Bicycling has become extremely popular in the last 10 years. There were an estimated 100 million cyclists in the United States in 1993.1 In addition to providing efficient transportation, bicycling can be an enjoyable form of aerobic exercise. The sport is not without hazards, however. In 1991, bicycle-related injuries necessitated approximately 600 000 emergency-department visits and contributed to approximately 800 deaths.2 Many of those injured or killed were children and adolescents.

Head injury from cycling is the most common cause of death (70% to 80% of cases) and the leading cause of disability.3,4 One fourth of injured bicyclists treated in emergency departments have head injuries, as do half of those admitted to the hospital.5,6 Many children are injured falling from their bicycles, and collision with fixed objects or motor vehicles plays a significant role in making bicycle safety a major pediatric health issue.

According to the National Safety Council, 180 000 collisions between motor vehicles and bicycles occurred in 1991.2 Eight hundred of these resulted in fatalities.2 Forty-two percent of these deaths occurred in children younger than 15 years.2 With the proliferation of mountain bikes, these patterns of injury may change for the worse as more cyclists venture into potentially treacherous areas.

Relatively low-cost, lightweight bicycle helmets capable of protecting against head injury are now available. Voluntary impact standards have been developed by the Snell Memorial Foundation and the American National Standards Institute (ANSI), and helmets meeting these standards are labeled Snell or ANSI. Studies in Australia7 and England8 have clearly demonstrated the efficacy of helmet use.

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