Recreational activities and sports are a common and popular way for youth to enjoy physical activity; however, there are risks related to physical injury. Injuries can potentially result in death and long-term disability, especially from traumatic brain injury. Helmet use can significantly decrease the risk of fatal and nonfatal head injury, including severe traumatic brain injury and facial injuries when participating in recreational sports. The most robust evidence of helmet effectiveness has been demonstrated with bicycling and snow sports (eg, skiing, snowboarding). Despite this evidence, helmets are not worn consistently with all recreational sports. A multipronged approach is necessary to increase helmet use by children and youth participating in recreational sports. This approach includes legislation and enforcement, public educational campaigns, child education programs, and anticipatory guidance from clinicians. This policy statement guides clinicians, public health advocates, and policymakers on best practices for increasing helmet use in recreational sports, including bicycling and snow sports.

Recreational sports and physical activities continue to increase in popularity, with an estimated 218.5 million United States residents older than 6 years engaging in these activities in 2018.1  The benefits of sports for youth are well established2,3 ; nonetheless, there are risks related to physical injuries, including morbidity and mortality from traumatic brain injuries (TBIs). Injury rates from recreational sports among participants 5 years and older are highest for children 5 through 14 years of age (76.6/1000 persons) and youth 15 through 24 years of age (55.6/1000 persons).4  Sports-related activities account for an increasing proportion of TBIs.5  Children and adolescents engage in a variety of recreational activities using motorized and nonmotorized, wheeled devices, as well as engaging in nonwheeled activities. Some recreational sports associated with risks for head injuries include bicycling,6,7  skiing and snowboarding (henceforth collectively termed “snow sports”),8  ice skating,9  and equestrian sports.10  All-terrain vehicles are addressed in a separate policy statement and technical report, currently in development.

Serious head injuries, including TBIs, from recreational sports can often be prevented or the injuries can be mitigated. Helmet use in sports and recreational activities significantly decreases the risk of nonfatal and fatal head injuries and facial injuries.1014  Despite the strong evidence for the effectiveness of helmets in decreasing head and facial injuries, their use is not consistent among sports participants.10,1520  Helmet use is also cost-effective in the prevention of head injuries.21,22  To increase helmet use, a multipronged approach including legislation,2325  enforcement of laws and rules,26  public educational campaigns,27  child education programs,28,29  anticipatory guidance from clinicians,30,31  and equitable access to helmets will be required. The purpose of this policy statement is to guide clinicians, public health advocates, and policymakers regarding the evidence-based best practice for helmet use and promotion in recreational sports, including bicycling and snow sports. This policy statement accompanies the technical report, “Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports.” Although concussions are an important type of head injury, concussions and their prevention are not addressed here because this topic is addressed in another American Academy of Pediatrics clinical report, “Sport-Related Concussion in Children and Adolescents.”32 

Bicycle riding is one of the leading causes of sport-related head injuries in pediatrics,57  resulting in an estimated 26 000 emergency department visits annually.33  Snow sports (ie, skiing and snowboarding) are another leading cause of recreational sport-related head injury, and the risk of TBI is increased if the participant is not wearing a helmet.8,13  Among other recreational sports, ice skating9,34  and equestrian sports10  are also associated with risks of head injury.

The effectiveness of helmets in decreasing head and facial injuries has been best studied among bicyclists. A Cochrane review based on 5 international studies reported that helmets decreased the risk of head, brain, and severe brain injury by 63% to 88% for bicyclists of all ages and calculated a summary adjusted odds ratio (OR) of 0.31 (95% confidence interval [CI]: 0.26–0.37).12  Two more recently published meta-analyses reported similar protective effects of helmets against bicycle-related head and facial injuries.35,36 

Helmets are also effective in decreasing the risk of head injuries in snow sports. One meta-analysis including 6 studies reported that helmets decreased the risk of head injuries with a pooled OR of 0.58 (95% CI: 0.51–0.77),37  and another based on 9 studies reported a pooled OR for head injury of 0.66 (95% CI: 0.55–0.79).38  The evidence on helmets for decreasing head injuries in other recreational sports (eg, skating, ice skating, nonmotorized wheeled sports) also reports decreased odds for head injury in helmeted compared with unhelmeted children, but the research is more limited.7,20,39,40 

