Cycling is a common form of exercise and active transportation. According to the Canadian Fitness and Lifestyle Research Institute, in 2004, 88 per cent of Canadian children owned a bicycle.1 For children, a bike can represent independence and mobility. Compared to other forms of active transportation, cycling is very accessible due to the relatively low cost of a bike and a helmet.
Most cycling injuries to children are due to the high speeds reached by riders, lack of experience in controlling the bicycle and lack of protective gear.2
Young children are in the process of developing their motor skills, which leaves them vulnerable to falls as they learn bike handling skills. Generally poor motor skills can also cause falls. These factors are compounded by a child’s high centre of gravity which makes balancing difficult, particularly when cycling and navigating turns.
Children develop physical and thinking skills around age 10 – but their ability to ride on the road may depend on their experience, environment and development. Younger children should be accompanied by adults or older children whenever they ride their bikes, especially in traffic. To help determine if a child is ready to ride on the road, parents need to think about the roads around them (e.g. do streets have a lot of traffic, many intersections to cross), the amount of practice the child has riding on streets, and their knowledge of the rules of the road. Before 10 years of age, children are unlikely to understand the risks of traffic, are more likely to be impulsive and distracted while playing, and are not able to process the multiple pieces of information necessary to ride their bike or other wheeled apparatus on the road.2
Children 10 to 14 years of age experience periods of rapid growth and development. Children in this age group may therefore not have sufficient awareness of their current body size and shape and the consequences of risk taking behaviour. At the same time, they have mastered the basics of many physical skills and so they feel confident to attempt high-speed tricks and complicated manoeuvres.2
Twenty-nine per cent of childhood emergency department visits for cycling-related injuries can be attributed to fractures. Eleven per cent of all serious injuries and deaths associated with child cyclists involve collisions with motor vehicles. The most severe injuries involve the head and brain and even seemingly minor head injuries may cause permanent brain damage. Eight per cent of all injuries to children related to cycling result in a brain injury.3
The human skull is approximately one centimetre thick and can be shattered by an impact of only seven to 10 km/h.4 Young cyclists ride at speeds averaging 11 to 16 km/h.5
A properly fitted helmet helps protect the head by absorbing the force from a crash or a fall, decreasing the risk of serious head and brain injury by as much as 80 per cent.6, 7 This means that four out of five head injuries could be prevented if every cyclist wore a helmet.
There is a public perception that helmets may not provide protection in crashes that involve motor vehicles, but helmets have been proven effective in preventing head injury from all types of falls and crashes.6-8
The Canadian Standards Association has established a nationaly recognized standard for bike helmets. The standard is voluntary and not law.
Legislation requiring cyclists to wear helmets has been shown to be highly effective in increasing the number of children and adults who wear helmets. An increase in helmet use should decrease the number of serious head injuries among Canadian children.9, 10 Education in isolation is less effective in increasing bike helmet use.
Children 10 to 14 years of age are the least likely to wear a helmet and other protective gear (compared with younger children). A considerable amount of research has been done to identify barriers to helmet use among older children and teens. The most commonly reported reasons are that the helmet is uncomfortable and doesn’t look cool.15, 16 Other contributing factors include: not owning a helmet, poor fit, peer acceptance and lack of perceived dangers in not wearing one. Some children based their decision about wearing a helmet on the length of time and location of their trip. For example, if they were going for a short ride near home, or on a street not perceived to be dangerous, they did not wear a helmet. Teenagers perceived a greater risk of injury from a collision with a motor vehicle than a non-collision fall from a bicycle. Positive influences for wearing a helmet are reported to be friends, parents, the law and personal considerations for safety.11, 12
Children develop physical and thinking skills around age 10 – but their ability to ride on the road may depend on their experience, environment and development. Younger children should be accompanied by adults or older children whenever they ride their bikes, especially in traffic. To help determine if a child is ready to ride on the road, parents need to think about the roads around them (e.g. do streets have a lot of traffic, many intersections to cross), the amount of practice the child has riding on streets, and their knowledge of the rules of the road. Riding a bike near motor vehicles requires a complex set of skills that children develop gradually between 10 and 14 years of age. They must be able to balance their bike and signal while simultaneously paying attention to vehicles. A child’s brain cannot manage this combination of physical and cognitive skills before 10 years of age, at the earliest.13 The ability to juggle these tasks around traffic may be further challenged in high-risk situations.
