Should A Toddler Wear A Helmet On A Tricycle?

A sweet trike and helmet for a sweet girl!

My husband and I are both avid cyclists, recreationally and for commuting purposes. We both owe our lives, several times over, to helmets. Some of our crashes have been due to, shall we say, “operator error,” while others have been the result of collisions with vehicles. Aside from those crashes that were severe enough to have been potentially life-threatening, we’ve also both been in a number of crashes that would have likely caused traumatic brain injury (commonly called concussion) had we not been wearing helmets. It’s easy to dismiss the importance of wearing a helmet on a bicycle, scooter, or similar non-motorized vehicle, particularly if one doesn’t believe the risk of death is significant in the event of a crash (e.g., I’m just riding a cruiser down the sidewalk; I won’t die if I crash). Nevertheless, any time a person is thrown or falls from a moving bike or similar, there’s the significant risk of head injury. Further, there’s a growing body of research that links even mild traumatic brain injury to depression, cognitive impairment, and early-onset dementia (see, for instance, Guskiewicz et al [2005 and 2007], Kiraly et al). Even people who don’t ride a non-motorized vehicle in a way that makes death a significant risk in the event of a crash are at risk for traumatic brain injury, and its associated complications.

There’s some concern among physicians that the use of the term “concussion” confuses parents and downplays the seriousness of this injury (DeMatteo et al). It should be noted that a concussion is a traumatic brain injury, is associated with alterations in brain blood flow in children (Maugans et al), and can cause developmental delays and functional losses that persist months to years post-injury (Rivara et al). Traumatic brain injury is one of the leading causes of disability and death in children (Keenan et al.)

Last week, we decided W was old enough for her first tricycle. I found a really cool company called Wishbone that makes a 3-in-1; it converts from a low-rider trike for the toddler set to a low-rider bike, and finally to a taller bike for older children. Best of all, it has no pedals; it’s a so-called “run bike,” which allows little ones to work on refining balance and steering before having to coordinate pedaling action. And I love the company’s ethics and commitment to sustainability. Anyway, with the bike on order, we went and bought W a helmet. For a toddler. Riding a trike. With no pedals. No joke. There were a few reasons for this. First, while it might seem suspect that a toddler could fall off a trike and do any significant damage, there are actually many reports of serious trike injuries (see, for instance, Powell et al [1997 and 2000], Sacks et al, Sosin et al). Toddlers and preschoolers who fall off tricycles sustain head, face, and mouth injuries with great frequency, and researchers strongly recommend helmets for this group. Secondly, among toddlers, it’s not just accidents while riding that account for tricycle injuries; these not-yet-stable walkers can fall and sustain a head injury while attempting to mount or dismount a tricycle. The final reason we bought W a helmet was simply to get her in the habit early on, which has been quite successful even over the course of just a few days; if she wants to ride her trike, she points to her helmet. I’m happy to be getting her into this habit early, because the kid will be wearing a helmet every time she gets on a trike, bike or similar, rides a skateboard, or skis. Every time. And her parents will too, both because it sets a good example, because we know from experience, and because, as an article published in the Journal of the American Medical Association (Sacks et al) put it:

From 1984 through 1988, bicycling accounted for 2985 head injury deaths (62% of all bicycling deaths) and 905,752 head injuries (32% of persons with bicycling injuries treated at an emergency department). Forty-one percent of head injury deaths and 76% of head injuries occurred among children less than 15 years of age. Universal use of helmets by all bicyclists could have prevented as many as 2500 deaths and 757,000 head injuries, ie, one death every day and one head injury every 4 minutes.

 

Science Bottom Line:* Use a brain bucket. Wear a skid lid. Invest in some skull insurance. Don’t crack your melon.

 

Do you wear a helmet when you ride a bike? Do you make your kids wear one?

 

References:

DeMatteo et al. “My child doesn’t have a brain injury, he only has a concussion”. Pediatrics. 2010 Feb;125(2):327-34. Epub 2010 Jan 18.

Guskiewicz et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005 Oct;57(4):719-26; discussion 719-26.

Guskiewicz et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007 Jun;39(6):903-9.

Keenan et al. Epidemiology and outcomes of pediatric traumatic brain injury. Dev Neurosci. 2006;28(4-5):256-63.

Kiraly et al. Traumatic brain injury and delayed sequelae: a review–traumatic brain injury and mild traumatic brain injury (concussion) are precursors to later-onset brain disorders, including early-onset dementia. Scientific World Journal. 2007 Nov 12;7:1768-76.

Maugans et al. Pediatric sports-related concussion produces cerebral blood flow alterations. Pediatrics. 2012 Jan;129(1):28-37. Epub 2011 Nov 30.

