Can we go too far when it comes to children’s injury prevention?


We have several decades of combined research experience focused on child injury prevention. We enjoy doing this work as a way to affect real change and improve the lives of children and their families. We have had the privilege of joining a local, national and international family, each doing our bit for the collective whole. It has been immensely gratifying to see some real impacts from our collective efforts.

We have, however, become increasingly concerned that some of our efforts to keep children safe may be doing unintended harm – particularly as it relates to children’s play. We have had children’s best interests at heart, but our exclusive focus on injury prevention has been akin to only paying attention to whether we’re getting enough exercise, but not what kind of food we’re eating.

A child has many needs – safety being a very crucial one among many. But by only thinking about safety, we can lose sight of how we may inadvertently cause serious harms in other ways. Here at the BC Injury Research and Prevention Unit, we have written peer-reviewed research articles about this before – you can access them for free here: and

Recently, the ASTM Committee on Sports Equipment, Playing Surfaces, and Facilities has been struggling with the decision to lower thresholds for Impact Attenuation Materials. Essentially, they want to require that surfaces under playground structures be more absorbent in order to reduce the likelihood of head injury. At first blush, this may seem like a great idea. Who wouldn’t want their child to avoid head injuries??! Not as evident are the ramifications, both immediate and long term, of a decision like this. While playground safety standards are not policies and are developed by a voluntary organization, they are typically applied as policy. This is because of liability concerns. If anything goes wrong, the playground provider wants to be able to support the fact that their playground met the safety standards as a measure of due diligence.

So what this means is that every time there is a playground standard change, schools, daycare centres, recreation facilities and so on across the country have to rip out equipment, surfacing, etc., to comply with new standards. There are several issues with this:

  1. Head injuries on the playground are extremely rare and there is no evidence that they are increasing on playgrounds. For example, studies that have looked at injuries across entire school districts in Canada and New Zealand have not documented even one head injury on the playground. In fact, your child is more likely to get injured doing sports than on the playground.
  2. The head injury criterion (HIC) is measured by dropping a head form straight down, but children do not fall that way. The most common injuries on the playground are arm fractures because children try to break their falls. Australian data show that introducing stricter playground safety standards in 1996 had no impact on head injury rates.
  3. Ripping out and replacing surfacing is a very expensive proposition, especially if you consider the sheer number of playgrounds across the US that will be affected. The resources have to come from somewhere, which means they won’t go to supporting other worthy and necessary activities. Also, a change in the ASTM standard is likely to have knock-on effects for standards in other countries, ultimately representing a huge worldwide shift in spending. A previous cost-benefit analysis found that it represented a large investment for very little return.
  4. Kids want and need to take risks and experience uncertainty. So reducing risks has several major ramifications:

(a) Taking risks is part of how they learn about the world, the consequences of actions, and how to keep themselves safe in different circumstances. I’d much rather my children learn that wet surfaces are slippery while playing, than when they’re driving their first car.

(b) Evidence suggests that kids take more risks when things are made safer – they’ll climb higher and fall harder.

(c) If they’re not getting the chance to take risks in playgrounds (where it’s relatively safe), they’re going to look for them elsewhere, through means that could be far more dangerous or destructive.

(d) Or they could disengage altogether, turning to screens, and other forms of sedentary entertainment. We are aware of the major concerns about children’s lack of physical activity and increasing rates of obesity.

  1. We’re already doing a miserable job of providing stimulating play opportunities for children. Making safety standards more stringent will just make it even harder. Lots of research has documented the effect of playground design on children’s development and well-being. We know how to design optimal play spaces for children and yet the vast majority of play spaces have uninspiring equipment with very little play value.

The members of the ASTM committee have a very difficult task ahead of them. It is one we also struggle with regularly through the course of our work. It is no easy feat to figure out the optimal balance between risk and safety. But we think it is possible to keep safety at top of mind, while still being sensitive to other aspects of children’s health, well-being and development. In this case, we believe that changing the standards will not reflect the best decision for children. Hence we would urge the committee to put the proposal on hold, and to engage in a wider debate about how standards can help us get the balance right.

We would also encourage you to read a posting by Professor David Ball for thoughtful and thorough consideration of arguments on this issue.

