Trampoline Trauma: Toddlers at higher risk for bounce injuries
Bouncing is big business. From gyms to backyards to indoor parks, trampolines are promoted for exercise and fun. But parents and doctors are now issuing an urgent warning about trampolines after startling numbers reveal very small children are suffering very big injuries.
INDIANAPOLIS -- When Carrie Clark heard about "Toddler Time" at a local trampoline park, she couldn't wait to take her 2-year-old son Cooper.
"I thought it was a good activity to get him exercise and maybe wear him out a little before naptime," Clark told WTHR. "I was a first-time mom. I thought I was just doing something fun with my child."
The Clarks August visit to Sky Zone in Fishers ended with the blonde-haired toddler in an emergency room with a broken leg.
Instead of fond memories, Cooper returned home with a bright orange toe-to-waist cast that wrapped around his torso. His mom was left with endless questions.
"How could something like that happen?" Clark still asks months later. "I had no clue. And don't tell me this was just a freak accident. Freak implies it's uncommon."
An Eyewitness News investigation finds tens of thousands of kids are seriously hurt on trampolines each year. 13 Investigates' analysis of nationwide data shows young children are especially at risk, with many of the smallest jumpers suffering the biggest injuries. And those injuries frequently do not happen how you might expect.
When you think of serious accidents involving a trampoline, you might think of scenarios like the one that paralyzed Austin Dodd. The Fountain County teenager had successfully done hundreds of flips on his backyard trampoline, but it took just one bad landing to change his life forever.
"I did a double front flip and landed on my neck," Dodd told WTHR as he arrived home in a motorized wheelchair from a month of hospitalization and physical therapy.
"The doctors said he smashed his spinal cord pretty good…so they say he'll never walk again," said Dodd's father, Bruce, who thought padding and a protective net around the outside of the trampoline would help ensure his son's safety.
The reality is much different. And when it comes to trampolines, 13 Investigates has discovered it doesn't take a flip -- or even a fall -- to result in a devastating injury.
"He was just jumping, then he came down and started screaming," explained Clark, recalling her trip to Sky Zone with Cooper. "I was right there with him, supervising the whole time."
The Noblesville mom then paused and very slowly re-emphasized the main cause of her astonishment: "He…was…just…jumping."
Sky Zone posts signs around its facilities to warn participants about risky behavior that can result in injury. Customers are instructed not to push, tackle, run, race, engage in horseplay, double flip, single flip more than two times in a row, land on their head or neck, or to attempt any skill outside of their personal limitations.
"He wasn't doing any of that!" said Clark. "Jumping. Just jumping with no other kids around him. And he's two. He can only jump that high," she added, holding her hand six inches off the floor. "I didn't see how that could possibly break a leg. How can jumping just a few inches on a trampoline end up in a fractured left femur?"
To many parents, the answer may come as a surprise.
"It can snap"
"Pediatric bone is different than adult bone," explained Dr. Randall Loder, an orthopedic surgeon at Riley Hospital for Children in Indianapolis and chairman of the Indiana University Department of Orthopaedic Surgery. "The younger child's bone, it's softer. It's more compressible. It's spongy. Pediatric bone can fail relatively easily. If the forces are just right, it can snap."
It happens more frequently than many parents realize.
13 Investigates analyzed nationwide injury data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System. For 2014 (the most recent year for which data is available), hospital records show an estimated 104,691 people suffered trampoline injuries serious enough to visit an emergency room. The vast majority (85%) involve children – many of them very young.
CPSC data reveals children ages 2 to 5 accounted for 24,318 trampoline-related ER visits in 2014. A whopping 42% of those injuries among toddlers and pre-schoolers were for bone fractures.
And to put the trampoline fracture rate in perspective, government data shows emergency rooms across the United States treated seven times the number of broken bones for 4 to 6 years olds injured on trampolines compared to 4 to 6 years olds injured by playing soccer.
Yet Sky Zone and other trampoline parks market directly to parents of toddlers without ever mentioning the CPSC numbers.
"Some of the fractures can really be quite problematic," Loder said. "People think that a fracture in a child is a simple thing just to put a cast on, but that's not necessarily true. I don't think the public really understands the magnitude of the severity of some of these injuries that can happen."