Powell et al. Bicycle-related injuries among preschool children. Ann Emerg Med. 1997 Sep;30(3):260-5.

Powell et al. Cycling injuries treated in emergency departments: need for bicycle helmets among preschoolers. Arch Pediatr Adolesc Med. 2000 Nov;154(11):1096-100.

Rivara et al. Disability 3, 12, and 24 months after traumatic brain injury among children and adolescents. Pediatrics. 2011 Nov;128(5):e1129-38. Epub 2011 Oct 24.

Sacks et al. Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. How many are preventable? JAMA. 1991 Dec 4;266(21):3016-8.

Sosin et al. Pediatric head injuries and deaths from bicycling in the United States. Pediatrics. 1996 Nov;98(5):868-70.

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10 Comments (+add yours?)

  1. MrPopularSentiment
    May 03, 2012 @ 13:10:00

    We have one of these cool push trikes with a handle, since our 1-year-old can’t really be expected to propel himself yet. We have him wearing a helmet whenever he’s on it. A huge part of it, for me, is training him to accept helmets as a necessary part of being on anything bike-like.

    Reply

  2. Ashley @ C is for Cockerham
    May 03, 2012 @ 14:25:08

    I enjoy road biking and always, always, always wear a helmet. A couple years ago I was involved in a low-speed crash due to user error of an inexperienced cyclist four riders in front of me. No user error on my part. No cars involved. Traveling about 5 mph up a hill. You just can’t plan for everything. I cannot imagine what my head would have looked like without my helmet…the plastic and foam was completely destroyed. Needless to say, T will always, always, always be wearing a helmet while riding anything bike-like. And I totally agree, it’s never to early to start the habit. It’s like they won’t know any differently. When I started cycling, I was shocked that people didn’t wear helmets. It was normal for me to wear one and not normal for me to see someone riding and not wearing one. We also have T wearing one when he rides in the pull-along bike trailer behind our bikes.

    Reply

  3. Eileen
    May 07, 2012 @ 23:57:00

    I agree completely with the habit-forming component. Kids need to learn early on that going on wheels = helmet. I work in a school and occasionally the trauma nurses come in and do their “wear a helmet” assembly for the kids. One of their main points is that the human skull was not designed for impacts at any faster than 3-5 miles per hour,(that’s a brisk walk or a gentle run). So pretty much anytime you are on wheels, you are going faster. Maybe not on a trike (I’ve had to slow my walk to wait for the tricyclist I’m with), but the even bigger danger is impact with something else, like hitting a car. God forbid that happens, but kids on trikes have less control of where they’re going and are often paying more attention to making the thing move than they are to what’s going on around them.

    Reply

    • SquintMom
      May 08, 2012 @ 10:10:41

      Thanks for your comment. The other thing to consider in addition to speed of travel in assessing risk is distance of fall. This is one of the reasons little kids can get hurt on trikes. Also, little kids are like lawn-darts; they’re very heavy in the head (compared to adults) and tend to land head first. They’re also less capable of breaking a fall with their arms. These factors all feed into the high incidence of trike head injuries!

      Reply

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  5. Kayla
    Jun 02, 2012 @ 14:49:57

    I love the whole article. It also speaks volumes about our own manifestations of what has happened in our younger years. My brain injury resulted in deafness and years, years of depression.

    But sometimes I get the whole, “Well, we all survived crashes, etc, as little kids”. I think we forget that manifestations don’t always show up quick. Brain injury isn’t a joke. And post-injury damages can creep up and not be fully realized until YEARS after the fact.

    Thanks for this post!

    Reply

  6. Jenn Guitart
    Dec 09, 2014 @ 13:01:02

    Hi Kirstin,

    My name is Jenn Guitart, and I’m the Director of Communications and Development at the California Bicycle Coalition. CalBike (as we are also known) works to promote policies enabling more people to ride bikes.

    I’m writing a holiday email appeal for our organization; the email is entitled “We’re for tricycling too!” and is about how we are going to work in 2015 to get more kids and families riding bikes. I google image searched “children on tricycles” and the unbelievably darling photo of your daughter on her little wooden trike popped up. I’m writing to ask your permission to use the photo in the email. I could include a photo credit or not, as you prefer. That photo is just so darling! I can’t imagine anyone looking at it and not wanting to promote more bicycling — and tricycling!

    Thank you!
    Jenn

    Reply

    • Kirstin
      Dec 09, 2014 @ 14:19:43

      Jenn,
      Thanks for your kind comments! You are more than welcome to use the photo. Please just put my website (www.beautifulentropy.wordpress.com) as a credit! Cheers!

      Reply

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