Poor visibility adds to the risk of a crash for all types of road users. Visibility aids have the potential to influence drivers’ reaction, detection and recognition of cyclists and pedestrians. Materials made in fluorescent yellow, red and orange can improve a driver’s detection during the day. Lamps, flashing light and retro reflective material in red and yellow or a “bio-motion” pattern can draw attention at night. Although, there is no current evidence that increased visibility results in a reduction of death and serious injuries, visibility aids do increase driver’s perception of cyclists.14
Slowing down motor vehicle traffic can increase safety for cyclists sharing the same roads.8 An international review of traffic-calming measures (such as reduced speeds or speed bumps) found that road crashes of all kinds, including those with child and adult cyclists, declined by 15 per cent overall and 25 per cent on residential streets in particular.15 When 20 cities in the United Kingdom established traffic-calming zones at 40 km/h, child cyclist injuries declined by 48 per cent.16
Each dollar invested in a helmet saves an estimated $30 in societal costs.17 In addition, each severe brain injury costs our medical system over $400,000 at the time of injury. Costs remain approximately the same each year following the incident due to indirect expenses and follow-up treatment.18
Parents can provide a positive role model for their children. Research has shown that if a parent wears a bike helmet when riding with their child, their child is more likely to wear a helmet.19
While the CSA has a standard for bicycle helmets, there is no legal requirement for bicycle helmet manufacturers to build their helmets to meet this standard. Since the majority of helmet manufacturers are located in the United States, and the U.S. market is significantly larger than the Canadian one, manufacturers build helmets to meet the standards required by the laws of the United States.
1 Cragg S, Cameron C, Craig CL. 2004 national transportation survey. Ottawa, ON: Canadian Fitness and Lifestyle Research Institute; 2006.
2 Victorian Injury Surveillance System. Recreational injury to older children (10-14 year olds). Victoria, AU: Monash University; 1997.
3 Public Health Agency of Canada. Injuries associated with wheeled, non-motorized devices. In. Ottawa: The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), All ages, 1990-2007.
4 Canadian Bike Helmet Coalition. Bike helmets for children: how to organize a community project. Ottawa; 1994.
5 Thompson D, Rebolledo V, Thompson RS, Kaufman A, Rivara FP. Bike speed measurements in a recreational population: validity of self reported speed. Inj Prev 1997;3(1):43-5.
6 Thompson DC, Rivara F, Thompson R. Helmets for preventing head and facial injuries in bicyclists. The Cochrane Database of Systematic Reviews 2009(1).
7 Attewell RG, Glase K, McFadden M. Bicycle helmet efficacy: a meta-analysis. Accid Anal Prev 2001;33(3):345-52.
8 World Health Organization. World report on road traffic injury prevention. Geneva: World Health Organization; 2004.
9 Karkhaneh M, Kalenga JC, Hagel BE, Rowe BH. Effectiveness of bicycle helmet legislation to increase helmet use: a systematic review. Inj Prev 2006;12(2):76-82.
10 Macpherson A, Spinks A. Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries. Cochrane Database of Systematic Reviews 2008(3):CD005401.
11 Finch CF. Teenagers' attitudes towards bicycle helmets three years after the introduction of mandatory wearing. Inj Prev 1996;2(2):126-30.
12 Finnoff JT, Laskowski ER, Altman KL, Diehl NN. Barriers to bicycle helmet use. Pediatrics 2001;108(1):E4.
13 Leblanc J, Huybers S. Improving bicycle safety: the role of paediatricians and family physicians. Paediatric Child Health 2004;9(5):315-8.
14 Kwan I, Mapstone J. Interventions for increasing pedestrian and cyclist visibility for the prevention of death and injuries. Cochrane Database Syst Rev 2006(4):CD003438.
15 Elvik R. Area-wide urban traffic calming schemes: a meta-analysis of safety effects. Accid Anal Prev 2001;33(3):327-36.
16 Webster D, Mackie A. Review of traffic calming schemes in 20 mph zones. Crowthorne: TRL Limited; 1996. (TRL Report 215).
17 Miller TR, Levy DT. Cost-outcome analysis in injury prevention and control: eighty-four recent estimates for the United States. Med Care 2000;38(6):562-82.
18 ThinkFirst Canada. Brain injury fact sheet. In. Toronto: ThinkFirst Canada.
19 Khambalia A, MacArthur C, Parkin PC. Peer and adult companion helmet use is associated with bicycle helmet use by children. Pediatrics 2005;116(4):939-42.