To ensure optimal protection against head injury, proper helmet fit is important because multiple sizes are available in the consumer market. For a correct fit, the helmet should be positioned on the head so it sits low on the forehead with the child able to see the brim of the helmet when looking upward. The helmet should sit parallel to the ground when the head is upright and should have any pads adjusted (ie, installed or removed) for a snug fit. The chin strap should be comfortably secure, allowing only 2 fingers aligned side by side to fit between the chin and the strap. The helmet should then be secure enough so it will not come off or move forward over the eyes with shaking of the head.41 

Despite the evidence for the effectiveness of helmets in decreasing the risk of head and facial injuries in recreational sports, helmets are not consistently worn. For children 5 through 17 years of age, a 2012 study of United States bicycle helmet use reported that only 42% always wore a helmet, and 31% never wore a helmet.18  A national study of skateboarders and snowboarders younger than 18 years reported that 52% of children injured were unhelemeted.20  Reported reasons for not wearing a helmet when participating in recreational sports include: cost, discomfort, and lack of belief helmets are necessary to prevent injury.4245  It is important to note that adult helmet-wearing, younger child age (4 through 12 years old), and female sex have been associated with increased helmet-wearing in children.18,42,44 

To increase helmet use and decrease the risk of head injuries in children and youth participating in recreational sports, there is evidence for several effective approaches. Legislation resulting in increased helmet use in children has been primarily studied in bicyclists.16,25,46  As of 2022, 21 states and the District of Columbia have bicycle helmet laws applying to children 17 years or younger, although age requirements vary by state.47  A 2010 Cochrane narrative review examined the effectiveness of bicycle helmet legislation for children and concluded legislation is effective in increasing helmet use and decreasing head injuries.48  School- and community-based bicycle safety programs, including promoting helmet use, have also been effective in increasing bicycle safety knowledge and helmet use, although the long-term effects of these programs on helmet use has not been reported.26,28,29,49  Anticipatory guidance from pediatric clinicians has also been shown to be effective in increasing bicycle helmet use.30,31  A prospective randomized study of 2183 children (fifth to ninth grade) among 12 pediatric practices with interventions focused on either alcohol and cigarette use or bicycle helmets, gun storage, and seatbelt safety found only bicycle helmet use improved when compared with the previous year.31 

  1. Helmet use:

    • a. Children and youth, as well as their adult caregivers, should always wear an appropriate and correctly fitting sport helmet during participation in recreational sports, including, but not limited to, bicycling, snow sports, ice skating, and equestrian sports. Because of the differences in engineering, helmet types should match the sport for which they are designed. Multisport helmets can be used for bicycling, as well as other recreational sports (eg, skiing, snowboarding); however, bicycle helmets should be used only for bicycling and not for other activities.

    • b. To promote helmet use, children can be encouraged to choose their own helmet and decorate it to reflect their individuality. Reflective stickers and/or lights (eg, light-emitting diode lights) can also be added if not already on the helmet to increase visibility of the child when bicycling on the road.

    • c. The helmet should be replaced if involved in a crash, damaged, or outgrown. Helmets should also be replaced every 5 years or in the time frame recommended by the manufacturer in the instructions, because the materials can degrade over time.

    • d. Preferably, when possible, use of previously owned helmets should be discouraged because the integrity and age of the helmet may be unknown.41 

  2. Anticipatory guidance from clinicians to patients and families:

    • e. Pediatric clinicians in the primary care, emergency department, and tertiary care settings should inform parents and patients of the importance of wearing helmets during recreational activities and sports, including discussing age- and sport-appropriate helmet use as part of injury-prevention anticipatory guidance. The Centers for Disease Control and Prevention has helmet information sheets for the lay public focused on different team and recreational sports (https://www.cdc.gov/healthyschools/bam/safety/helmets.html).

    • f. Parents and adult caregivers should also be advised to wear helmets to model safe behavior, especially because such modeling has been shown to be a predictor for helmet use in children and youth.18,41,43 

    • g. Clinicians should know their state and municipal laws regarding helmet use and age limits.

  3. Education of the lay public:

    • h. The effectiveness of helmets in reducing the risk of head injury, including TBIs, should be promoted among the lay public. This education can be accomplished through public health advertising campaigns, including public service announcements, and through sports organizations.5053  State and local legislation and regulations should also be included in these educational campaigns.