Sydney Little understands what the surgeon is talking about, but she found out too late.
"I've had three surgeries already," said the fourth grader.
A lifetime of surgeries
Her story begins three years ago, when she and her younger brother bought a backyard trampoline with money they earned from a garage sale.
"At the time, I was excited thinking it would give them a break from their video games and iPads," said Sydney's mother, Susan. "Get the kids outside, get them exercise, fresh air, fun. I thought 'perfect.' It will be a great purchase."
At first, the plan seemed to be working, with the Littles and other kids in their Whiteland neighborhood coming over for frequent jumping sessions on the new trampoline.
Then, while jumping under the supervision of a babysitter, 6-year-old Sydney felt something she had never felt before.
"I went up, then I went back down, and then I just somehow landed on it wrong," she said. "I knew something wasn't right because I couldn't walk."
"She wasn't doing any kind of stunts. She was jumping. That's all they were doing was just jumping," her mom pointed out.
An x-ray showed Sydney broke her leg in two places – and then the REALLY bad news.
"One of those breaks went through the growth plate," Susan said.
"That's a problem," said Loder, who diagnosed the injury. "That's not a small injury."
A growth plate is an area of soft cartilage tissue near the end of children's bones. As kids get older, that thin band of cartilage produces new cells that harden and make the bone longer. It's a natural process that explains how children get taller. But if a growth plate gets cracked or badly injured, it means the bone's ability to grow in that area is jeopardized. While some growth plate injuries heal with no long-term implications for a child, others result in bones that stop growing and years of surgical intervention.
Loder surgically placed pins in Sydney's growth plate to stabilize the severe fracture she suffered while jumping on her trampoline. A second surgery was required to remove the pins, followed by a third operation to grind away uneven bone growth surrounding her damaged growth plate. It has meant navigating at Pleasant Crossing Elementary School in a wheelchair for much of the past two years.
Because Sydney's right leg is now a full inch shorter than her left, more surgeries lie ahead.
"Yeah, I know there will probably be more in the future…it's pretty scary," she admitted.
Sensing the gravity of her situation, she offered a moment of levity.
"We joke that I'm going to change my name to Eileen. I lean to the right," she said, showing the resilient sense of humor of a 9-year-old who's mature well beyond her years.
Her mother giggled, then reflected on the difficult reality facing her daughter.
"We have a long way to go. A lifetime to go. It's going to be our issue for the rest of her life," she said. "I had no idea that a trampoline could result in such a long term injury from just jumping. I had no idea."
No safe age
"Parents don't understand, nor would you expect them to. They're not physicians. They're not surgeons, " Loder told WTHR. "But once you've seen a child with significant growth plate problems and you know they have six or eight surgeries ahead of them in the future and, even then, they'll never truly have a normal extremity, you decide it's time to educate."
Part of that education is a comprehensive study on trampoline injuries that Loder published 16 months ago . Using the same government data reviewed by 13 Investigates, he discovered trampolines had resulted in about a million serious injuries during the previous decade. The doctor's findings – combined with his own personal work to repair children's bones that have been broken on trampolines – have caused him to issue a stern warning to any parent willing to listen:
"Children should not be on trampolines. The injury rate is just too high," he said.
So at what age is it safe to jump on a trampoline?
"I just don't think there's any safe age for a child to be on trampoline. Period," he replied.
Is such a broad statement overreacting?
"No, I certainly don't think so," Loder continued. "We all want our kids to be active. We all want them to be healthy. But there's lots of other things to do besides trampolines. Children should not be on trampolines. I stand by my statement."
His position is actually backed by the American Academy of Pediatrics. The organization's official position recommends pediatricians should advise parents to keep their kids off recreational trampolines – like those found at trampoline parks and those sold for backyard use.
Among the findings of AAP's own study:
- Many injuries occur even with reported adult supervision.
- Multiple jumpers increase injury risk, particularly to the smallest participants.
- Individuals 5 years and younger appear to be at increased risk of fractures and dislocations from trampoline-related injuries.
