Child Cyclists Research Articles

Investigating population level trends in head injuries amongst child cyclists in the UK

Case control studies suggest that cycle helmets offer their wearers protection from injury in the event of an accident. Nevertheless, encouragement and even compulsion of cycle helmet wearing has been controversial. This paper will re-examine another potential source of evidence for the role of cycle helmets. Administrative datasets are attractive because of their availability, but require careful analysis. The results presented here are obtained from analysing such data with an appropriate form of generalised additive model. Whilst helmet wearing surveys in the UK suggest strongly divergent trends in wearing rates between male and female children, there is little evidence from “Hospital Episode Statistics” to indicate similarly divergent trends in terms of head injury. Conversely, it can be confirmed that head injuries are falling faster among cyclists than pedestrians. Although case control studies suggest cycle helmets are not effective in reducing overall injuries, it is worth noting an increase in the proportion of male child cyclists reported by the police as being killed or seriously injured in road collisions. It might be tempting to use these results to suggest that helmets are not effective in reducing head injury at the population level. Whilst the careful analysis of population level data presented here is clearly important, this paper will discuss the reasons why population and individual level analyses of cycle helmets might be different and consider some of the difficulties in assigning cause and effect with imperfect observational data.

Severe traffic injuries to children, Trent, 1992–7: time trend analysis

Objective To examine trends in hospital admission rates and socio‐economic gradients for traffic injuries in children, 1992–97.Design and location Analysis of hospital admission data, Trent, UK.Participants Children aged 0–14 years admitted to hospital for pedal, pedestrian or other transport‐related injury.Results Admission rates for severe injuries among cyclists and pedestrians significantly increased during the study period. In 1992–93, admission rates (per 100 000) for severe injuries among child cyclists were 22.5. By 1996–97, these had increased to 28.3. The rates for pedestrians were 9.2 and 11.3, respectively. Other transport‐related injuries decreased during the study period. Socio‐economic gradients in admission rates did not change significantly.Conclusions Hospital admission rates for severe injuries to child cyclists and pedestrians increased in 1992–97, but not the rates for other transport‐related injuries.

The ‘lids For kids’ Project Team. Inequalities in cycle helmet use: cross sectional survey in schools in deprived areas of Nottingham

Aims To describe cycle helmet owning and wearing among children in a deprived area and to investigate the association between helmet ownership and wearing and socioeconomic deprivation.Methods Cross‐sectional survey in 28 primary schools in deprived areas of Nottingham; 1061 year 5 schoolchildren were studied.Results All year 5 children attending school on the day of the survey completed the questionnaire (87% of children registered at participating schools). Children residing in a deprived area were less likely to own a bike and more likely to ride it 4 days a week or more. Half the children owned a helmet (52%), but only 29% of these always wore their helmet. Children in deprived areas were less likely to own a helmet, but those that owned a helmet were not less likely to always wear one. Family encouragement and parental warning of dangers of not wearing a helmet were associated with increased helmet ownership rates. Family encouragement and best friends wearing a helmet were associated with higher rates of helmet wearing.Conclusions Programmes aimed at preventing head injury among child cyclists will need to address the inequality in helmet ownership that exists between children residing in deprived and non‐deprived areas. Strategies to increase family encouragement to wear a helmet may be useful, as may those recognizing the importance of the attitudes and behaviours of peers, such as peer education programmes. Further work is required to assess how exposure to risk of cycling injury varies with deprivation.

Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study

Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study

Inequalities in cycle helmet use: cross sectional survey in schools in deprived areas of Nottingham

Aims: To describe cycle helmet owning and wearing among children in a deprived area and to investigate the association between helmet ownership and wearing and socioeconomic deprivation. Methods: Cross sectional...

Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study.

Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study.

Central and peripheral cardiovascular adaptations to exercise in endurance-trained children.

Stroke volume (SV) response to exercise depends on changes in cardiac filling, intrinsic myocardial contractility and left ventricular afterload. The aim of the present study was to identify whether these variables are influenced by endurance training in pre-pubertal children during a maximal cycle test. SV, cardiac output (Doppler echocardiography), left ventricular dimensions (time-movement echocardiography) as well as arterial pressure and systemic vascular resistances were assessed in 10 child cyclists (VO2max: 58.5 +/- 4.4 mL min-1 kg-1) and 13 untrained children (UTC) (VO2max: 45.9 +/- 6.7 mL min-1 kg-1). All variables were measured at the end of the resting period, during the final minute of each workload and during the last minute of the progressive maximal aerobic test. At rest and during exercise, stroke index was significantly higher in the child cyclists than in UTC. However, the SV patterns were strictly similar for both groups. Moreover, the patterns of diastolic and systolic left ventricular dimensions, and the pattern of systemic vascular resistance of the child cyclists mimicked those of the UTC. SV patterns, as well as their underlying mechanisms, were not altered by endurance training in children. This result implied that the higher maximal SV obtained in child cyclists depended on factors influencing resting SV, such as cardiac hypertrophy, augmented myocardium relaxation properties or expanded blood volume.

