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PEDIATRICS Vol. 108 No. 4 October 2001, pp. 1030-1032
AMERICAN ACADEMY OF PEDIATRICS:
Bicycle Helmets
Bicycling remains one of the most popular
recreational sports among children in America and is the leading cause
of recreational sports injuries treated in emergency departments. An
estimated 23 000 children younger than 21 years sustained head
injuries (excluding the face) while bicycling in 1998. The bicycle
helmet is a very effective device that can prevent the occurrence of up
to 88% of serious brain injuries. Despite this, most children do not
wear a helmet each time they ride a bicycle, and adolescents are
particularly resistant to helmet use. Recently, a group of national
experts and government agencies renewed the call for all bicyclists to
wear helmets. This policy statement describes the role of the
pediatrician in helping attain universal helmet use among children and
teens for each bicycle ride.
ABSTRACT
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Abstract
Background
Recommendation
References
Bicycling continues to be one of the most popular
recreational sports in America. An estimated 44.3 million children
younger than 21 years ride bicycles in the United States.1
It is a clean, efficient mode of transportation for children to make short neighborhood trips, and bicycling can be an enjoyable form of
aerobic physical activity for children and adolescents.
As with all physical activities, bicycling is not without hazards.
Children are at risk of injury from falls resulting from either
intrinsic factors, such as exceeding their ability level, or extrinsic
factors, such as swerving from or striking a motor vehicle or fixed
object. Bicycle-related injuries among children younger than 21 years
resulted in approximately 275 deaths2 and an estimated
430 000 visits to emergency departments in 1998.3 Among
all recreational sports, bicycling injuries are the leading cause of
emergency department visits for children and adolescents. Traumatic
brain injury accounts for two thirds of all bicycle-related fatalities.4 An estimated 23 000 children required
emergency care after sustaining a traumatic brain injury while
bicycling in 1998, accounting for about 5% of all bicycle-related
injuries.3
Use of a bicycle helmet can prevent or lessen the severity of brain
injury during a bicycle crash. Helmets work by absorbing some of the
energy and dissipating the sharp energy peak of the blow over
a larger area for a slightly longer time. A bicycle helmet typically
consists of rigid crushable foam covered with a thin layer of plastic.
It is held to the head by a retention system (chin strap) composed of
flexible straps and hardware. The skull provides another layer of
protection and absorbs additional energy. If forces are not extreme and
the helmet is intact and worn correctly, the helmet-skull system should
protect the brain from injury in most cases.
Correctly placing and securing a helmet on the head is important to
maximize protection. Because 4 helmet sizes exist and models fit
slightly differently, a child should try on several sizes and models to
find the best fit when purchasing a helmet. Correct fit involves
positioning the helmet on the head so it sits low on the forehead and
is parallel to the ground when the head is held upright (the wearer
should be able to see its lower brim when looking all the way up);
installing or removing inside pads to make the helmet snug; and
adjusting the chin strap so it is comfortably snug (ie, tight with room
for only 2 fingers to be inserted between the strap and the chin). When
in place with the chin strap secure, the helmet should not come off or shift over the eyes when the wearer tries to shake it loose.
Even when worn properly, a helmet does not offer an unlimited degree of
protection, particularly against high-energy crashes. Even in
low-impact falls, the helmet may be damaged by the force delivered,
rendering it less effective in subsequent impacts. This damage
may not be apparent to the eye. Accordingly, any helmet that has
sustained a substantial blow should be discarded and replaced,
including any helmet involved in a crash in which the head has hit a
hard surface or in which a fall has resulted in marks on the shell.
Furthermore, helmet integrity does not persist throughout time. Because
some helmet materials deteriorate with age, the Snell Memorial
Foundation, a nonprofit organization established to test and certify
helmet safety, recommends that a helmet be replaced at least every 5 years, or sooner if the manufacturer recommends it.
