Bounce house sales are on the rise. So are injuries caused by them.

Daniel Goldstein’s daughter was 6 when she climbed out of a big bounce castle unable to move her arm. The injury occurred inside the inflatable when a friend had been trying to pull her up to a standing position. As an orthopedic surgeon, Goldstein never expected that the first nursemaid’s elbow — an injury in which the radius becomes dislocated — he would see would be his daughter’s. Luckily, the injury wasn’t severe, and he was able to pop the bone back in place himself. His daughter’s mobility returned immediately, and she was pain-free within 30 minutes.

“As an orthopedic surgeon who used to cover pediatric injuries in an emergency room, my fear was always trampolines, monkey bars, the things you normally hear about,” Goldstein tells Yahoo Life. “When she got hurt in this freak accident, which is probably the most common injury in a bounce house, it spurred me to look into it. I didn’t realize that there are more than 10,000 annual [emergency room] visits a year just from bounce house injuries, so it’s amazingly common and we just don’t think about it.”

Bounce house injuries have been steadily increasing since 2000. A recent study by Children’s Hospital of Orange County (CHOC), in California, found that the most common types of injuries are fractures (25.8%), muscle strain (25.7%) and contusions (14.5%). Most of these injuries (96%) occur at home.

Bounce houses can also become dangerous when they are “dragged, blown over or lofted by winds,” according to 2022 study that found that there have been a sizable number (at least 479) of weather-related bounce house injuries, and more than two dozen deaths, between 2000 and 2021. Based on their findings, the study’s authors also developed a website to educate the public about weather-related bounce house events and states’ various safety regulations and guidelines (or lack thereof).

Despite the huge increase in bounce house-related injuries over the last two decades, these inflatables have surged in popularity in recent years. They are now more widely available because parents can buy their own online, saving themselves the cost of rental fees for individual events. Also, for many parents during the height of pandemic lockdowns, bounce houses in the backyard became a much sought-after way for their kids to release energy.

“It was the best during COVID,” Crady Schneider, a mom of three and co-owner of Memphis Moms Collective, tells Yahoo Life. Her family only uses their bounce house inside, where it has evolved into more than a place for her kids to jump. “My kids play with it in all kinds of ways,” she shares. “They do bounce in it and run around it. They use it as a fort. Set all their stuffed animals and make a village for them and lay in it and play games and use just the slide.” Schneider’s kids have never been injured in it, but they do occasionally get rug burns from the rough material.

The increased popularity of bounce houses during the pandemic is what first led CHOC to investigate them. “Anecdotally, during COVID, we saw a lot of new injuries that we weren’t seeing before. ... We had a lot of bounce house injuries,” Makenzie Ferguson, an injury prevention educator in CHOC’s trauma center and co-author of its study, tells Yahoo Life. “The good thing is, these injuries aren’t super-severe; normally the kids just go home from the ER.”

Most of these injuries are also preventable. Here’s what can parents do to keep their kids safe in and around bounce houses.

Set it up in a safe space and make sure it’s properly secured

Dr. Marla Levine, a pediatric emergency medicine physician at Monroe Carell Jr. Children's Hospital at Vanderbilt, advises parents to set up bounce houses on a flat surface, and, if outside, away from any trees. Ferguson also encourages parents to make sure the door or slide opens to a soft surface, such as grass, so kids are not falling out of the bounce house onto concrete. The inflatable also needs to be properly secured, and the environmental conditions need to be right. It should not be windy enough for the bounce house to blow over or roll. “A good rule of thumb is if the tops of trees are swaying, don’t set up the bounce house,” Levine tells Yahoo Life.

Kids should wear appropriate clothing

“[You] don’t want injuries based on how the child is dressed in the bounce house,” Levine says. Kids should jump barefoot or wear non-slip socks to avoid slipping. They should also avoid loose-fitting clothing or necklaces that can be pulled, and sharp objects like jewelry, glasses or hair clips.

Limit the number of kids jumping, and group kids by size

“Try to group the kids in there by age or size, because a lot of times we see injuries where they get hit by older kids because they’re smaller,” Ferguson says. Goldstein also wants parents to keep kids from bouncing near the entrance to the bounce house, because a lot of injuries happen when kids fall out.

Goldstein knew that he would never allow his kids to have a trampoline at home because of the high risk for injury, but, even after his daughter’s dislocation, he was OK with owning a bounce house. They store it in the basement and use it inside. “These things are great for kids,” he says. “They love them, and they generally are safe, but you have to make sure you are keeping the kids as safe as possible.”