"Pediatricians need to actively discourage recreational trampoline use," wrote an author of the AAP's most recent policy statement. "Most trampoline injuries (75 percent) occur when multiple people are jumping on the mat. The smallest and youngest participants are usually at greater risk for significant injury, specifically children 5 years of age or younger. Forty-eight percent of injuries in this age group resulted in fractures or dislocations."
What about gymnastics?
The American Academy of Pediatrics does note an important exception.
It says trampolines at structured gymnastics programs are acceptable because they offer trained coaches who teach kids how to use trampolines safely – something that rarely happens in the backyard or at an indoor park.
"In a training facility like ours, you won't see children just bouncing off the walls on trampolines. That's not going to be allowed. We know better," said Baron DeVeau, director of gymnastics at Geist Sports Academy. "Our biggest concern is making sure that their body is under control on the trampoline, and that is what we teach our students."
DeVeau, who's been a gymnast and coach for 37 years, said his training facility begins teaching gymnastics to children as young as 18 months old at a program designed for toddlers and parents; both receive instruction on the trampoline.
"It helps them learn balance and it's definitely useful," he said.
At local trampoline parks, 13 Investigates observed parents signing release waivers prior to participating in Toddler Time and adult employees were monitoring jumping areas, but neither parents nor their children received any instruction or training in safe jumping.
"If a child hasn't learned the basics of bouncing and controlling their bounce, that's when you get a free-for-all and a high level of risk," DeVeau said.
USA Gymnastics, the national governing body for gymnastics in the United States, agrees.
"Use of trampolines requires appropriate and careful supervision, competent instruction, and proper equipment and safety measures, in an environment where these requirements can be met," the organization said in a statement sent to WTHR. "In gymnastics clubs, coaches use a variety of teaching tools – a bungee system, rope/belt harness, pit training, etc. – and follow the accepted skill progression, which means an athlete does not do a skill until he/she has mastered the appropriate progression of easier and preliminary skills."
USA Gymnastics-sanctioned gyms contacted by Eyewitness News say, as a result of the training policies, they have had virtually no serious injuries on their trampolines in the past three years.
The same cannot be said for local trampoline parks.
"We're going to need an ambulance"
Eyewitness News reviewed emergency medical calls from Sky Zone facilities in Fishers and Plainfield dating back to 2012. The 9-1-1 calls show dozens of serious injuries involving customers of all ages.
Last March, an employee at Sky Zone in Plainfield requested an ambulance for a teenager injured on a trampoline used for dodgeball.
"We have someone with a really bad knee injury. We're going to need an ambulance," she told the Hendricks County dispatcher. "There's no broken skin, but you can tell his bones are not where they're supposed to be."
Later that week, another employee called 9-1-1 for a 14-year-old boy who needed paramedics for what was described as a dislocated knee.
And that same day, a supervisor at the Fishers Sky Zone requested an ambulance for a 21-year-old with a broken ankle.
"He does have a compound fracture. The bone is exposed," the employee told the 9-1-1 operator.
Paramedics were called to the two facilities at least 70 combined times in recent years. That number does not include serious injuries for which customers did not request an ambulance – such as the injury to Cooper Clark.
"They just looked at me like my son was having a meltdown. They didn't offer any help, so I just picked him up and got him out to the car as fast as I could," said his mother, Carrie.
Response from Sky Zone
Sixth months after Cooper's injury, he no longer wears a cast, and his limp has essentially disappeared.
"It took him 16 weeks to recover," his mom said. "It was almost like having a newborn again. He had to learn how to crawl, learn how to walk, just relearn everything. But we were lucky. It did not affect his growth plate. Other kids aren't so fortunate."
Clark says she later sent an e-mail to the owner of Sky Zone to explain what had happened, to share her doctors' advice that no child – let alone a toddler – should be jumping on a recreational trampoline, and to ask the business to consider cancelling its Toddler Time program.
"I don't want to sue them. I'm not looking for money. I just want them to stop promoting trampolines to toddlers. That's what's so upsetting to me. I don't want anyone else to go through what we went through," she said.
Clark says she has yet to receive a reply from Sky Zone.
WTHR contacted Sky Zone to ask questions.
Calls to the local facilities were referred to a public relations agency in California, where a representative in Los Angeles told Eyewitness News we could not interview any owners, managers or employees at Sky Zone parks in Indiana.
