American Academy of Pediatrics: Helmets Significantly Reduce Risks of Traumatic Brain Injury While Bike-Riding or Participating in Other Sports

Pediatricians can advise families on how to make sure helmets are sport- appropriate and fit well for all kinds of sports, whether they involve wheels, snowboards, skates or other devices.

Every year, thousands of children experience a traumatic brain injury or facial injury from a fall while bicycling, snowboarding or participating in another recreational sport. Many of these injuries – some of which are fatal – could have been prevented with use of a proper-fitting helmet, an abundance of research shows.

The American Academy of Pediatrics reviews the benefits of helmet use and encourages adults to model routine use of helmets, as well, in an updated policy statement released in the September 2022 Pediatrics. The statement, “Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports,” and an accompanying technical report also will be published online Monday, Aug. 15.

“The evidence is clear: helmets save lives and significantly reduce the risks of severe injury,” said Lois K. Lee, MD, MPH, FAAP, lead author of the statement, written by the AAP Council on Injury, Violence, and Poison Prevention. “And yet sports-related injuries make up a substantial proportion of all traumatic brain injuries. As a pediatric emergency medicine physician, I advise all my patients – and their parents-- to wear helmets.”

Research has shown that injury rates from recreational sports among participants 5 years and older are highest for children ages 5 through 14 years and youth 15 through 24 years. Bicycle riding is one of the leading causes of sport-related head injuries in pediatrics, resulting in an estimated 26 000 emergency department visits annually.

And yet a 2012 study of U.S. bicycle helmet use among children ages 5 through 17 reported that only 42% always wore a helmet, and 31% never wore a helmet. A national study of skateboarders and snowboarders younger than 18 found that 52% of children injured were not wearing helmets.

Snow sports, including skiing and snowboarding, are a leading cause of recreational sport-related head injury, and the risk of traumatic brain injury rises if the participant is not wearing a helmet. Ice skating and equestrian sports are also associated with risks of head injury, according to AAP.

The AAP recommends:

• Children, teens and their adult caregivers should always wear a sport-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.
• To promote helmet use, children can be encouraged to choose their own helmet and decorate it to reflect their individuality. Reflective stickers and lights can also be added to increase visibility of the child when bicycling on the road.
• The helmet should be replaced if involved in a crash, damaged, or outgrown. It’s best to avoid using previously owned helmets, if possible.
• Pediatricians should inform parents and patients of the importance of wearing helmets during recreational activities and sports, including discussing age- and sport-appropriate helmet use.
• Public education and advocacy should include comprehensive and consistent legislation and regulations regarding helmet use in sports, comparable to child safety restraint laws and motor vehicles.
• Studies focused on health inequities as related to injuries and barriers to helmet use should be conducted to inform interventions in high-risk populations.

“We love to see children out on bikes and enjoying physical activities of all kinds,” Dr Lee said. “Make helmets part of your routine, like requiring seatbelts, and encourage kids to personalize their helmet and make it fun. Families who wear helmets together are safer together.”

To request a copy of the policy statement or technical report, or to request an interview with an expert, contact AAP Public Affairs.

Additional resources for parents can be found in these HealthyChildren.org articles:

• Bike Riding & Beyond: 4 Times Your Kids Should Wear Helmets
• How To Get Your Child to Wear a Bicycle Helmet

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.