Bouncy-House Injuries Skyrocket

Yael Waknine

November 27, 2012

The number of bouncy-house injuries has skyrocketed in the last 10 years, reaching the point where an American child is injured every 46 minutes, according to research published online November 26 in Pediatrics.

Meghan C. Thompson, BA, from the Center for Injury Research and Policy, Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and colleagues analyzed injury records for almost 65,000 children, finding that the rate and number of bouncy-house-related injuries increased 15-fold from 1990 to 2010, more than doubling in the last 2 years alone.

"Bouncer-related injury patterns identified in this study were similar to those described for trampolines," the authors write. For both trampolines and inflatable bouncers, with increasing age the frequency of upper-extremity injuries and fractures decreased and lower-extremity injuries increased.

Children aged 6 to 12 years were most often hurt compared with those aged 0 to 5 years and 13 to 17 years (54.0% vs 35.8% and 10.2%, respectively).

Boys were more likely to sustain injuries than girls (54.6% vs 45.4%), including concussions/closed head injuries and lacerations (relative risk [RR], 2.49 [95% confidence interval (CI), 1.46 - 4.25] and 2.41 [95% CI, 1.55 - 3.73], respectively), or injure their head/neck or face (RR, 1.37 [95% CI, 1.09 - 1.73] and 1.76 [95% CI, 1.35 - 2.30], respectively). In contrast, girls were more likely than boys to sustain lower-extremity injury (RR, 1.39; 95% CI, 1.17 - 1.64).

Of the 65.2% of cases for which a venue was reported, 43.7% of injuries occurred at a sports or recreational facility and 37.5% occurred at home.

The vast majority of children treated in the emergency were released or left against medical advice (96.6%); only 3.4% of injuries required hospitalization or 24-hour observation, primarily for fractures (81.7%).

"Policy makers must consider whether the similarities observed in bouncer-related injuries warrant a similar response" to the recommendations given for trampolines, the authors write, noting that although pediatric bouncer-related injury rates are currently lower than trampoline-related rates (5.28 vs 31.9 per 100,000 in 2009), they are rising rapidly. "[P]olicy makers should, at minimum, formulate recommendations for safer bouncer usage and design," they emphasize.

65,000 Injuries Over the Course of 20 Years

For the study, researchers analyzed the National Electronic Injury Surveillance System records for an estimated 64,657 children younger than 18 years who had been treated in US emergency departments for inflatable bouncer-related injuries from 1990 to 2010.

Results revealed that the rate and number of bouncy-house related injuries increased 15-fold during the period from 1995 to 2010, from 1.01 per 100,000 children (95% confidence interval [CI], 0.70 - 1.32 injuries/100,000 children) in 1995 to 15.2 per 100,000 children (95% CI, 9.93 - 20.56 injuries/100,000 children) in 2010. There were 702 (95% CI, 284 - 1120) injuries in 1995 compared with 11,311 (95% CI, 7115 - 15,506) injuries in 2010. (P < .001 for both). In 2010 the average number of injuries in the United States was 31 per day, corresponding to an injury report every 46 minutes.

Fractures were the most common type of injury (27.5%) and most frequently occurred in children aged 5 years and younger (relative risk [RR], 1.31; 95% CI, 1.12 - 1.54); strains and sprains were also common (27.3%) and were reported most frequently among teenagers aged 13 to 17 years (RR, 1.45; 95% CI, 1.12 - 1.88). Teenagers were also more likely to experience lower-extremity injuries (RR, 1.37; 95% CI, 1.13 - 1.66).

As with trampoline-related accidents, the majority of injuries occurred to the extremities (lower, 32.9%; upper, 29.7%). An additional 18.5% of injuries involved the head and neck, 9.3% affected the face, and 9.0% were trunk injuries.

Lacerations were 14.3 times (95% CI, 10.46 - 19.53 times) more likely to occur in the face than any other body region, and fractures were 3.31 times (95% CI, 2.58 - 4.24 times) more likely to occur in the upper extremity than any other body region, particularly among children aged 12 years and younger (RR, 1.89; 95% CI, 1.05 - 3.41).

Stunts and Collisions

As with trampoline-related accidents, falling was the major source of injury, accounting for 43.3% of cases. More children were injured falling in or on the bouncer than getting on or off (26.1% vs 17.2%), which may be a matter of design, the authors note.

Other sources of injury included other children (16.2%), with 9.9% of cases attributable to colliding with or being pushed/pulled by another person and 6.3% the result of another child's fall.

"Stunts and collisions were common injury mechanisms in this study and in previous bouncer and trampoline studies," the authors write, noting that as with trampolines, the presence of several children on a single bouncer is a risk factor for injury.

According to the authors, the similar nature and mechanism of trampoline- and bouncer-associated injuries suggests that prevention methods for one may be extrapolated to the other, but this concept has not been adequately explored.

As previously reported by Medscape Medical News, recommendations from the American Academy of Pediatrics in 2012 addressed trampolines and recommended their use only as part of a structured training program that includes appropriate safety measures. These recommendations made no mention of bouncy houses because they do not fall into the training category. Other organizations such as ASTM International and the US Consumer Product Safety Commission have attempted to address bouncer safety issues. In the end, the standards are set by individual manufacturers, the authors write.

"To date, the medical and public health community has not provided safety recommendations regarding pediatric use of inflatable bouncers," the authors assert, noting that the recent increase in injuries also underscores the need for guidelines to improve bouncer use and design.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 26, 2012. Full text