  4. Advocacy:

    • i. More comprehensive and consistent legislation and regulations regarding helmet use in sports, comparable to child safety restraint laws and motor vehicles,54  will be important to increase helmet use and decrease head injuries on a broad scale. State legislation and local regulations are effective in increasing helmet use and decreasing head injuries.25,46  At the time of this publication, only 21 states and the District of Columbia have bicycle helmet legislation, which applies only to children and teenagers.47  There is no legislation regarding helmet use for other recreational sports.

    • j. Policymakers, public health advocates, and clinicians interested in advocacy should advocate for stronger legislation and regulations regarding helmet use, especially for bicycling, snow sports, and equestrian activities.

    • k. Clinicians and public health advocates can encourage school districts to require bicycle helmet use when bicycling to and from school.41 

    • l. Retail outlets and rental facilities should be encouraged to sell and/or rent affordable helmets when they sell recreational sports equipment (eg, bicycles, skis, snowboards, ice skates, equestrian equipment).

    • m. Payers should be enlisted to cover the cost of sports helmets as durable medical equipment given their cost-effectiveness,21,22  as has been done in some cases for car safety seats for children. This may also help address inequities in helmet use due to cost.

  5. Enforcement:

    • n. Although legislation is important in increasing helmet use, enforcement is an essential aspect. In addition to issuing tickets for helmet legislation noncompliance, alternative strategies including having offenders attend a bicycle safety class and rewarding helmet wearers for compliance could be considered.23 

    • o. Pediatric clinicians may collaborate with education and law enforcement officials as well as community-based organizations to develop and implement community-specific programs to improve enforcement.

  6. Helmet promotion programs:

    • p. Multifaceted injury prevention programs have demonstrated increased helmet use in children and may be school-, community-, or health care setting-based.23,24,26,28,31,55  These programs can involve one or more of these components: (1) education, (2) helmet giveaways, and (3) enforcement of existing helmet legislation.26 

    • q. Institutions and medical centers should consider providing helmets at cost or gratis to patients, which could be a standalone program or part of a larger injury prevention program (eg, Safety Store).

  7. Research:

    • r. Epidemiologic research: Despite the popularity of recreational sports in pediatrics, there are limited data on the epidemiology of and helmet effectiveness for specific types of injuries within these sports. This includes activities such as skateboarding and riding scooters. Understanding the number of annual injuries by age group, body areas affected, and severity of injuries are critical for informing and promoting injury prevention efforts. Even less well understood is the prevalence of helmet use in these sports, outside of bicycling.

    • s. Health inequities research: Studies focused on health inequities as related to injuries and barriers to helmet use should be conducted to inform interventions in high-risk populations.

    • t. Interventional research: For recreational sports besides bicycling, there are limited studies on interventions to increase helmet use in children and youth. Evaluation of best practices of multipronged injury prevention approaches to mitigating health disparities related to helmet use and injuries is also essential.

Recreational sports are an important part of the health and well-being of the developing child and adolescent. Although injuries occur commonly with these activities, the risk of head injuries, including TBIs, are decreased with helmet use. Helmets must be used in conjunction with safe behaviors when participating in recreational sports to prevent and mitigate head injuries. A multifaceted approach including legislation and enforcement, educational campaigns, school/community/health care setting programs, and anticipatory guidance will be necessary to promote and increase helmet use in pediatrics. Research on the epidemiology of recreational sports injuries, prevalence of helmet use, and effective interventions to increase helmet use will be important to inform future injury prevention efforts.

Lois K. Lee, MD, MPH, FAAP

Michael R. Flaherty, DO

Ashley M. Blanchard, MD, MSc, FAAP

Maneesha Agarwal, MD, FAAP

Benjamin Hoffman, MD, FAAP, chairperson

Phyllis F. Agran, MD, MPH, FAAP

Michael Hirsh, MD, FAAP

Brian Johnston, MD, MPH, FAAP

Sadiqa Kendi, MD, CPST, FAAP

Lois K. Lee, MD, MPH, FAAP

Kathy Monroe, MD, FAAP

Judy Schaechter, MD, MBA, FAAP

Milton Tenenbein, MD, FAAP

Mark R. Zonfrillo, MD, MSCE, FAAP

Kyran Quinlan, MD, MPH, FAAP, immediate past chairperson

Lynne Janecek Haverkos, MD, MPH, FAAP, National Institute of Child Health and Human Development

