WASHINGTON (AP) Ban the backyard trampoline, says one group of doctors.
Don't ban it, but watch it like a hawk, says another, after weighing essentially the same data.
The American Academy of Pediatrics and the American Academy of Orthopaedic Surgeons both agree that trampoline injuries are up sharply, and that parents who see the trampoline as a plaything don't realize the risk.
The groups, however, disagree on what to do about it.
Almost 82,400 cases of injuries from trampolines were seen in hospital emergency rooms in 1997, according to U.S. Consumer Product Safety Commission data analyzed by the orthopedic surgeons organization. In contrast, the CPSC tracking system found only 42,615 cases in 1993. Injuries range from bumps and bruises to broken bones and, in more rare cases, paralysis or death.
Children suffered the most, the orthopedic surgeons' group said; close to 64,000 of the 1997 injuries were to children 14 and younger.
"Trampolines should not be used for unsupervised recreational activity," the orthopedic surgeons' group declared in a position statement. "Competent adult supervision and instruction is needed for children at all times."
The pediatricians' group takes a harder line. "The trampoline should never be used in home or recreational settings," its position statement said. "The trampoline has no place in recreational sports."
"I'm not big on banning the things," said Dr. Dale Blazier, professor of orthopedic surgery at Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock. No one bans cars because of accidents, he said.
"There is that level of concern that we considered banning them," said Dr. John F. Sarwark of Children's Memorial Hospital, Chicago. "Our organization decided they can be used, but it has to be with extreme caution," said Sarwark, chairman of the orthopedic surgeons' public communications committee.
Not good enough, countered pediatrician Gary A. Smith of Children's Hospital, Columbus, Ohio. "They may be appropriate for certain selected children serious athletes interested in gymnastics," he said. "That's entirely different from using backyard toys."
A key point of dispute is that the orthopedic surgeons think a careful adult can head off many of the injuries. The pediatricians don't.
"The best thing for trampoline safety is to communicate with the parents themselves," said Dr. Vernon T. Tolo, chief of orthopedics at Children's Hospital, Los Angeles. "Some will see this and will change the way they let their kids play."
Some parents believe trampolines are safe because they are sold like playground equipment and toys in stores, Blazier said. It's an "implied trust" that, because a big retailer stocks it, the trampoline is safe, he said.
Kids will still get hurt, Smith said. "To me, supervision is a myth. I think this reliance on parental supervision has gotten us into trouble."
Parents don't have the training to anticipate injuries, and could not act to prevent many injuries even if they had training, Smith said. Most injuries occur on the trampoline itself, not from the 3-foot fall from the trampoline to the ground, he said. "A parent on the side ... isn't going to prevent an injury that's occurring on the mat," he said.
In his unpublished research, a majority of injuries occurred "while a parent was standing there watching," Smith said. "They say, `It happened so quickly I didn't have time to react."'
Doctors in both groups agree on the manner in which serious injuries occur. One common scenario involves more than one child on the trampoline, and a heavier child landing on the mat, causing it to bounce back up as a smaller child is coming down.
The upward movement of the mat and the downward movement of the younger child can generate enough force to snap the frontal leg bone of the younger child below the knee, Blazier said. "I have seen this over and over again," he said. The injuries require up to a month in a cast, but they heal, he said.
Children using the trampoline together can bounce into one another. Sometimes this pushes a child off balance, leading to an improper fall that can break a bone, the doctors said. In other cases, a child can be bounced onto one of the trampoline's metal supports, or off the trampoline onto the ground, they said.
Only one child should be on a trampoline at any time, the orthopedic surgeon's statement said. Spotters should be present, and high-risk activities such as somersaults should be avoided unless there is proper supervision and instruction, it said.
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