The bicycle injury death rate among children ages 14 and under declined 48 percent between 1987 and 1997. However, bicycles remain associated with more childhood injuries than any other consumer product except the automobile.

More than 70 percent of children ages 5 to 14 (27.7 million) ride bicycles. This age group rides about 50 percent more than the average bicyclist and accounts for approximately 24 percent of all bicycle-related deaths and more than 50 percent of all bicycle-related injuries,

Head injury is the leading cause of death in bicycle crashes and is the most important determinant of bicycle-related death and permanent disability. Head injuries account for more than 60 percent of bicycle-related deaths, more than two-thirds of bicycle-related hospital admissions and about one-third of hospital emergency room visits for bicycling injuries. The single most effective safety device available to reduce head injury and death from bicycle crashes is a helmet. Helmet use reduces the risk of bicycle-related death and injury and the severity of head injury when a crash occurs. Unfortunately, national estimates report that bicycle helmet use among child bicyclists ranges from 15 to 25 percent. Helmet usage is lowest (for all ages) among children ages I I to 14 (II percent). Bicycle education programs and mandatory bicycle helmet legislation are effective at increasing helmet use and, therefore, reducing bicycle-related death and injury.

DEATHS AND INJURIES

— In 1997, 225 children ages 14 and under died in bicycle-related crashes. Motor vehicles were involved in more than 200 of these deaths.

— In 1998, nearly 362,000 children ages 14 and under were treated in hospital emergency rooms for bicycle-relatcd injuries.

— In 1998, children ages 14 and under accounted for approximately 28 percent of bicyclists injured in motor vehicle crashes. It is estimated that collisions with motor vehicles account for nearly 90 percent of all bicycle-related deaths and 10 percent of all nonfatal bicycle-related injuries.

— Collision with a motor vehicle increases the risk of death, severity of injury, and the probability of sustaining a head injury.

— More than 40 percent of all head injury-related deaths and approximately three-fourths of head injuries occur among children ages 14 and under. Younger children suffer a higher proportion of head injuries than older children.

WHEN AND WHERE BICYCLE DEATHS AND INJURIES OCCUR

— Children are more likely to die from bicycle crashes at non-intersection locations (66 percent), during the months of May to August (55 percent), and between 3 p.m. and 6 p.m. (39 percent).

— Nearly 60 percent of all childhood bicycle-related deaths occur on minor roads. The typical bicycle/motor vehicle crash occurs within one mile of the bicyclist’s home.

— Children ages 4 and under are more likely to be injured in non-street locations around the home (driveway, garage, yard) than are children ages 5 to 14,

— Children ages 14 and under are nearly four times more likely to be injured riding in non-daylight hours (e.g., at dawn, dusk or night) than during the daytime.

— Among children ages 14 and under, more than 80 percent of bicycle-related fatalities are associated with the bicyclist’s behavior including, riding into a street without stopping; turning left or swerving into traffic that is coming from behind; running a stop sign; and riding against the flow of traffic.

— Injuries related to the use of bicycle-mounted child seats typically occur when the bicycle crashes or tips over and when the child falls out of the seat. Falls account for 80 percent of these injuries.

WHO IS A T RISK

— Riding without a bicycle helmet significantly increases the risk of sustaining a head injury in the event of a crash. Non-helmeted riders are 14 times more likely to be involved in a fatal crash than helmeted riders.

— Children under age 10 are at greater risk for serious injury and are more likely to suffer head injuries than older riders. Approximately half of all bicycle-related injuries among children under age 10 occur to the head/face, compared to one-fifth among older children.

— Bicyclists admitted to hospitals with head injuries are 20 times more likely to die than those without head injuries.

— Correct fit and proper positioning are essential to the effectiveness of bike helmets. One study found that children whose helmets fit poorly are at twice the risk of head injury in a crash compared to children whose helmet fit is excellent. In addition, children who wear their helmets tipped back on their head have a 52 percent greater risk of head injury than those who wear their helmets centered on their head.

— Children ages 14 and under are five times more likely to be injured in a bicycle-related crash than older riders.

— Males account for more than 80 percent of bicycle-related deaths and 75 percent of nonfatal injuries. Children ages 10 to 14, especially males, have the highest death rate from bicycle-related head injury of all ages.

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BICYCLE HELMET EFFECTIVENESS

Bicycle helmets have been shown to reduce the risk of head injury by as much as 85 percent and the risk of brain injury by as much as 88 percent. Bicycle helmets have also been shown to offer substantial protection to the forehead and mid face.

It is estimated that 75 percent of bicycle-related fatalities among children could be prevented with a bicycle helmet.

Universal use of bicycle helmets by children ages 4 to 15 could prevent between 135 and 155 deaths, between 39,000 and 45,000 head injuries, and between 18,000 and 55,000 scalp and face injuries annually.

Child helmet ownership and use increases with income and educational level, yet decreases with age, Children are more likely to wear a bicycle helmet if riding with others (peers or adults) who are also using one.

BICYCLE HELMET LAWS AND REGULA TIONS

— Currently, 16 states and numerous localities have enacted some form of bicycle helmet legislation, most of which cover only young riders.

— Various studies have shown bicycle helmet legislation to be effective at increasing bicycle helmet use and reducing bicycle-related death and injury among children covered under the law. One example shows that five years following the passage of a state mandatory bicycle helmet law for children ages 13 and under, bicycle-related fatalities decreased by 60 percent.

— Helmet use among children is greater in those regions of the United States with the highest proportion of mandatory helmet laws. A recent study reported that the rate of bicycle helmet use by children ages 14 and under was 58 percent greater in a county with a fully comprehensive bike helmet law than in a similar county with a less comprehensive law.

— As of March 10, 1999, all new bicycle helmets manufactured must meet the new U.S. Consumer Product Safety Commission federal safety standard. Helmets meeting American National Standards Institute (ANSI), the Snell Memorial Foundation and/or the American Society for Testing and Materials (ASTM) standards are safe and may be available in stores until March 2002.

HEALTH CARE COSTS AND SAVINGS

— The total annual cost of traffic-related bicyclist death and injury among children ages 14 and under is more than $3.4 billion.

— Every dollar spent on a bike helmet saves society $30 in direct medical costs and other costs to society.

— If 85 percent of all child cyclists wore bicycle helmets in one year, the lifetime medical cost savings could total between $109 million and $142 million.

— A review of hospital discharge data in Washington state found that treatment for nonfatal bicycle injuries among children ages 14 and under costs more than $113 million each year, an average of $218,000 per child.

PREVENTIONTIPS

— A bicycle helmet is a necessity, not an accessory. Always wear a bicycle helmet every time and everywhere you ride.

— Wear a bicycle helmet correctly. A bicycle helmet should fit comfortably and snugly, but not too tightly. It should sit on top of your head in a level position, and it should not rock forward and back or from side to side. The helmet straps must always be buckled.

— Buy a bicycle helmet that meets or exceeds the safety standards developed by the U.S. Consumer Product Safety Commission federal safety standard or those developed by ANSI, Snell or ASTM.

— Learn the rules of the road and obey all traffic laws. Ride on the right side of the road with traffic, not against; use appropriate hand signals; respect traffic signals; stop at all stop signs and stop lights; and stop and look left, right, and left again before entering a street.

— Cycling should be restricted to sidewalks and paths until a child is age 10 and able to show how well he or she rides and observes the basic rules of the road. Parental and adult supervision is essential until the traffic skills and judgment thresholds are reached by each child.