Marcia Frellick

September 18, 2017

CHICAGO — Going down a slide with a toddler on your lap could raise the risk for lower leg injuries, according to a study of national data presented at the American Academy of Pediatrics 2017 Conference.

Two things are happening here: the weight of an adult or older sibling increases momentum, and unsecured legs can easily catch on the side or surface of the slide, twist, and be pulled backward, said Charles Jennissen, MD, clinical professor and pediatric emergency medicine staff physician at the University of Iowa Carver College of Medicine in Iowa City.

Although he has seen quite a few patients throughout his career with tibia fractures that occurred when a child was going down a slide on the lap of an adult or older sibling, parents I've spoken with "say they had no idea this could happen," Dr Jennissen told Medscape Medical News.

"I was never told this as a pediatrician, and I wondered if this is something I need to warn families about," he explained.

There is very little literature on the subject, so to get a look at the national picture, he and his colleagues used the National Electronic Injury Surveillance System Database, which is maintained by the Consumer Product Safety Commission and collects a stratified sampling of emergency departments.

I was never told this as a pediatrician, and I wondered if this is something I need to warn families about.

Incident narratives indicated that an estimated 352,698 children younger than 6 years were injured on slides in the United States from 2002 to 2015. Almost 60% of those injured were boys, and injuries were very different when stratified by age group.

Legs were injured in more than 80% of slide incidents in children 11 months and younger, in two-thirds of the incidents in children 12 to 18 months, and in about half the incidents in children 18 to 23 months.

"When a child was on the lap, 94% of the injuries were in the lower extremities," Dr Jennissen reported.

It doesn't take much for a foot to touch the sides of a slide with enough friction to twist a leg, he explained. If children slide by themselves, their legs might touch the edges but they don't have the added momentum from the adult's weight to seriously injure themselves.

After age 3, children are more likely to fall and smack their face or fracture an arm when they use it to break a fall, he pointed out.

Research Supports Observations

"It's nice to have research behind an anecdotal observation," said Cora Breuner, MD, from the orthopedic and sports medicine clinic at the Seattle Children's Hospital, who reported that she has seen slide injuries in her practice.

"It's powerful to be proactive when talking about play with families," she told Medscape Medical News.

Dr Breuner said she would advise letting children slide only when they are old enough and big enough, or catching them at the bottom.

Another option is to secure the child's feet inside the adult's legs, "but we're suggesting people rethink doing that in general," said Dr Jennissen.

Healthcare providers should be aware that this is a potential risk, and pass the message on to parents, he said.

Dr Jennissen and Dr Breuner have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2017 National Conference and Exhibition. Presented September 18, 2017.

Follow Medscape Pediatrics on Twitter @MedscapePeds and Marcia Frellick @mfrellick

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