New safety regulations reduced injuries requiring treatment for children, study suggests

January 18, 2002

(Embargoed) CHAPEL HILL -- Regulations North Carolina adopted in 1996 to improve safety on daycare playgrounds appear to have contributed to fewer injuries serious enough to send children to doctors or hospitals across the state, according to a new University of North Carolina at Chapel Hill study.

The study, commissioned by the N.C. Department of Health and Human Services' Division of Child Development and conducted by UNC School of Public Health faculty, documented a 22 percent decline in the estimated rate of serious injuries between 1997 and 1999 at state childcare centers. The rate of injuries in licensed homes dropped 31 percent.

"To our knowledge, this is the first time anyone in the United States has been able to associate a real decline in the risk of child injuries with strengthening regulations for reducing hazards on childcare playgrounds," said Dr. Jonathan B. Kotch, professor of maternal and child health.

"Common sense told us that these rules would make a very real difference," said Peggy Ball, director of the N.C. Division of Child Care. "That's certainly why we worked hard to make them reality. Now, we have real data that shows the rules are dramatically improving the lives of North Carolina children in childcare."

Kotch, the principal investigator, carried out the study with colleagues in maternal and child health. They presented it to state officials late last year and released it publicly today (Jan. 17). After presenting results at an international injury conference in Montreal in May, the scientists plan to publish them in a professional journal.

"We reviewed and analyzed all 5,402 reports of medically attended injuries in regulated childcare settings in North Carolina over the three and a half years from 1997 to June, 2000," Kotch said. "We also conducted 294 playground safety inspections in late 1998 in randomly selected centers, repeated he inspections in 91 centers in August 2000 and surveyed 178 center directors in the fall of 1999."

Of the injuries, almost 91 percent happened in childcare centers, 3.5 percent occurred in homes offering care, and it was unknown where the remaining 5 percent took place, he said. Boys were injured most often and by bumping into or being hit by something. Most injuries happened in the morning on playgrounds and involved cuts and scrapes to the head or neck.

N.C. centers rated highest for safety had largely eliminated sharp points, corners or edges and minimized pinching, crushing and tripping hazards, the pediatrician said. Among safety features still needing attention were inadequate playground surfaces and structures or surfaces from which children might fall.

"The decline in injury rates coincided with implementation of new playground safety rules first promulgated by the North Carolina Child Care Commission in January, 1996," Kotch said. "Repeated playground safety inspections demonstrated improvements in eight of 10 playground safety concerns and 12 of 18 playground safety features between 1998 and 2000. Our conclusion then is that the declining injury rate probably came from a combination of playground safety enhancements, increased teacher awareness of injury and better supervision."

Decreased reporting of incidents, while unlikely, cannot be ruled out, he said. Also, adverse weather caused by hurricane Floyd and other events may have played a role.

"Nevertheless, we are encouraged by this trend, which links a significant decline in statewide child-care injury rates with improved regulation of playground safety in this country," Kotch said.

More than 213,000 N.C. children now attend out-of-home care, he said. That includes 196,000 served by the 4,000 licensed centers and nearly 17,000 who attend one of the 5,709 private homes licensed for that purpose.

In 1995, several child care injuries, including one death, heightened safety concerns and prompted the N.C. General Assembly's attention. In June 1997, the N.C. Division of Child Development contracted with UNC to study and report on the issue. For more than three years the division provided the UNC School of Public Health researchers with computerized records of injuries requiring medical attention.
Note: Kotch can be reached at 919-966-5976 or
News Services Contact: David Williamson, 962-8596
School of Public Health Contact: Lisa Katz, 966-7467

University of North Carolina at Chapel Hill

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