Mandatory helmet legislation and children's exposure to cycling

Background—Mandatory helmet legislation for cyclists is the subject of much debate. Opponents of helmet legislation suggest that making riders wear helmets will reduce ridership, thus having a negative overall impact...

Cardiac responses to exercise in competitive child cyclists.

Cardiovascular responses to exercise in highly trained child endurance athletes have not been well-defined. This study compared hemodynamic responses with progressive cycle exercise in seven competitive child cyclists (mean age 11.9 yr) compared with 39 age-matched untrained boys. Doppler echocardiography and gas exchange variables were utilized to assess cardiovascular changes during submaximal and maximal exercise. Mean VO2max was 60.0 (+/-6.0) and 47.0 (+/-5.8) mL x kg(-1) x min(-1) in the cyclists and nonathletes, respectively. At rest and maximal exercise, the cyclists demonstrated greater stroke index than the untrained subjects (resting mean 59 (+/-6) vs 44 (+/-9) mL x m(-2); maximal mean 76 (+/-6) vs 60 (+/-11) mL x m(-2)), but the ratio of maximal:rest stroke index was similar in both groups (1.31 for cyclists, 1.41 for nonathletes). Both groups showed a plateau in stroke volume beyond low-intensity work levels. No significant difference was observed in maximal arteriovenous oxygen difference. These findings indicate that 1) maximal stroke volume is the critical determinant of the high VO2max in child cyclists and 2) factors that influence resting stroke volume are important in defining VO2max differences between child endurance athletes and untrained boys.

Why do child cyclists in the United States remain unhelmeted?

The magnitude of bicycle-related head trauma and the protective value of helmets have been known for more than a decade, yet they are worn by all-too-few American children. The exact percentage is not known. In one survey conducted in 1991, the parents of 399 children under 15 years old reported that 26% owned or had use of a helmet, and that 15% wore the helmet “most or all of the time” while riding.1 In another survey conducted in 1994, the usage rate among children 5 to 14 years old was said to be 25%.2 Both studies depended on the reports of parents contacted through random-digit telephone dialing. Based on our own surveys indicating that parents substantially overreport helmet usage, we suspect that the actual rates are much lower. Other than in affluent neighborhoods, in most communities in the nation it is rare to see child cyclists wearing helmets. A successful national campaign, defined as inducing 70% of American schoolchildren to wear bicycle helmets, would result in more lives saved, more injuries prevented, and more long-term disability reduced than any other single injury control intervention available. That is because bicycle-related head injuries remain a relatively frequent and severe trauma problem for which an inexpensive (less than $20), and effective (85% reduction in risk of injury)3 intervention is readily available. Yet no such effort is currently on the planning board. What impels public health officials to launch intervention campaigns against some diseases or types of trauma and not against others? In 1993 4 children died as result of eating hamburger tainted with E coli 0157:H. As a result of these well-publicized deaths, lawsuits were successfully pursued, congressional hearings were held, and the Department of Agriculture proposed major changes in the handling and inspection of meat. Another swift …

Head injuries and bicycle helmet laws

The first year of the mandatory bicycle helmet laws in Australia saw increased helmet wearing from 31% to 75% of cyclists in Victoria and from 31% of children and 26% of adults in New South Wales (NSW) to 76% and 85%. However, the two major surveys using matched before and after samples in Melbourne (Finch et al. 1993; Report No. 45, Monash Univ. Accident Research Centre) and throughout NSW (Smith and Milthorpe 1993; Roads and Traffic Authority) observed reductions in numbers of child cyclists 15 and 2.2 times greater than the increase in numbers of children wearing helmets. This suggests the greatest effect of the helmet law was not to encourage cyclists to wear helmets, but to discourage cycling. In contrast, despite increases to at least 75% helmet wearing, the proportion of head injuries in cyclists admitted or treated at hospital declined by an average of only 13%. The percentage of cyclists with head injuries after collisions with motor vehicles in Victoria declined by more, but the proportion of head injured pedestrians also declined; the two followed a very similar trend. These trends may have been caused by major road safety initiatives introduced at the same time as the helmet law and directed at both speeding and drink-driving. The initiatives seem to have been remarkably effective in reducing road trauma for all road users, perhaps affecting the proportions of victims suffering head injuries as well as total injuries. The benefits of cycling, even without a helmet, have been estimated to outweigh the hazards by a factor of 20 to 1 (Hillman 1993; Cycle helmets—the case for and against. Policy Studies Institute, London). Consequently, a helmet law, whose most notable effect was to reduce cycling, may have generated a net loss of health benefits to the nation. Despite the risk of dying from head injury per hour being similar for unhelmeted cyclists and motor vehicle occupants, cyclists alone have been required to wear head protection. Helmets for motor vehicle occupants are now being marketed and a mandatory helmet law for these road users has the potential to save 17 times as many people from death by head injury as a helmet law for cyclists without the adverse effects of discouraging a healthy and pollution free mode of transport.

