Easy-to-follow rules can prevent serious injuries for child bicyclists

While this adorable little girl seems to be having a good time, she is also violating safe bicycling Rule # 1: always wear a helmet.

While this adorable little girl seems to be having a good time, she is also violating safe bicycling Rule # 1: always wear a helmet.

Summertime means the end of school days and the beginning of a three-month recess for millions of children across the nation. Many of these kids will spend a good portion of their newfound leisure time popping wheelies, jumping curbs or simply riding around their neighborhood - all on their bicycles, of course.

For decades, bicycles have been a recreational mainstay for youngsters. Bikes can, however, become extremely dangerous, even deadly, to the children that ride them.

In the following St. Louis Post-Dispatch article, Robert Bo Kennedy, M.D., a Washington University pediatrician at St. Louis Children's Hospital, outlines some of the dangers of bicycling and discusses steps that can be taken to reduce a child's risk while riding. Children need to know the rules on bike safety

(Republished with permission from the St. Louis Post-Dispatch. This article originally ran in the Health & Fitness section on Monday, June 14, 2004)

By Dr. Robert Bo Kennedy

10 rules for biking

  • Wear a certified protective helmet. Other protective items such as elbow pads and kneepads are a good idea for a beginner.
  • Ride single file on the right side of the road, with traffic. This is where drivers look for oncoming cars and are most likely to see a cyclist.
  • Do not ride at or after dusk.
  • Obey all traffic signals and stop signs. Wait for a green light.
  • Stay off streets that have a lot of car and truck traffic, and wear bright-colored clothing. You can also put reflective stickers on your helmet.
  • Ride in a straight line near the shoulder or curb.
  • Always try to ride with a buddy, but don't ride double.
  • Don't ride a borrowed bike. Ride one that fits you and keep it in good working condition.
  • Do not use the bike to try stunts and tricks.
  • Stop and look for traffic at all intersections, including those where the streets cross alleys and driveways; 75 percent of all child bike accident deaths occur where driveways, alleys or streets intersect.

SOURCE: American Academy of Pediatrics Bike accidents result in an estimated half-million injuries annually. Nearly 1,000 bike riders are killed each year, and more than 75 percent of these deaths involve head injuries, according to recent surveys by the U.S. Department of Transportation.

Bike accidents occur most often during summer months, followed by spring and fall. Boys are five times more likely to be injured or killed than girls. Children ages 6 to 12 are at greatest risk.

The American Academy of Pediatrics believes the use of bike helmets could save as many as 450 children each year. In addition, studies suggest that 90 percent of head injuries could be prevented by the use of hard-shell helmets.

Bike helmets are designed to perform two functions: protect the skull from fracture and protect the brain from inertial forces - the movement of the brain toward the skull on impact.

To be effective, a helmet must be fitted correctly to the size of the child's head, with the straps and padding properly in place. The straps should be adjusted so the helmet rides evenly on top of the head and does not slip backward. The chin strap should be tightened enough to allow only one finger between the chin and the strap.

Once straps are adjusted properly, the adjustments can be secured by wrapping tape around or by sewing thread through the strap junctures.

Head injuries

Even a seemingly mild blow to the head can cause permanent brain injury.

Brain injuries occur in two ways: direct contact and inertial forces. Direct contact causes facial and skull distortions and fractures that transmit the blow to the brain.

Inertial forces generate two additional types of injury. The brain may continue moving after the skull stops, causing impact between brain surfaces and the inside of the skull. Inertial forces, particularly if the head is turning at impact, also can be transmitted through brain tissue and cause distortions of small blood vessels and nerves connecting brain cells.

Although head injuries may not be visible, they can cause permanent physical, intellectual, personality and emotional changes or communication and learning disabilities. The outcome of a minor injury may remain unknown for months or years.

Causes of accidents

The American Academy of Pediatrics identifies four factors frequently associated with serious bike accidents:

  • Not wearing a helmet.
  • Riding a borrowed bike (too big or small).
  • Riding double (poor control).
  • Inadequate rider visibility (dark clothing).

The majority of bike accidents do not involve cars. Most are a result of falls. Falls can occur in the street, driveway or park - anywhere at any time. A child on a bike always needs the protection of a helmet and other protective gear.

Teaching children

Parents should teach children to treat a bike not as a toy, but as a speedy means of transportation that is subject to the same laws as motor vehicles, according to the academy of pediatrics guidelines.

Parents should restrict bicycling until a child can demonstrate basic competence and good judgment on a bike. A child must be able to:

  • Stop the bike quickly by using the brakes.
  • Start riding without wobbling out of a path one yard wide.
  • Stop and dismount without falling.
  • Ride in a straight line near the curb.

The most common excuse children give for not wearing a helmet is that it makes them look "funny" or different from their friends. Parents should teach their children, "No helmet, no bike."

The child as passenger

An adult carrying a child as a passenger on a bike must realize that doing so makes a bike less stable and increases braking time.

Infants under 6 months should never be carried on a bike. Children ages 1 to 4 must be belted into a seat. That minimizes the risk of injury from a fall and prevents hands from getting into the spokes.

All passengers must wear a helmet. And it's a good idea for a parent to use a trailer until the child is able to pedal on his own.

For more information about properly fitting a helmet, or to learn about helmet safety, call 314-454-5437.

Robert Bo Kennedy is an emergency room pediatrician at St. Louis Children's Hospital and an associate professor of pediatrics at Washington University School of Medicine.

Copyright 2004 St. Louis Post-Dispatch, Inc.