Wearing a bicycle helmet is one of the most effective safety measures a
child can take to prevent injury. The first study of helmet
effectiveness indicated that it could prevent 88% of serious brain
injuries.5 In subsequent studies, helmets prevented 69%
of head injuries6 and 65% of injuries to the mid and
upper face.7 Despite the enormous degree of protection
afforded by a bicycle helmet, a 1994 study indicated that only 25% of
children 5 to 14 years of age usually or always wore a helmet while
bicycling.8 In 1999, the percentage of children who
reported always using helmets varied among states from 13% to
65%.9 Reasons usually given for not using a helmet are
discomfort (especially heat), perceived lack of importance for casual
riding (in contrast to sport or race bicycling), lack of style, or peer
pressure.8,10 Cost was seldom cited as an important factor
now that helmets are widely available for less than $20.
Two factors are strongly associated with bicycle helmet use by young
children Recently, a group of national experts from safety organizations and
government agencies called for universal helmet use by all bicyclists,
regardless of age. This goal has 3 strategies: 1) creating a national
bicycle helmet safety campaign; 2) creating tools to promote helmet
use; and 3) assisting states and communities wishing to address helmet
use through legislation.16
Voluntary helmet safety standards have existed for many years, with the
American National Standards Institute (ANSI), Snell Memorial
Foundation, and American Society for Testing and Materials (ASTM) each
establishing their own safety standards based on the ability of a
helmet to manage the energy of a drop onto a metal anvil and the
strength of the strap system. In 1999, the US Consumer Product Safety
Commission (CPSC) issued a mandatory safety standard for bicycle
helmets, requiring all helmets manufactured or imported for sale in the
United States after March 1999 to comply with this
standard.17 Accordingly, parents should look for a sticker
documenting CPSC approval on the inside liner of any new helmet
purchased. Older helmets certified by the ASTM and/or the Snell
Memorial Foundation may continue to be used, but helmets certified only by the ANSI should be discarded, because they were drop-tested from a height below the current 2 meter standard. Multisport helmets are designed for in-line skating, skateboarding, bicycling, and other sports. If a multisport helmet is intended or
marketed (even by implication) to be used while bicycling, it must be
certified to meet the CPSC standard for bicycle helmets.
Helmet Use
BACKGROUND
Top
Abstract
Background
Recommendation
References
helmet use by an accompanying parent and a state mandatory
helmet use law or local ordinance. In one study, a helmet was worn by
90% of children from a low-income neighborhood and 100% of children
from a high-income neighborhood when an accompanying parent wore a
helmet.11 After enactment of a helmet law in Georgia,
reported helmet use increased from 35% to 53%,12 and in
Oregon, enactment of a helmet law was associated with a doubling of
observed helmet use to 49% among children and youth.13 Presently, 17 states and the District of Columbia have age-specific bicycle helmet laws, usually covering bicyclists younger than 16 years.
These laws affect 49% of all US children younger than 15 years.
Another 2 states have recently enacted legislation. Such legislation
has been shown to be more cost-effective than community-based or
school-based interventions14 and is a Healthy People
2010 objective.15
RECOMMENDATIONS
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Abstract
Background
Recommendation
References
Advocacy
- Pediatricians should encourage parents and other child care providers to require children to wear a bicycle helmet when they begin riding tricycles or other wheeled vehicles or toys. Pediatricians should inform parents and patients of the importance of wearing a bicycle helmet and the dangers of riding without one. This information is especially important for adolescents, because they are particularly resistant to wearing a helmet.
- Pediatricians should encourage parents to wear a helmet when bicycling to model safe behavior for their children.
- Pediatricians should serve as community and legislative advocates to encourage state and local governments to enact legislation requiring helmet use by all bicyclists and mandating bicycle rental agencies to include helmets as part of the rental contract. The American Academy of Pediatrics has developed model state legislation titled "Child Bicycle Safety Act."19
- Pediatricians should encourage school districts to make helmet wearing mandatory during bicycle rides to and from school and during school-related bicycle trips.
- Coalitions of physicians, parents, and community leaders should develop and support community-based and school-based education programs to promote bicycle safety training that emphasizes helmet use. A national initiative to encourage all children to wear a helmet whenever bicycling deserves support.
- Retail outlets are urged to carry affordable helmets and include them in the purchase of every new bicycle sold.
- Organizations promoting helmet use are encouraged to provide attractive posters and educational videotapes for retailers and pediatricians to display as well as other materials for parent groups to distribute, emphasizing the safety advantages and attractiveness of protective headgear. All materials should teach how to wear a helmet correctly.
