51 per cent of the playground-related visits to emergency for a traumatic brain injury, Dr. Tabitha Cheng of the UCLA emergency medicine department in Los Angeles and her co-authors found.

“The annual rate of traumatic brain injury emergency department visits increased significantly from 2005 to 2013,” the researchers said.

The U.S. numbers parallel those in Canada, with a dip around 2005 and increases since, said Dr. Suzanne Beno, an emergency physician at the Hospital for Sick Children in Toronto.

“A rise in the rates of traumatic brain injury should concern everybody because traumatic brain injury is a public health burden,” given how common it is, said Beno. She was not involved in the U.S. study.

Greater awareness

“I think it needs to be parsed out and studied a bit more in terms of how much is actual increasing rates of TBI and how much of that is more awareness.”

Parents may be more aware of the need to get medical attention if a child has a head injury.

With Canadian safety standards and changes in many playgrounds, the severity of injuries has reduced, Beno said.

The researchers’ suggestions to further cut down on the number and severity of playground-related traumatic brain injuries included:

• • Better adult supervision.
• • Checks on whether children are behaving appropriately.
• • Regular equipment maintenance.
• • More improvements in playground surfaces and environments.

If the surface looks worn or feels too hard, experts suggest parents call the school or city to ask about maintenance.

At a playground in Toronto, Garrick Lau appreciated the newer rubber surfaces.

“Our little one just sort of bounced off this ground,” Lau said. “I think she was more scared from the fall. But the impact didn’t hurt her at all so that’s great.”

In the study, monkey bars or playground gyms and swings were the equipment most frequently associated with a traumatic brain injury.

Most of the injuries happened on weekdays in April, May and September.

Be available if injury occurs

Nick Reed, co-director of the concussion centre at Holland Bloorview Kids Rehabilitation Hospital in Toronto, speculates those are times of the year when children are becoming familiar with playground equipment and injuries may be more likely.

Reed has a suggestion to prevent injuries. “We want to make sure there is some form of appropriate supervision. That doesn’t mean hand holding and not letting children play the way they need to play to develop and be social but it does mean being available if an injury does take place.”

To monitor for signs of concussion, Reed said parents should be on the lookout for changes in behaviour and:

• Physical symptoms such as headaches, nausea and dizziness.
• Cognitive or thinking symptoms, such as feeling like they are thinking through a fog.
• Sleep issues.
• Emotional or mental health symptoms such as increased irritability or increased sadness.

If you look for all of those and even recognize just one, you want to make sure you’re seeking medical attention.”

That’s because a child’s developing brain can be more vulnerable to the impact of a concussion.

The authors of 2014 study of Ontario pediatric emergency department and office visits for concussion found playgrounds were the eighth most common cause after hockey or skating, motor vehicle accidents, football/rugby, snow sports, bicycling, baseball and soccer.

There was no external funding for the U.S. study.