Back to school time means more children headed for the school playground - and more risk for injuries.

Safe Kids says playground accidents are one of the leading causes of injury to children in elementary school. Each year, in the United States, more than 200,000 children receive emergency department care for injuries that occurred on playground equipment. Approximately 3 out of 4 playground accidents occur on public playgrounds, including school facilities, as opposed to backyard play equipment.

Safe Kids says strangulation is the main risk on playgrounds. The group says some 15 die each year when a piece of loose clothing or jewelry gets caught on equipment or the child's head gets stuck between climbing bars.

As far as injuries, falls are the big concern. Safe Kids says almost half of all playground-related injuries are severe including fractures, internal injuries, concussions,dislocations, and amputations.

"A child who falls 10 feet is at risk of spinal cord injury, paralysis and death,” Cherie Sage, State Director for Safe Kids Kansas, said in a statement. “Protective surface materials can make a life-and-death difference.”

The U.S. Consumer Product Safety Commission issues guidelines for playground surfacing and age-appropriate warning labels on playground equipment. In 15 states, some or all of the guidelines in the CPSC’s Handbook for Public Playground Safety are mandatory under state law.

“Nothing can take the place of active supervision, but we do need to make sure our kids are playing in safe environments in the first place,” Sage said. “The ground should be covered 12 inches deep with shredded rubber, hardwood fiber mulch or fine sand, extending at least six feet in all directions around the equipment.”

To reduce a child's injury risk, Safe Kids says children’s clothing and outerwear should be free of drawstrings and should fit snugly to minimize the risk of getting stuck in a piece of equipment. Do not allow kids to wear helmets, necklaces, purses or scarves on theplayground or engage in any pushing, shoving or crowding around playground equipment.