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Adolescent on ATV

Courtesy of the University of Iowa Stead Family Children's Hospital Injury Prevention Program

Pair of reports aim to put brakes on youth injuries, deaths from ATVs

September 26, 2022

All-terrain vehicles (ATVs) remain a serious safety concern for children and adolescents. Since the first four-wheeler was brought to the market in 1979, pediatric ATV-related deaths and injuries have remained high. In fact, more children younger than 16 years of age die in ATV incidents than from bicycle crashes.

It has been over 20 years since the last AAP policy statement regarding ATVs was published. Since then, the primary ATV crash mechanisms, major risk factors and injury patterns for children and adolescents have been well-described in the literature. Despite this, success in preventing ATV-associated injuries and deaths in youths remains limited.

An updated policy statement, American Academy of Pediatrics Recommendations for the Prevention of Pediatric ATV-Related Deaths and Injuries, and a new technical report, A Comprehensive Report on All-Terrain Vehicles and Youth: Continuing Challenges for Injury Prevention, are available at and They will be published in the October issue of Pediatrics.

The documents, from the Council on Injury, Violence and Poison Prevention, present a broad background on key ATV-related information and evidence related to best practices. Detailed recommendations offer health care providers, parents and other stakeholders strategies to help protect children and adolescents and reduce the number of injuries and deaths resulting from ATVs.

ATV safety practices

The AAP’s primary recommendation regarding youths on ATVs remains the same: No child younger than 16 years old should operate or ride as a passenger on an ATV. This is the consensus-based best practice and could eliminate ATV-related deaths and injuries in this age group.

Despite its recommendations, the Academy recognizes that many parents and adults allow children to ride on ATVs. For families who make this choice, it is imperative that they follow safety practices that may reduce harm from the most serious ATV risk factors. Failure to follow these rules places children at significant and unnecessary danger of injury. These practices include the following:

  • Never operate an ATV on a public roadway. ATVs are designed for off-road use only, and manufacturers warn they should not be used on public roads.
  • Never cross a public roadway unless permitted by law and supervised by an adult age 18 years or older.
  • Never carry or ride as a passenger on a single-rider ATV (all youth models and the majority of adult models).
  • Only operate ATVs that are the right size for the operator, i.e., that meet anthropometric fit criteria and meet manufacturer age recommendations for the rider.
  • Always wear a Department of Transportation-compliant helmet. Head injuries are the most frequent cause of ATV-related deaths.
  • Never ride at night.
  • Never operate an ATV under the influence of alcohol, illicit drugs or substances/medications that physically or cognitively impair the ability to maintain vehicle control.

No youth ATVs are designed for children under 6 years, and they should not be permitted as operators or as passengers on any ATV. Children ages 7-15 years who are allowed to operate an ATV should be directly supervised by an adult (but not as a rider on the same vehicle) to ensure safe riding behaviors are practiced. Beyond a helmet, youths should wear other protective gear, including a face shield or goggles, long sleeves, long pants, boots and gloves.

Families are encouraged to have potential operators complete formal ATV safety training, preferably with a hands-on component. Although those ages 16 years and older may be allowed to ride on public roadways in some jurisdictions, this should be avoided, as should nighttime riding. See the policy statement for further recommendations.

Engineering approaches

The AAP recommends independent investigation of design modifications that aim to increase the safety of youth and adult ATVs, including those outlined in the policy statement. If found to be effective, the modifications should be required as standard design.

Education, legislation

The public’s awareness of the significant danger ATVs pose to youths appears limited. The AAP recommends that manufacturers, public health institutions and regulatory agencies increase their educational efforts. Pediatricians and other providers should identify patients who have had or may have exposure to ATVs and provide safety anticipatory guidance based on the recommendations in the policy statement.

The AAP calls on pediatricians and other stakeholders to advocate for legislative efforts that promote ATV safety and to support efforts to repeal laws and ordinances that encourage unsafe riding behaviors, such as the recreational use of ATVs on public roadways.

Decades of research and experience show that ATVs pose a unique and serious danger to youths. Preventing these deaths and injuries will require concerted efforts by caregivers, health care providers, child safety advocates, policymakers, enforcement agencies and the ATV industry.

Dr. Jennissen is a lead author of the policy statement and technical report. He is a member of the Council on Injury, Violence and Poison Prevention and the Section on Emergency Medicine.



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