Dr. Mariana Brussoni 1
Dr. Alison Macperhson 2
Dr. Ian Pike 3


  1. Assistant Professor, Department of Pediatrics, School of Population and Public Health, University of British Columbia; Academic Scientist, BC Injury Research & Prevention Unit; Scientist, Child & Family research Institute; Director, BC Children’s Hospital Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)
  2. Associate Professor, School of Kinesiology & Health Science, York University; CIHR Canada Research Chair in Reproductive, Child and Youth Health; Adjunct Scientist, Institute for Clinical Evaluative Sciences.
  3. Associate Professor, Department of Pediatrics; Director, BC Injury Research & Prevention Unit; Associate Scientist, Child & Family research Institute; Network Researcher, Auto 21; Co-Executive Director, Preventable
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This post has 12 Comments

  1. Bernard Spiegal on April 1, 2015 at 8:07 am

    Thank you for this article. It is a timely and helpful contribution to current discussions about ASTM’s proposal to tighten playground surfacing standards. And of course it has wider application.

    You rightly point people to Professor David Ball’s article – ‘Observations on Impact Attenuation Criteria for Playground Surfacing’. David’s and your article reinforce and complement each other. It occurs to me that together they constitute to what might be called a ‘Guide to the Evidentially Perplexed’.

  2. Tim Gill on April 1, 2015 at 9:48 am

    Maria, Alison and Ian – thank you for this clear, concise and timely contribution on a complex issue. I am sure that ASTM committee members – who are voting on the issue in the coming weeks – will appreciate your independent and impartial perspectives.
    I have announced your article on my website, and also shared the paper via social networks and email. The link is here:

  3. Robin Sutcliffe on April 1, 2015 at 10:32 am

    It is really comforting to have such international support for this issue. As Chair of the Play Safety Forum in the UK, i welcome this article and hope it will be read widely. I will now re-blog on Grumpy Sutcliffe

  4. Peter Clinch on April 1, 2015 at 1:02 pm

    A sane, well researched, balanced and intelligent view with which I heartily concur (despite my daughter suffering a couple of days of blurred vision after a playground fall last year… she’s okay though, and still enjoying her play). Thank you!

  5. Rolf Huber on April 4, 2015 at 12:22 am

    This is an incredibly bad conclusion, based on inadequate research. The original premise and report of the Montreal conference was to promote play, but Can we go too far when it comes to children’s injury prevention (Brussoni, Macpherson, Pike, 2015) could not be further from reality…for more visit

  6. Mariana Brussoni on April 16, 2015 at 5:11 pm

    We thank everyone for their comments. This is clearly an issue that many people are passionate about.
    We would agree with Mr. Huber’s post that head injuries are a major concern. The BCIRPU has a central research program on concussion prevention. However, head injuries on the playground are not common, as the data very clearly show. Playground falls are an important source of hospital admissions, but they are by and large related to fractures, not head injuries. We would encourage anyone to have a look at the data themselves. They can access BC data using our iDOT tool available on the BCIRPU front page.
    Many of the statistics cited in Mr. Huber’s paper relate to concussions in general or falls in general, or playground injuries resulting in fractures. We would urge caution in interpreting his statements. If the reader closely examines them, it is apparent they do not provide support for the ASTM surfacing change.

  7. Tim Gill on April 17, 2015 at 2:08 pm

    Rolf – in your recent paper, which I found on your website, you say right at the start “falls are the leading cause of playground injuries, greater than all other causes combined and is one of the leading causes of death.” I am struggling to make sense of this statement.
    I would appreciate a clear answer from you to this question: how many children die from falls in public playgrounds?
    All the figures I have seen suggest that fatalities from playground falls are vanishingly rare. CDC figures imply a single such fatality each year across the USA. In Canada, experts tell me they have not heard of a single case over the last 20 years or so. Here in the UK, Prof David Ball’s report estimated one every 3 or 4 years.
    David Ball’s report: (see section 2.2)

  8. Mariana Brussoni on April 17, 2015 at 6:52 pm

    In follow-up to Tim Gill’s comment, you can see Canadian playground stats on page 26 of the following report:
    I also invite the reader to access our iDOT tool to crunch their own BC numbers at:

  9. Barry Pless on April 18, 2015 at 7:58 pm

    I have pleaded with the authors of this posting on the BC Injury and Prevention Unit website to provide solid evidence in support of their assertions. Without such evidence, not the collective opinion of practitioners but evidence of the same kind they would wish to have if they were being urged to stop giving a child’s potentially life saving medication on the grounds that it might be harmful, I judge this posting misleading and irresponsible. It seems especially so coming from an organization supposedly dedicated to preventing injuries. The reference to playground head injury stats is deceptive because it fails to acknowledge that the encouragingly low numbers of head injuries are a tribute to safety measures, such as surfacing, already taken. It will only take one severe life altering traumatic brain injury to persuade any reasonable parent that other measures that could have prevented it are fully justified. To oppose additional safety measures based on a supposition that a child’s development will be impaired if playgrounds are made safer is wrong until that hunch is proven using accepted scientific criteria. Thus, I entirely disagree with Clinch’s characterization of the piece as a “sane, well researched, balanced and intelligent view”. And I find it bizarre that he does not realize that his daughter’s “couple of days of blurred vision” might have been a lifetime of blindness or worse had the surface been just a bit less safe and forgiving.

  10. Mariana Brussoni on April 20, 2015 at 9:55 pm

    Barry – thanks for your comment.
    1. I would like to be clear that our post does not suggest that existing safety measures be removed, but rather that surfacing thresholds should not be increased beyond current levels. It is clear that head injuries are rare on playgrounds. The evidence being used to support the change in surfacing requirements comes from motor vehicle crash data, not playground data.
    2. As population health professionals, we must think beyond the individual case to consider the sum total benefit. This has 3 implications:
    a) We must be careful where we invest our increasingly limited resources to ensure that the evidence supports their effectiveness. This is not the case for attenuation criteria playground surfacing.
    b) There comes a point at which further investment brings a diminishing return. This is clearly the case for playground surfacing.
    c) We must consider the unintended negative consequences of our public health interventions. We have outlined in our post many potential negative implications in this case.

  11. Tim Gill on April 21, 2015 at 2:30 pm

    Barry – as Mariana points out, the central question is not about the existing surfacing standard – it is about tightening it. I have a couple of questions for you. First, what in your view is a reasonable response to an extremely rare but life-altering injury? It is not hard to imagine what a parent of an injured child might feel should be done. But surely a cornerstone of evidence-based injury prevention is to take a wider look at the problem, and to resist hasty, ill-thought-through responses.
    You compare this situation with decisions about medication. This is a helpful comparison: the proposal is really a public health measure, not a product safety issue. Here’s my second question: are you happy with a situation where a decision about mandating a new public heath measure – potentially costing hundreds of millions of tax dollars – is being made without any robust clinical trials, and without any proper evaluation of costs and benefits? And moreover where the decision is being made not by an independent, impartial body whose work is open to public scrutiny, but by a committee voting in private, where even the committee membership is not available to the public, and where a number of members have a direct financial interest in the outcome?

  12. Barry Pless on April 28, 2015 at 4:19 pm

    Mariana: our dispute is not about resurfacing a playground, per se. It is about the underlying rationale and from what you have written, in the journal and in the blog, part of your rationale appears to be that you want to encourage risk taking because you are convinced it is important for ‘healthy child development’. I can’t agree until I see some convincing evidence. I don’t care how rare head injuries are; my position as a parent, grandparent, and doctor is that if it can be prevented it should be and the brain or the life should not be sacrificed on the altar to thinking beyond the individual and worrying about limited resources. You refer to unintended negative consequences without ever spelling them out but the implication is that they are at least as severe as a TBI and equally well supported by evidence. If so, you have an obligation to share with us.

    As for Gill, My reasonable response to an extremely rare but life-altering injury is simple: it must be prevented if we can and the parent is right and if you want to invoke evidence-based criteria please share that view with Mariana and her colleagues. Evidence based includes a wider view but also the narrow view of the individual child. Perhaps your question can best be put to Clinch assuming that the blurred vision ended up being blindness. See what he or she would choose. Again, if you want robust trials then share that view with those who believe they are not necessary – that subjective opinions of those from many disciplines is sufficient for making decisions.
    If all of you are cut up in a quarrel with playground surfacing on money grounds or lack of transparency, etc. please don’t put children’s brains at risk while you are sorting this out. It is an entirely different issue and should be resolved by different criteria. I repeat: the fundamental issue here, and in the paper that precipitated it, is the authors conviction that risk taking is good for kids. I will not be convinced until I can examine the evidence.