We periodically get asked about the use of trampolines by people with Down syndrome. Trampolines cause many injuries to both children and adults. The American Academy of Orthopaedic Surgeons reported that the Consumer Product Safety Commission identified more than 295,000 “medically treated trampoline injuries” in the United States in 2015. This included 102,943 emergency department visits.
The American Academy of Pediatrics Health Supervision for Children and Adolescents With Down Syndrome published in 2022 states:
“Discuss with caregivers that trampoline use should be avoided by all children, with or without Down syndrome, unless part of a structured training program with appropriate supervision and safety measures in place…Parents can be advised that participation in contact sports, such as football, soccer, and gymnastics, places children at risk for spinal cord injury.”
We are not aware of research that demonstrates a normal neck x-ray (one that does not show atlantoaxial instability (AAI)*) eliminates (or even reduces) the likelihood of severe injury and, thus, makes it safe for a child with Down syndrome (DS) to play on a trampoline. It is known, for example, that a normal neck x-ray found when screening people with DS with lateral x-rays before surgery does not eliminate the potential for spinal cord injury during anesthesia. (It is recommended that all people with DS be treated with the same cautions while under anesthesia whether they have AAI or not).
The American Academy of Orthopaedics recommends the following for all children (with or without DS) to minimize and avoid trampoline injuries:
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Do not allow children younger than 6 years of age to use trampolines.
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Provide careful adult supervision, property safety measures, and instruction when trampolines are used for physical education, competitive gymnastics, diving training, and other similar activities.
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Allow only one participant at a time to use a trampoline.
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Ensure that spotters are present when participants are jumping. Somersaults or high-risk maneuvers should be avoided without proper supervision and instruction; these maneuvers should be attempted only with proper use of protective equipment, such as a harness.
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Place the trampoline jumping surface at ground level.
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Ensure that supporting bars, strings, and surrounding landing surfaces have adequate protective padding that is in good condition and appropriately placed.
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Regularly check equipment for safety conditions; discard worn or damaged equipment if replacement parts are unavailable.
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Do not rely on safety net enclosures for injury prevention; most injuries occur on the trampoline surface.
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Remove trampoline ladders after use to prevent unsupervised access by young children.
*AAI is the slippage of the position of the first vertebrae in the neck compared to the position of the second. The particular concern with AAI or instability anywhere in the spine is that the canal formed by the vertebrae is where the spinal cord sits. If the canal becomes narrowed, the spinal cord can get "pinched" (compressed), and damage to the spinal cord (which can cause neurologic impairments) can occur. Additional information about AAI can be found in this podcast episode from the Down Syndrome Center of Western Pennsylvania.
This article was adapted from a Q&A developed in partnership with LuMind IDSC Foundation. This Q&A is available for free along with other Q&As at www.myDSC.org.
