Oct. 20, 2022

More than 800,000 children sustained trampoline injuries in the U.S. between 2009 and 2018, most of whom were under the age of 16, according to a 2022 report using a national database and published in Pediatric Emergency Care. Most of these injuries occurred at the children's own homes. Of these injuries, 34% were long bone fractures in the lower and upper extremities. Radius and ulna fractures were the most common — usually the result of a fall on an outstretched hand.

But trampoline injuries cover a wide spectrum, from small lacerations to fractures of the spine, head, ribs and sternum. And the number and variety of injuries continue to climb, despite efforts to make trampolines less dangerous with enclosure nets and other safety features.

"Kids are endlessly inventive in figuring out ways to break bones on trampolines," says William J. Shaughnessy, M.D., a pediatric orthopedic surgeon at Mayo Clinic's campus in Rochester, Minnesota. "Safety nets are pretty effective at preventing children from falling off, but in the absence of those, they inevitably do fall. And even with netting, injuries can occur when two or more kids are jumping at the same time and one lands on top of the other. We have also seen cases where children were injured when they crawled under the trampoline. And we had one 14-year-old who broke both arms jumping over the net. We told him, 'Nets are meant to keep you from doing this.' "

Even children who don't jump are at risk, he says, describing a young girl who promised her parents she would stay off trampolines entirely. True to her word, the girl sat on the sidelines, watching her friends, until one child bounced off, landing on the bystander and breaking her arm. Other kids are injured in unique ways: One teenage boy treated for a trampoline injury in mid-January admitted that a sled and a snowmobile might have been involved too.

It's no exaggeration to say that Dr. Shaughnessy has pretty much seen it all.

"The only thing I've never seen — and I'm very happy about that — is a life-threatening injury or paralysis that has turned into a permanent neurological deficit," he says. "All have been injuries from which kids have recovered, including a broken neck. Trampolines rarely result in loss of life or limb, which I think is why they're still being sold."

Treating trampoline injuries

Dr. Shaughnessy says even non-life-threatening injuries may require more care than smaller hospitals are comfortable providing.

"Some emergency doctors are comfortable putting casts on displaced fractures and will follow up with the child's family physician or call Mayo to follow up. Others have less experience treating children and would prefer to transfer pediatric patients. In that case, they should verify that the child's neurological status is intact and splint the fracture before transfer," he explains. "They should send these patients to the emergency department (ED), where we can either cast the broken bone or admit them — kids with femur or cervical fractures usually are admitted."

Dr. Shaughnessy says about 20% to 30% of children with trampoline injuries need surgery. "Some fractures are automatically treated surgically, especially supracondylar fractures of the humerus. For some reason, that bone breaks easily when someone lands on an outstretched hand, which often happens when children reach out to catch themselves," he says.

At Mayo Clinic, a pediatric physician is available for round-the-clock consultations. "Some doctors want us to look at X-rays; others want to discuss a plan for treating a specific fracture or discuss the possibility of transfer. It's helpful to have someone verify that a particular plan is correct. All these approaches are fine, although kids with displaced fractures should be referred to Mayo unless there is an orthopedic surgeon at a smaller hospital who can follow them," Dr. Shaughnessy says.

Kids versus trampolines

Dr. Shaughnessy also suggests that ED health care providers discuss prevention strategies with injured kids and their families. Measures to consider include:

• Ensuring that a backyard trampoline has a net — that alone can cut the fracture rate in half.
• Allowing only one child on the trampoline at a time. A significant mismatch in size and weight, such as a teen and a toddler, is especially dangerous.
• Teaching kids not to jump onto the trampoline from roofs and other high places, which can lead to especially serious injuries.
• Checking homeowners insurance; most policies don't cover trampoline injuries.

Dr. Shaughnessy says trampoline injuries aren't all that different from injuries kids get in bike or playground accidents. Still, he says, "If kids weren't so creative, they wouldn't get as injured."

For more information

Hussein MH, et al. Trampoline injuries in children and adolescents: A jumping threat. Pediatric Emergency Care. 2022;38:e894.

Refer a patient to Mayo Clinic.