"From a PR standpoint, it's a very touchy subject," explained Emily Johnston, an account coordinator at Konnect Public Relations.
The PR firm did send WTHR a statement on Sky Zone's behalf:
"We closely monitor activity in our parks to ensure safety. Out of the thousands of guests of all ages, who jump at Sky Zone Fishers, our injury rate is extremely low. We want our guests to have fun while jumping safely, which is why SkyZone has a strict set of safety guidelines that are enforced by our team members. Sky Zone offers special session times for younger children so they may jump with kids their own age. If parents choose to have their younger children jump, all of Sky Zone's safety rules adhere to the American Academy of Pediatrics safety precautions for trampolines that include the following:
- Adult supervision at all times
- Only one jumper on the trampoline at a time
- Adequate protective padding on the trampoline that is in good condition and appropriately placed"
While the Sky Zone facilities do post signs stating only one jumper is permitted on a trampoline at a time, 13 Investigates observed multiple children jumping on trampolines with no intervention by adult staff members.
Sky Zone's statement references the American Academy of Pediatrics safety precautions recommended for parents who choose to have their children jump on trampolines. But the company did not acknowledge or address the AAP's primary recommendation that parents should not allow their children to jump on recreational trampolines at all.
Sky Zone did not grant WTHR access to its injury rate numbers or how the company calculates that figure.
The company did not respond to WTHR's inquiry about whether it would consider suspending its Toddler Time program.
In the meantime, the Little and Clark families hope other families will learn from their painful lessons.
"As a mother, that's what you want. You want to protect your child, and I feel like I didn't protect my children by allowing them to do this," said Susan Little. "Just don't let them do it. It's not worth it."
"I don't want anyone else to go through what we went through," agreed Carrie Clark. "It is so preventable."
Trampoline advice for parents
The following recommendations for trampoline use come from the American Academy of Pediatrics:
Pediatricians should counsel their patients and families against recreational trampoline use and explain that current data indicate safety measures have not significantly reduced injury rates and that catastrophic injuries do occur. For families who persist in home trampoline use despite this recommendation, pediatricians should advise parents and their children on the following guidelines until better information becomes available:
- Homeowners should verify that their insurance policies cover trampoline-related claims. Coverage is highly variable and a rider may need to be obtained.
- Trampoline use should be restricted to a single jumper on the mat at any given time.
- Trampolines should have adequate protective padding that is in good condition and appropriately placed.
- Trampolines should be set at ground level whenever possible or on a level surface and in an area cleared of any surrounding hazards.
- Frequent inspection and appropriate replacement of protective padding, net enclosure, and any other damaged parts should occur.
- Trampolines should be discarded if replacement parts are unavailable and the product is worn or damaged.
- Somersaults and flips are among the most common causes of permanent and devastating cervical spine injuries and should not be performed in the recreational setting.
- Active supervision by adults familiar with the above recommendations should occur at all times. Supervising adults should be willing and able to enforce these guidelines. Mere presence of an adult is not sufficient.
- Parents should confirm that these guidelines are in place anytime their child is likely to use a trampoline.
- Data are insufficient regarding the safety of trampoline parks and similar installations. Until further safety information is available, the cautions outlined here regarding home trampolines are also applicable to recreational trampoline use in any setting.
- Pediatricians should advocate for all commercial jump parks to inform jumpers of the risk associated with trampoline use and the AAP guidelines for use.
- Parents should be aware that the rules and regulations of jump parks may not be consistent with the AAP guidelines for trampoline use and that the jumpers may be at increased risk for suffering an injury, potentially catastrophic.
- Injury rates at these facilities should be monitored.
- The trampoline was designed as a piece of specialized training equipment for specific sports. Pediatricians should only endorse use of trampolines as part of a structured training program with appropriate coaching, supervision, and safety measures in place. In addition to the aforementioned recommendations, the following apply to trampolines used in the training setting:
- Any attempts at new skills, particularly somersaults or flips, should only follow an appropriate skill progression and include appropriate coaching and spotting measures.
- Use of safety belts/harnesses is encouraged when skill development is being taught.