April 6, 2015 – This week’s blog post is also available from TREKK (Translating Emergency Knowledge for Kids).
Head injuries due to bicycle crashes are a common reason that children present to the emergency department. Bicycle helmets were designed to decrease head injuries. Different approaches to encourage bicycle helmet use have been evaluated. These range from legislation where individuals are required by law to wear a helmet when cycling to media campaigns and other health promotion activities, such as promoting the use of bicycle helmets in schools or offering free helmets through community-based programs.
An overview of Cochrane systematic reviews was conducted in order to bring together evidence from reviews that focused on different aspects of the topic of bicycle helmet use. The reviewers identified three systematic reviews that included 35 studies involving children. The reviews looked at:
- the use of helmets for preventing head and facial injuries in bicyclists
- bicycle helmet legislation to increase the uptake of helmet use and prevent head injuries
- nonlegislative interventions to promote use of bicycle helmets in children (these included health education programs, subsidized or free helmets, and media campaigns)
Some of the key findings:
- helmet use in children decreased medically reported head injuries by 63%
- helmet use decreased brain injuries by 86%
- mandatory helmet laws for children decreased the odds of head injury hospitalizations by 45%
- after helmet legislation, the odds of traumatic brain injuries decreased by 18%
- legislation resulted in an increase in the number of children wearing a helmet
- nonlegislative helmet promotion activities also resulted in an increase in the number of children wearing a helmet
- there were no risks involved with using bicycle helmets
The authors concluded that bicycle helmets are effective in reducing head injuries in children. They also concluded that both legislative and non-legislative interventions are helpful in reducing injuries and promoting helmet use. However, the authors noted that there are some who oppose helmet legislation. The main reasons are that they feel that this may encourage people to cycle more recklessly or less frequently.
Dr. Tony Woodward, Chief of Emergency Medicine at Seattle Children’s Hospital states that “there’s no question that the best way to protect your child when they’re on a bike, scooter, or skates is to wear an appropriately sized helmet. In the emergency department, the children we see who are the most seriously injured are the ones that don’t have helmets or have helmets that are inappropriately sized or inappropriately worn.”
 Russell, K., Foisy, M., Parkin, P., & Macpherson, A. (2011). The promotion of bicycle helmet use in children and youth: an overview of reviews. Evidence-Based Child Health: A Cochrane Review Journal, 6(6), 1780-1789. doi: 10.1002/ebch.901
 Owen, R., Kendrick, D., Mulvaney, C., Coleman, T., & Royal, S. (2011). Non-legislative interventions for the promotion of cycle helmet wearing by children. Cochrane Database of Systematic Reviews, (11). doi:10.1002/14651858.CD003985.pub3
 Macpherson, A., & Spinks, A. (2008). Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries. Cochrane Database of Systematic Reviews, (3). doi:10.1002/14651858.CD005401.pub3
 Thompson D., Rivara, F., & Thompson, R. (1999). Helmets for preventing head and facial injuries in bicyclists. Cochrane Database of Systematic Reviews, (4). doi:10.1002/14651858.CD001855
TREKK (Translating Emergency Knowledge for Kids) Resources:
- Valani, R., & Riley, J. (2010). Emergency Medicine Cases Podcast: Pediatric Head Injury. [Podcast]
- TREKK (Translating Emergency Knowledge for Kids). (2015). Severe Head Injury: Evidence Repository.
ChildSafetyLink. (2014). Keep Kids Safe: A Parent’s Guide to Helmet and Recreation Safety.
Government of Manitoba. (2013). Bike Helmet Safety Video.