Helmets by Timothy J. Patrick-Miller, M.D. The Pediatric Group, P.A., Princeton

This is the third article in a series written for Princeton Online on summer hazards.

Bicycle riding is a fun outdoor activity to share with your family. An excellent cardiovascular, low-impact sport, it should be encouraged for all ages. Not only an efficient, evironmentally friendly means of transportation, biking is a “cool” way for children of all ages to see the world and exercise simultaneously, alone or with friends!

Unfortunately, biking --on any surface-- can be dangerous, especially for the careless, the reckless or the irresponsible, but even for the unlucky! For it is not only one’s biking skill that determines whether or not an injury occurs, but also the care of other bikers and automobile drivers, as well as the condition of the road or path. Yearly reviews of emergency room visits in the U.S.A. reveal 600,000 bicycle-related injuries per year! More than half occur in the 5-14 year old age group. One fourth of the bike-related injuries in 1991 involved the head, causing frequent disability and 80% of the 800 biking fatalities. Sadly, more than 300 deaths occurred in children less than 15 years old. (This means, of course, that nearly 500 deaths occurred in those over 15 years old.) A 1989 study from Seattle (confirmed by subsequent studies elsewhere) showed that bike helmets reduced the risk of head injury by 85% and of brain injury by 88%. Despite this known protection, less than 5% of children riding bikes in 1995 wore helmets! How can this be?

To quote the American Academy of Pediatrics Committee on Injury and Poison Prevention:

“All cyclists should wear a properly fitted ANSI or Snell-approved helmet specifically designed for cycling. Children riding as passengers must wear appropriate sized helmets in specially designed protective seats.”

Peer pressure may contribute to non-use of helmets, but so does poor role-modeling by adults. Being uncool, fettered or inconvenienced is a small price for you or your child to pay. Wear a helmet! Wear it every time, even for a short ride around the block, in the back yard or on a bike path, even if your youthful or adult companions do not wear theirs. I tell my young patients that their head and brain are like an egg...”And all the king’s doctors and all the king’s men could not put Humpty Dumpty back together again”. Children are sometimes foolish. They should not be given a choice in this matter. They must wear their helmet.

A properly sized helmet fits snugly on the top half of the head and is worn with the front edge just over the eyebrows, not cocked back or to one side. The chin strap must be fastened. Check out website pages of the Bike Helmet Safety Institute at http://www.bhsi. org/webdocs/guide.htm and http://www.bhsi.org/webdocs/bdsguide.htm for specifics on brands, sizing and costs of bicycle helmets. If a helmet is too drab for your child’s taste, have him or her decorate it with patterns or stripes. In fact, a fancy helmet is easier for car drivers to see.

But a helmet by itself is not enough. A helmet cannot prevent unsafe or dangerous riding.

Remember the “Rules of the Road”:

* A bicycle is a vehicle.
* OBEY ALL TRAFFIC LAWS. STOP at red lights and STOP signs.
* Ride on the right hand side, with traffic.
* Yield to pedestrians.
* Signal your turns by pointing your left hand/arm in the direction of your turn or downward for a stop.
* If you ride after dark, you must use a white light in front and a red light in the rear (this is law in N.J.). It also helps drivers see you if the bicycle has many reflectors and you wear light colored clothing.
* Always wear a helmet. (By law in N.J., anyone up to the age of 14 years must wear a helmet when they bike or skate on streets.This is not to say that those over 14 should not wear one. They should.)
* Cycle in a predictable manner. Ride in a straight line; don’t swerve left or right wildly.
* Be especially alert for pedestrians and turning vehicles when riding on sidewalk bike paths.
* Be aware of opening car doors.
* Call out hazards and your intentions loudly when riding with other cyclists (“On your left” if you are going to pass on the left; “Car back” or “Car up” if a car is approaching from the rear or the front, “Bump”, “Hole”, “Grate”, Tracks, “Roots”, etc. for warning following riders of various road hazards).

You can find more useful information at the website of the League of American Bicyclists (www.bikeleague.org).

YOU CAN MAKE A DIFFERENCE. YOU CAN HELP KEEP BICYCLING SAFE FOR TRANSPORTATION AND RECREATION.

All Rights Reserved 6/98 The Pediatric Group, P.A.

Dr. Patrick-Miller has been a member of the staff at The Pediatric Group since 1985. Dr. Patrick-Miller has served on several Departmental and hospital committees. He has published original work while at The Pediatric Group. He and his wife enjoy travel. He also likes hiking, biking, gardening and reading.