Counseling About Bicycle Safety
Each year in the United States, approximately 900 persons die from injuries due to bicycle crashes, and more than 500,000 persons are treated in emergency departments for bicycle mishaps. Head injury is the greatest risk posed to bicyclists, comprising one third of emergency department visits, two thirds of hospital admissions, and three fourths of deaths. Facial injuries to bicyclists occur at a rate nearly identical to that of head injuries (43 and 45 per 100,000 population, respectively). Although more than 90% of deaths from bicycle-related injuries are caused by collisions with motor vehicles, these collisions are associated with fewer than 25% of nonfatal head injuries. More than 40% of deaths occur in cyclists 15 years of age and younger. Males have higher injury rates than females in all age categories, with the overall rate of emergency department-treated injuries being 320 per 100,000 males and 130 per 100,000 females. The rates are highest for 5- to 14-year-old males. When cycling trips rather than population is the denominator, children ages 5 to 15 years have the highest injury rates of 430.7 injuries per 1 million trips.
Bicycle safety counseling includes recommending helmet use, encouraging parents to select a properly fitting bicycle, providing training in riding skills, and encouraging supervision of childrens riding. Skills training programs and information are offered by local and national bicycle clubs and state and local traffic safety education programs. In most states, bicycles are covered by the motor vehicle laws; cities, towns, and municipalities may have ordinances governing bicycle riding, registration, and licensing. Parents can be held legally responsible for their childs violation of local bicycle ordinances as well as the state motor vehicle laws.
Wearing a bicycle helmet is the most feasible strategy to reduce bicycle-related head and facial injuries. Substantial evidence from scientific studies over the past 10 years indicates that wearing a bicycle helmet is the most readily implemented intervention to reduce bicycle-related head and brain injuries. The scientific evidence that bicycle helmets protect against head, brain, and facial injuries has been established by five well-designed case-control studies. Additional evidence has been provided from time series studies in Australia and the United States. Bicycle helmets protect cyclists of all ages who are involved in a bicycle crash. This protection extends to crashes from a variety of causes (such as falls and collisions with fixed and moving objects) and includes crashes involving motor vehicles. A case-control study found that helmet use reduces the risk of head injury by 85%, brain injury by 88%, and severe brain injury by at least 75%. Parents should set an example for children by wearing helmets themselves. Annual observations of bicyclists in Seattle, Washington, for the past 10 years have shown that children are much more likely to wear helmets if they are riding with adults who wear helmets.
Helmets come in a wide variety of sizes, styles, and colors and range in price from about $10 to $140. Helmets certified by Snell, the Consumer Product Safety Commission, ASTM, or ANSI are equally protective. Helmets should be comfortable and fit well when placed in a level position on the head. Chin straps should be snug so that the helmet does not move out of position when pushed gently from the back, side, or front. The helmet should not pull off with the strap fastened. Encourage parents to let their child select the helmet and decorate it with stickers. Finding a good helmet fit takes time. Parents should allow as much as 30 minutes to get a proper helmet fit. A good time to adjust the helmet is when the child is watching TV, when he or she is relaxed and the parent has plenty of time.
Diane C. Thompson, MS, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
Comment: Injuries are the number one killer of Americans ages 1 to 40 years. Thus, counseling about injury prevention should be a priority. For bike injuries, the counseling message is helmets, helmets, helmets! In addition, there have been reports of handle-bars acting as hidden "spears" (Pediatrics. 1998;102:596601) and the bike center bar causing serious straddle injuries (Pediatrics. 2000;105:e32). Helmet padding and equipment redesign may decrease the severity of these injuries. As mentioned, teaching youth bike-riding skills and safety rules, monitoring developmentally appropriate locations for bike riding, and providing adult supervision also are important for a child to enjoy the many benefits of bicycling safely.
Tina L. Cheng, MD, MPH, Associate Editor, In Brief
References
Prevention of Bicycle-related Injuries: Helmets, Education and Legislation. Rivara FP, Thompson DC, Patterson MQ, Thompson RS. Annu Rev Public Health. 1998;19:293-318[Medline]
Review of Childhood Injuries, Bicycles and Prevention Materials, Bike Helmet Fact Sheet, Bike Helmet FAQ, Bike Helmet Campaign Guide, Tips to Get Kids to Wear Helmets, Training Programs for Bicycle Safety. Harborview Injury Prevention and Research Center Web Page:
http://depts.washington.edu/hiprc
Effectiveness of Bicycle Safety Helmets in Preventing Head Injuries: A Case-Control Study. Thompson DC, Rivara FP, Thompson RS. JAMA. 1996;276:1968-1973[Abstract]
Effectiveness of Bicycle Safety Helmets in Preventing Serious Facial Injury. Thompson DC, Nunn ME, Thompson RS, Rivara FP. JAMA. 1996;276:1974-1975[Abstract]
Increasing Bicycle Helmet Effectiveness: The Importance of Proper Helmet Fit and Wearing Position. Thompson DC, Thompson RS, Kaufman A, Rivara FP. HMO Practice. 1997;11:25-26[Medline]
The Seattle Childrens Bicycle Helmet Campaign: Changes in Helmet Use and Head Injury Admissions. Rivara FP, Thompson DC, Thompson RS, et al. Pediatrics. 1994;93:567-569[Abstract]
I'm another one of those bad parents with a trampoline. DD does gymnastics as well as cheerleading. DS skateboards and plays football. We live life on the edge I guess! 