Jonathan D. Midgett, PhD, Consumer Product Safety Commission

Bethany Miller, MSW, MEd, Health Resources and Services Administration

Judith Qualters, PhD, MPH, Centers for Disease Control and Prevention

Alexander W. (Sandy) Sinclair, National Highway Traffic Safety Administration

Richard Stanwick, MD, FAAP, Canadian Pediatric Society

Bonnie Kozial

Dr Lee led the authorship group that included Drs Flaherty, Blanchard, and Agarwal; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2022-058878.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

     
  • CI

    confidence interval

  •  
  • OR

    odds ratio

  •  
  • TBI

    traumatic brain injury

1
Physical Activity Council
.
2019 Physical Activity Council’s Overview Reports on U.S. Participation
.
Jupiter, FL
:
Sports Marketing Surveys USA
;
2019
.
2
Zahl
T
,
Steinsbekk
S
,
Wichstrøm
L
.
Physical activity, sedentary behavior, and symptoms of major depression in middle childhood
.
Pediatrics
.
2017
;
139
(
2
):
e20161711
3
Beets
MW
,
Pitetti
KH
.
Contribution of physical education and sport to health-related fitness in high school students
.
J Sch Health
.
2005
;
75
(
1
):
25
30
4
Sheu
Y
,
Chen
L-H
,
Hedegaard
H
.
Sports- and recreation-related injury episodes in the United States, 2011–2014
.
Natl Health Stat Rep
.
2016
;(
99
):
1
12
5
Gilchrist
J
,
Thomas
KE
,
Xu
L
,
McGuire
LC
,
Coronado
V
.
Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ≤19 years–United States, 2001–2009
.
MMWR Morb Mortal Wkly Rep
.
2011
;
60
(
39
):
1337
1342
6
Kaushik
R
,
Krisch
IM
,
Schroeder
DR
,
Flick
R
,
Nemergut
ME
.
Pediatric bicycle-related head injuries: a population-based study in a county without a helmet law
.
Inj Epidemiol
.
2015
;
2
(
1
):
16
7
Lindsay
H
,
Brussoni
M
.
Injuries and helmet use related to non-motorized wheeled activities among pediatric patients
.
Chronic Dis Inj Can
.
2014
;
34
(
2-3
):
74
81
8
Summers
Z
,
Teague
WJ
,
Hutson
JM
,
Palmer
CS
,
Jowett
HE
,
King
SK
.
The spectrum of pediatric injuries sustained in snow sports
.
J Pediatr Surg
.
2017
;
52
(
12
):
2038
2041
9
Knox
CL
,
Comstock
RD
,
McGeehan
J
,
Smith
GA
.
Differences in the risk associated with head injury for pediatric ice skaters, roller skaters, and in-line skaters
.
Pediatrics
.
2006
;
118
(
2
):
549
554
10
Short
SS
,
Fenton
SJ
,
Scaife
ER
,
Bucher
BT
.
Helmet under-utilization by children during equestrian events is associated with increased traumatic brain injury
.
J Pediatr Surg
.
2018
;
53
(
3
):
545
547
11
Sulheim
S
,
Holme
I
,
Ekeland
A
,
Bahr
R
.
Helmet use and risk of head injuries in alpine skiers and snowboarders
.
JAMA
.
2006
;
295
(
8
):
919
924
12
Thompson
DC
,
Rivara
FP
,
Thompson
R
.
Helmets for preventing head and facial injuries in bicyclists
.
Cochrane Database Syst Rev
.
2000
;(
2
):
CD001855
13
Bailly
N
,
Laporte
JD
,
Afquir
S
, et al
.
Effect of helmet use on traumatic brain injuries and other head injuries in alpine sport
.
Wilderness Environ Med
.
2018
;
29
(
2
):
151
158
14
Bandte
A
,
Fritzsche
FS
,
Emami
P
,
Kammler
G
,
Püschel
K
,
Krajewski
K
.
Sport-related traumatic brain injury with and without helmets in children
.
World Neurosurg
.
2018
;
111
:
e434
e439
15
Fischer
CM
,
Sanchez
CE
,
Pittman
M
, et al
.
Prevalence of bicycle helmet use by users of public bikeshare programs
.
Ann Emerg Med
.
2012
;
60
(
2
):
228
231
16
Dellinger
AM
,
Kresnow
MJ
.
