The recreational environment ranges from playground and playground equipment to sports programs to swimming areas to artificial sun tanning to body piercing and tattooing which may lead to scarring and infections. Small children may become infected when they play with animals. Skin eruptions of all types occur from being in the outdoor environment and exposed to a variety of plants which the sensitive individual normally does not encounter.

Obviously, the problems which have been identified in other environments, especially air pollution and water, soil, and land contamination, also apply to the recreational environment.

Faulty equipment, improper surfaces, and careless behavior contribute to more than 200,000 children being treated in the emergency room of hospitals on a yearly basis. About 45% of playground-related injuries are severe including fractures, internal injuries, concussions, dislocations, and amputations. About 75% of playground injuries are caused by equipment in public playgrounds, mostly schools and daycare centers. There is a serious concern about blood-borne infections including hepatitis, HIV, and methicillin-resistant Staphylococcus aureus.

About 3.5 million sports injuries occur each year in the 5-24-year-old age group. These injuries are caused by improper sports gear, inadequate physical preparation including warm-up, temperature, and the risky behavior of young people.

Recreational water-related illnesses and injuries are prevalent among children. Microorganisms are spread by swallowing contaminated water, breathing in aerosols or physically coming in contact with contaminated water in swimming pools, hot tubs, water parks, etc. Recreational water illnesses include gastrointestinal, skin, ear, respiratory, neurological, and wound infections. Most frequently the children will have diarrhea, which may be caused by several different microorganisms. Drowning can occur when swimming and boating. Non-fatal drowning can cause brain damage and associated problems. The most frequent injury category among 1 to 4-year-old children is drowning. (See endnote 51.)

Artificial sun tanning, even as few as 10 times per year, can increase the chance of melanoma during a lifetime by sevenfold. Approximately 60,000 people are diagnosed with melanoma each year and at least 8000 of them die. Squamous cell carcinoma and basal cell carcinoma are also associated with tanning beds. Each year, 250,000 people are diagnosed with squamous cell carcinoma, and at least 800,000 people are diagnosed with basal cell carcinoma yearly. The problem of tanning beds is especially significant in teenage girls.

Dogs bite more than 4.7 million people a year, 800,000 of whom are treated in an emergency room. About half of these people are children, typically aged between 5 and 9 years.

There are health hazards associated with tattooing and body piercing. It is estimated that 15-20% of the young adult and teenage populations in the United States have tattoos or body piercings. There is a serious concern about blood-borne infections, HIV transmission, cardiac problems, skin disruption, and skin infections. Serious scarring and disfigurement can be an additional concern in some people.

Best Practices for Children in the Recreational Environment (See Chapter 10, “Recreational Environment and Swimming Areas”)

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