- When bicyclists are shown in the popular media (including television, advertisements, movies, and promotional materials), those responsible are urged to consistently show them wearing a helmet.
Committee on Injury and Poison Prevention, 2001-2002
Marilyn J. Bull, MD, Chairperson
Phyllis Agran, MD, MPH
H. Garry Gardner, MD
Danielle Laraque, MD
Susan H. Pollack, MD
Gary A. Smith, MD, DrPH
Milton Tenenbein, MD
Joseph Wright, MD, MPH
Liaisons
Ruth A. Brenner, MD, MPH
National Institute of Child Health and Human Development
Stephanie Bryn, MPH
Health Resources and Services Administration/Maternal and Child Health Bureau
Richard A. Schieber, MD, MPH
Centers for Disease Control and Prevention
Alexander (Sandy) Sinclair
National Highway Traffic Safety Administration
Deborah Tinsworth
US Consumer Product Safety Commission
Lynn Warda, MD
Canadian Paediatric Society
Consultants
Murray L. Katcher, MD, PhD
Howard Spivak, MD
Randy Swart
Bicycle Helmet Safety Institute
Staff
Heather Newland
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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ANSI, American National Standards Institute; ASTM, American Society for Testing and Materials; CPSC, Consumer Product Safety Commission.
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REFERENCES |
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Abstract
Background
Recommendation
References
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- Rodgers GB Bicycle and bicycle helmet use patterns in the United States in 1998. J Safety Res 2000; 31:149-158
- Centers for Disease Control and Prevention, National Center for Health Statistics. 1998 Mortality Tapes. Hyattsville, MD: Division of Data Services, National Center for Health Statistics; 2000
- US Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS). Bethesda, MD: US Consumer Product Safety Commission; 1999
- Centers for Disease Control and Prevention. Injury-control recommendations: bicycle helmets. MMWR Morb Mortal Wkly Rep. 1995;44(RR-1):1-17
- Thompson RS, Rivara FP, Thompson DC A case control study of the effectiveness of bicycle safety helmets. N Engl J Med 1989; 320:1361-1367 [Abstract]
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Thompson DC,
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Effectiveness of bicycle safety
helmets in preventing head injuries. A case-control study.
JAMA
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Effectiveness of bicycle
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Bicycle helmet use among
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[Abstract/Free Full Text] - National Center for Chronic Disease Prevention and Health Promotion. Behavioral Risk Factor Surveillance System (BRFSS). Available at: http//www.cdc.gov/nccdphp/brfss. Accessed August 19, 2001
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Howland J,
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Effect of a state law on reported bicycle helmet ownership and use.
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[Abstract/Free Full Text] - Hatziandreu EJ, Sacks JJ, Brown R, Taylor WR, Rosenberg ML, Graham JD The cost effectiveness of three programs to increase use of bicycle helmets among children. Public Health Rep 1995; 110:251-259 [Medline]
- US Department of Health and Human Services. Healthy People 2010. Vol 1 and 2. 2nd ed. Washington, DC: US Government Printing Office; 2000
- National Highway Traffic Safety Administration, National Center for Injury Prevention and Control, and Federal Highway Administration. National Strategies for Advancing Bicycle Safety. Washington, DC: US Department of Transportation; 2001
- Safety Standard for Bicycle Helmets. 63 Federal Register 11711-11747 (1998) (codified at 16 CFR §1203)
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Powell EC,
Tanz RR
Tykes and bikes: injuries associated with
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Pediatrics (ISSN 0031 4005). Copyright ©2001 by the American Academy of Pediatrics
Statements of reaffirmation:
- AAP Publications Retired or Reaffirmed, October 2006
- American Academy of Pediatrics
Pediatrics 2007 119: 405.[Extract] [Full Text] [PDF]
-
AAP Publications Reaffirmed and Retired, February and May 2008
Pediatrics 2008 122: 450.[Extract] [Full Text] [PDF]
The following policy statement has been revised:
- Bicycle Helmets
- Committee on Injury and Poison Prevention
Pediatrics 1995 95: 609-610.[Abstract] [PDF]
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