Bicycle helmet use among children in the United States: the effects of legislation, personal and household factors
.
J Safety Res
.
2010
;
41
(
4
):
375
380
17
Bier
G
,
Bongers
MN
,
Othman
A
, et al
.
Impact of helmet use in equestrian-related traumatic brain injury: a matched-pairs analysis
.
Br J Neurosurg
.
2018
;
32
(
1
):
37
43
18
Jewett
A
,
Beck
LF
,
Taylor
C
,
Baldwin
G
.
Bicycle helmet use among persons 5years and older in the United States, 2012
.
J Safety Res
.
2016
;
59
:
1
7
19
Klein
KS
,
Thompson
D
,
Scheidt
PC
,
Overpeck
MD
,
Gross
LA
.
HBSC International Investigators
.
Factors associated with bicycle helmet use among young adolescents in a multinational sample
.
Inj Prev
.
2005
;
11
(
5
):
288
293
20
Sadeghian
H
,
Nguyen
B
,
Huynh
N
,
Rouch
J
,
Lee
SL
,
Bazargan-Hejazi
S
.
Factors influencing helmet use, head injury, and hospitalization among children involved in skateboarding and snowboarding accidents
.
Perm J
.
2017
;
21
:
16
161
21
Michael
PD
,
Davenport
DL
,
Draus
JM
Jr
.
Bicycle helmets save more than heads: Experience from a pediatric level I trauma hospital
.
Am Surg
.
2017
;
83
(
9
):
1007
1011
22
Costa
CK
,
Dagher
JH
,
Lamoureux
J
,
de Guise
E
,
Feyz
M
.
Societal cost of traumatic brain injury: a comparison of cost-of-injuries related to biking with and without helmet use
.
Brain Inj
.
2015
;
29
(
7-8
):
843
847
23
Huybers
S
,
Fenerty
L
,
Kureshi
N
, et al
.
Long-term effects of education and legislation enforcement on all-age bicycle helmet use: a longitudinal study
.
J Community Health
.
2017
;
42
(
1
):
83
89
24
Fenerty
L
,
Heatley
J
,
Young
J
, et al
.
Achieving all-age helmet use compliance for snow sports: strategic use of education, legislation and enforcement
.
Inj Prev
.
2016
;
22
(
3
):
176
180
25
Macpherson
A
,
Spinks
A
.
Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries
.
Cochrane Database Syst Rev
.
2007
;(
2
):
CD005401
26
Gilchrist
J
,
Schieber
RA
,
Leadbetter
S
,
Davidson
SC
.
Police enforcement as part of a comprehensive bicycle helmet program
.
Pediatrics
.
2000
;
106
(
1 Pt 1
):
6
9
27
Karl
FM
,
Smith
J
,
Piedt
S
,
Turcotte
K
,
Pike
I
.
Applying the health action process approach to bicycle helmet use and evaluating a social marketing campaign
.
Inj Prev
.
2018
;
24
(
4
):
288
295
28
Hooshmand
J
,
Hotz
G
,
Neilson
V
,
Chandler
L
.
BikeSafe: evaluating a bicycle safety program for middle school aged children
.
Accid Anal Prev
.
2014
;
66
:
182
186
29
Lachapelle
U
,
Noland
RB
,
Von Hagen
LA
.
Teaching children about bicycle safety: an evaluation of the New Jersey Bike School program
.
Accid Anal Prev
.
2013
;
52
:
237
249
30
Chen
J
,
Kresnow
MJ
,
Simon
TR
,
Dellinger
A
.
Injury-prevention counseling and behavior among US children: results from the second Injury Control and Risk Survey
.
Pediatrics
.
2007
;
119
(
4
):
e958
e965
31
Stevens
MM
,
Olson
AL
,
Gaffney
CA
,
Tosteson
TD
,
Mott
LA
,
Starr
P
.
A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion
.
Pediatrics
.
2002
;
109
(
3
):
490
497
32
Halstead
ME
,
Walter
KD
,
Moffatt
K
.
Council on Sports Medicine and Fitness
.
Sport-related concussion in children and adolescents
.
Pediatrics
.
2018
;
142
(
6
):
e20183074
33
Safe Kids Worldwide
.
Bicycle, skate and skateboard safety fact sheet (2016) fatalities
.
34
McGeehan
J
,
Shields
BJ
,
Smith
GA
.
Children should wear helmets while ice-skating: a comparison of skating-related injuries
.
Pediatrics
.
2004
;