Controversy Children and cycle helmets—the case against

Much of the literature on child cycling accidents appears to blame the child as a victim, as though children's activities of playing and travelling were somehow wrong and that children are at fault when an adult drives a car over them. This adult-centred approach then leads to the idea that children should protect themselves with helmets, and that they are to blame if they are injured. However, adults who continue to hold the fantasy that helmets might be of value should know that the British Standard for cycle helmets protects only in a vertical fall of 1 m -- certainly not motor vehicle crashes. Thicker motor cycle helmets would give better protection but, of course, are heavier (and therefore unsaleable). Yet even with compulsory wearing helmets, more motor cyclists still die of head injuries than pedal cyclists. In the Newcastle study, five times as many child pedestrians died of road accidents as child cyclists. Convinced helmeteers should recommend all children playing or travelling in the streets to wear helmets (presumably heavy motor-cycle helmets). Slightly more sceptical proponents might prefer half of them -- in a randomized controlled trial. Car driving appears to have as serious health consequences as tobacco, alcohol and drugs, and to be as addictive (McCarthy 1992). Helmets are similar to filters in cigarettes -- they give the illusion of safety to both consumer and producer of the product, but the illusion is fatal. Yet, for their cardiovascular and mental health, children should have the freedom to cycle in safety around where they live. A profound change in the habits of adults is needed, rather than suits of armour for children.

Rates of bicycle helmet use in an affluent Michigan county: L. B. Jacques. Public Health Reports, 109(2), 296–301

Bicycle helmet use in the United States has remained low despite clear demonstration of its beneficial effect on reducing the incidence of serious head injury. Several interventions have been reported, with variable results and costs. Much of the recent literature has focused on child cyclists and on demographic factors associated with helmet use. This paper reports on helmet use by children and adults in a sample of 652 riders in an affluent southeast Michigan region, chosen to minimize the effect of previously recognized socioeconomic negative predictors that are not readily changed by intervention. Subjects were classified by age, sex, location, riding surface, type of bicycle, child bicycle seat use, child bicycle trailer use, and helmet use by companions. Overall helmet use was 24 percent; infants and toddlers had the highest rate of helmet use at 61 percent, followed by adults at 26 percent and school-aged children at 17 percent. The strongest predictor of helmet use in all age categories was the presence of a helmeted companion. Adult helmet use was also positively predicted by riding in the street and by riding a racing-type bicycle. The use of a city-type bicycle negatively predicted helmet use. For non-adults, female sex and the use of a child seat or trailer were positive predictors. Fostering peer pressure to increase helmet use may be an effective yet relatively inexpensive way to achieve the goal of widespread use of bicycle helmets.

Prevention of Bicycle-Related Injuries in Childhood: Role of the Caregiver

To assess perceptions of bicycle-related head injuries, helmet use, and safety practices, we had questionnaires distributed to caregivers of 2,500 children in the third through sixth grades; 1,006 (40.2%) completed surveys were returned. Eight hundred thirty-two caregivers (82.7%) indicated that they had a child cyclist in their household; approximately 65% responded that they believed head injury was likely if their child was involved in a bicycle mishap. A majority (approximately 70%) also said that a bicycle helmet may prevent head injury in between 25% and 75% of all occurrences. Yet 758 (91.1%) students did not own or have access to a bicycle helmet. Among the caregivers whose child did not have a bicycle helmet, 530 (69.9%) stated that they had never thought about purchasing one. Caregivers of both helmeted and nonhelmeted youngsters indicated concern for bicycle safety (100% versus 94%, respectively). Most caregivers (approximately 64%) stated that they would encourage their child to attend a bicycle safety camp. These findings suggest that caregivers perceive the dangers associated with bicycling but are not cognizant of available programs and methods that prevent the risk of serious injury to bicyclists.

The urban environment and child pedestrian and bicycle injuries: Interaction of ecological and personality characteristics

AbstractIt is argued that the study of injuries to child pedestrians and cyclists in urban contexts must involve the study of complex elements interacting within a total environment. This complexity, and the need for further research, is illustrated from a study of 400 child victims in an urban, ecological study, and of 67 individually studied child victims and controls. It is argued that the individual vulnerability of some children puts them at high risk when they live in certain types of urban neighbourhoods.

