The authors from Children’s Hospital, Los Angeles sought to describe skeletal injuries related to the use of inflatable bouncers and to determine possible risk factors for injury.
PICO
Question: What types of musculoskeletal injuries are seen in children playing in inflatable bouncers?
Question type: Descriptive
Study design: Retrospective case series
The records of all children seen in the Level I trauma center and subsequent fracture clinic for an injury from an inflatable bouncer from October 2002 to March 2007 were reviewed. Parents were contacted by telephone survey to provide information about activity, number of children in the bouncer, presence of adult supervision, and age difference of the children who were in the device at the time the injury occurred.
During the review period, a total of 4,367 children were seen in the emergency room for trauma, with 49 (1.1%) sustaining an injury while in an inflatable bouncer. The majority of inflatable bouncer-injured children were male (74%) and the mean age was 7.8 (range 1.5–15) years; 35% of the patients were between seven and nine years old. Injuries occurred in either the upper (66%) or lower extremity (34%).
The most commonly injured area was the elbow with supracondylar humerus fracture being the most common single injury (22%; 11/49). Most injuries were minor fractures with only one open fracture and only 14% requiring manipulation of a deformity.
A total of 21 families (43%) could be reached by telephone. Among these families, all injuries occurred at home on a rented device. Adult supervision was absent in 9/21 (43%), the mean number of children in the device at the time of the injury was 5.4 (range 3–11), and 11/21 (52%) had children of different ages jumping inside. The two most common mechanisms of injury were collision between two children (67%, 14/21) and falling out of the bouncer (19%, 4/21). During the period of review only 14 (0.3% of all injuries) cases of trampoline-related injuries were seen. Injury mechanism and fracture distribution were similar for the children with the trampoline injuries, but less common.
The authors conclude that inflatable bouncers can cause serious orthopedic injuries. Children playing in the bouncer should be placed in small groups according to their size.
Commentary
Dr. Schwend has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Similar to the epidemiology of trampoline injuries, collision and falling out of the bouncer are the most common mechanisms of musculoskeletal injury associated with inflatable bouncers.2 In 1999 the AAP advised parents against home trampoline use.1
Often, multiple children of different sizes play at the same time with poor or no adult supervision on either trampolines or inflatable bouncers. Parents see inflatable bouncers as fun and safe since they are padded, soft, and are not trampolines. Although few major injuries were reported in this series, severe injuries can occur. We recently saw a teenage boy with a cervical spinal cord injury after a head-first dive into a bouncer. With inflatable bouncer use increasingly popular, the prevalence of injuries associated with their use is also increasing.
In 2001, the Consumer Product Safety Commission reported 1,993 injuries associated with inflatable bouncers. In 2004, the last year that data has been analyzed, the estimated total was 4,900.3 As inflatable bouncers have few safety regulations the number of injuries is likely to continue to increase.
Potential problems with this study include its retrospective study design, recall bias from the phone interview that occurred years after the injury, the small number of families contacted, and dearth of outcome data.
There is no demographic information on the number of children at risk, so it is impossible to assess relative risk of sustaining an injury. Although the percentage of children injured while playing in an inflatable jumper was over three times that of children seen for trampoline injuries, the nature of this study does not allow one to determine which equipment is more likely to cause an injury. For now, playtime in inflatable jumpers is one more activity that parents need to supervise closely or avoid altogether.
Editors’ Note
With the epidemic of obesity attributed both to calorie-laden diets and sedentary lifestyles, it almost seems a shame to put a crimp in the style of any activity. At the very least, we can jump into the discussion of bouncer safety by educating our patients’ parents about bouncer-related injuries and their prevention.
- Copyright © 2009 by the American Academy of Pediatrics
