When the pediatrician asks a 14-year-old about her favorite activities during a well-child visit, she says she likes to ride her bike with friends. The pediatrician then discusses the importance of wearing a bicycle helmet. The teen asks about the evidence showing helmets prevent head injuries, and her parent inquires if their state has any laws requiring kids to wear bicycle helmets.
Bicycle riding and snow sports are two of the leading causes of sports-related head injuries in children. Therefore, the importance of wearing a helmet when participating in these activities is a relevant topic for anticipatory guidance for many families with toddlers to college-age children.
An updated AAP policy statement and accompanying technical report provide pediatricians with the evidence on the effectiveness of helmets in preventing traumatic brain injury and facial injury. The effectiveness of legislation, anticipatory guidance, and school and community safety programs also is discussed, along with the need for more epidemiologic, health equity and interventional research in this area.
The policy statement and technical report Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports, from the AAP Council on Injury, Violence and Poison Prevention, are available at https://doi.org/10.1542/peds.2022-058877 and https://doi.org/10.1542/peds.2022-058878 and will be published in the September issue of Pediatrics.
Most of the data on the effectiveness of helmets and strategies to increase their use are related to bicycle riding. Helmet use decreases the risk of head injuries by about 85% and facial injuries by about 65% among bicyclists.
For snow sports (e.g., skiing, snowboarding), it is estimated that helmets decrease head injuries by about 40%. Helmets have not been associated with increasing neck injuries.
Helmets also play a critical role in decreasing pediatric injuries in other sports and recreational activities such as ice skating, nonmotorized wheeled activities (e.g., skateboarding and roller skating) and horseback riding.
Barriers to use
Reasons cited for not wearing a helmet include cost, discomfort, appearance, believing helmets are unnecessary to prevent injury and nonuse by friends and family. In contrast, reasons for wearing a helmet include protection from injury, to comply with rules/laws and family recommendation.
Strategies to increase helmet use
State legislation has been found to increase helmet use and prevent head injuries. In the U.S., 21 states and the District of Columbia have laws for helmet use when riding a bicycle. However, laws have been enacted only for children, and age limits vary by state (https://bit.ly/3IUkh50).
Additional strategies to increase helmet use include enforcement of state laws and local rules (e.g., at ski resorts), public educational campaigns, school and community injury-prevention programs, and anticipatory guidance from pediatricians.
Adults modeling helmet use during sports also is an important factor to increase use among children.
Recommendations for pediatricians
- Advise children and caregivers to wear helmets every time they participate in recreational sports (i.e., bicycling, skateboarding, snow sports, horseback riding).
- Discuss the importance of making sure the helmet fits correctly and wearing the right type of helmet based on activity.
- Encourage caregivers to wear helmets consistently to model safe behavior for their children.
- Know your state and local laws regarding helmet use.
Dr. Lee is a lead author of the policy statement and technical report. She is chair of the Council on Injury, Violence and Poison Prevention Executive Committee and a liaison from the Society for Pediatric Research to the AAP Committee on Federal Government Affairs and Committee on Pediatric Research.
- Fitting a bike helmet
- Information for parents on bicycle helmets from Healthychildren.org, https://bit.ly/3yVOQ5N and https://bit.ly/3PIsCLA
- Helmet safety from the Centers for Disease Control and Prevention