Head injuries in infants and children: measures to reduce mortality and morbidity in road accidents.

In the 6-year period from 1983 to 1988, 12 infants (less than 24 months of age) and 103 children (2 to 14 years of age) were killed in road crashes in South Australia. This represents an annual incidence of 6.4 deaths per 100,000 children at risk. At least 4 other children were killed in off-road vehicle-related accidents. Of these deaths, approximately half were car passengers, one third pedestrians, and one sixth pedal cyclists. Most of these infants and children died at the accident site or soon after, but 26 of them survived long enough to be admitted to hospitals with neurosurgical units and an audit of these patients suggests that there were at least 3 preventable deaths. However, autopsies of 78 patients show that the great majority of these deaths resulted from devastating brain and/or trunk visceral injuries. Better emergency care and the use of neurosurgical retrieval teams may save some lives. But more lives might be saved by the use of appropriate restraints for infants and children in cars, by reducing the exposure of child pedestrians and cyclists to road traffic, and by mandatory use of helmets by child cyclists. Off-road vehicular accidents are not as a rule included in road crash statistics; the practice of giving small motorcycles to young children has created a new category of vehicular accidents sometimes causing severe head injury.

Some aspects of transport‐related accidents to children in the U.K.

Certain aspects are considered of transport‐related accidents to children within the context of child development and within the overall framework of the interaction between the child, the agent causing the injury, and the environment. The emphasis is mainly on various physical or environmental means of reducing the numbers of accidents and the severity of the injuries sustained, rather than on the education of children or their parents. Four main areas are discussed: children as passengers in cars, including the establishment of loan schemes for infant restraints; child cyclists, including bicycle design and the use of helmets; child pedestrians; and motor‐cycle accidents to children in off‐the‐road ‘scrambling’ activities, in which children's developmental capability of controlling a mechanically propelled vehicle is often overestimated.

Child cyclist injuries: a prospective study.

A prospective study of pedalcycle accident morbidity and mortality was carried out from February to mid-November 1983 because of the high frequency of child cyclist injuries that were occurring on the relatively flat Redcliffe Peninsula. These injuries were apparently associated with the large number of young children who use a bicycle as their main mode of transport to and from school. The schools were surveyed for the extent of bicycle use and cyclists were surveyed for the amount of protective clothing that was worn while involved in cycling. It was found that a disturbingly large number of young children made regular bicycle trips on public roads with the minimal use of safety helmets or any other form of protective clothing. Nearly 40% of on-road accidents involved children of less than 12 years of age, and over 10% of these involved children of six years of age or less. No child in our series of on-road accidents was, at the time of injury, wearing a safety helmet or any other form of protective clothing. No bicycle accidents occurred on the exclusive cycle track of approximately 1 km in length on the Peninsula.

Pediatric Neuromuscular Diseases

<b>Aims:</b> To describe cycle helmet owning and wearing among children in a deprived area and to investigate the association between helmet ownership and wearing and socioeconomic deprivation. <b>Methods:</b> Cross sectional survey in 28 primary schools in deprived areas of Nottingham; 1061 year 5 schoolchildren were studied. <b>Results:</b> All year 5 children attending school on the day of the survey completed the questionnaire (87% of children registered at participating schools). Children residing in a deprived area were less likely to own a bike and more likely to ride it four days a week or more. Half the children owned a helmet (52%), but only 29% of these always wore their helmet. Children in deprived areas were less likely to own a helmet, but those that owned a helmet were not less likely to always wear one. Family encouragement and parental warning of dangers of not wearing a helmet were associated with increased helmet ownership rates. Family encouragement and best friends wearing a helmet were associated with higher rates of helmet wearing. <b>Conclusions:</b> Programmes aimed at preventing head injury among child cyclists will need to address the inequality in helmet ownership that exists between children residing in deprived and non-deprived areas. Strategies to increase family encouragement to wear a helmet may be useful, as may those recognising the importance of the attitudes and behaviours of peers, such as peer education programmes. Further work is required to assess how exposure to risk of cycling injury varies with deprivation.

Child cyclist accidents and cycling proficiency training

An investigation of the effect of training children to ride pedal cycles was undertaken by asking school children to fill in questionnaires on their cycle training and accidents. Children who failed the cycling proficiency test had much higher accident rates than other children. Boys aged 10 and 11 years who had been trained and passed the cycling proficiency test had sliglftly lower accident rates than other boys, but this did not apply to girls. There were no other statistically significant differences in the accident rates, severity, or type of accidents, for boys or girls who had passed and those who never took the cycling proficiency test.