114
(
1
):
124
128
35
Høye
A
.
Bicycle helmets–to wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries
.
Accid Anal Prev
.
2018
;
117
:
85
97
36
Olivier
J
,
Creighton
P
.
Bicycle injuries and helmet use: a systematic review and meta-analysis
.
Int J Epidemiol
.
2017
;
46
(
1
):
278
292
37
Hume
PA
,
Lorimer
AV
,
Griffiths
PC
,
Carlson
I
,
Lamont
M
.
Recreational snow-sports injury risk factors and countermeasures: a meta-analysis review and Haddon matrix evaluation
.
Sports Med
.
2015
;
45
(
8
):
1175
1190
38
Russell
K
,
Christie
J
,
Hagel
BE
.
The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis
.
CMAJ
.
2010
;
182
(
4
):
333
340
39
Ong
JS
,
Soundappan
SV
,
Adams
S
,
Adams
S
.
Helmet use in bicycles and non-motorised wheeled recreational vehicles in children
.
J Paediatr Child Health
.
2018
;
54
(
9
):
968
974
40
Lustenberger
T
,
Talving
P
,
Barmparas
G
, et al
.
Skateboard-related injuries: not to be taken lightly. A National Trauma Databank analysis
.
J Trauma
.
2010
;
69
(
4
):
924
927
41
American Academy of Pediatrics Committee on Injury and Poison Prevention
.
Bicycle helmets
.
Pediatrics
.
2001
;
107
(
2
):
437
441
42
Fenerty
L
,
Thibault-Halman
G
,
Bruce
BS
, et al
.
Helmets for skiing and snowboarding: who is using them and why
.
J Trauma Acute Care Surg
.
2013
;
74
(
3
):
895
900
43
Kroncke
EL
,
Niedfeldt
MW
,
Young
CC
.
Use of protective equipment by adolescents in inline skating, skateboarding, and snowboarding
.
Clin J Sport Med
.
2008
;
18
(
1
):
38
43
44
Provance
AJ
,
Engelman
GH
,
Carry
PM
.
Implications of parental influence on child/adolescent helmet use in snow sports
.
Clin J Sport Med
.
2012
;
22
(
3
):
240
243
45
Ruedl
G
,
Kopp
M
,
Rumpold
G
,
Holzner
B
,
Ledochowski
L
,
Burtscher
M
.
Attitudes regarding ski helmet use among helmet wearers and non-wearers
.
Inj Prev
.
2012
;
18
(
3
):
182
186
46
Meehan
WP
III
,
Lee
LK
,
Fischer
CM
,
Mannix
RC
.
Bicycle helmet laws are associated with a lower fatality rate from bicycle-motor vehicle collisions
.
J Pediatr
.
2013
;
163
(
3
):
726
729
47
Insurance Institute for Highway Safety
.
Bicycle helmet use
.
Available at: https://www.iihs.org/iihs/topics/laws/bicycle-laws. Accessed July 18, 2022
48
Macpherson
A
,
Spinks
A
.
Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries
.
Cochrane Database Syst Rev
.
2008
;(
3
):
CD005401
49
Kirsch
SED
,
Pullen
N
.
Evaluation of a school-based education program to promote bicycle safety
.
Health Promot Pract
.
2003
;
4
(
2
):
138
145
50
Canadian Ski Council
.
Helmet safety
.
Available at: https://www.skicanada.org/safety/why-wear-a-helmet/. Accessed December 10, 2018
51
Nation Ski Areas Association
.
Lids on kids
.
Available at: https://www.nsaa.org/safety-programs/lids-on-kids/. Accessed December 10, 2018
52
National Ski Patrol
.
Safety on the slopes
.
Available at: https://www.nsp.org/. Accessed December 10, 2018
53
USA Lacrosse
.
US Lacrosse Sports Science & Safety Committee Position Statement on Helmet Use in Lacrosse
.
54
Durbin
DR
.
Committee on Injury, Violence, and Poison Prevention
.
Child passenger safety
.
Pediatrics
.
2011
;
127
(
4
):
788
793
55
Bishai
D
,
Qureshi
A
,
Cantu
N
,
Parks
C
.
Contracting with children and helmet distribution in the emergency department to improve bicycle helmet use
.
Acad Emerg Med
.
2003
;
10
(
12
):
1371
1377

Competing Interests

FINANCIAL/CONFLICT OF INTEREST DISCLOSURES: None.