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Heads Up: Helmet Tips for Safer Bicycling

National data show bicycle injuries tend to spike in June. In 2021, 81 patients were treated at Cook Children's for traumatic injuries to the head or body from bike accidents.

Whether your child is a beginner on training wheels or an expert on the stunt ramps, every bicyclist should consistently wear a helmet that fits snugly and buckles securely. stock-photo-a-sporty-kid-bike-riding-on-a-park-571374070.jpg

That’s according to the safety experts at Cook Children’s, where 81 patients were treated for traumatic injuries to the head or body from bike accidents in 2021. Another 93 patients were treated last year for traumatic injuries on scooters, skateboards, skates and hoverboards. Most reported they weren’t wearing a helmet.

National data show bicycle injuries tend to spike in June. The most at-risk population? Boys in the 10- to 24-year age group. More than any other sport or recreational activity, bicycling accounts for the highest number of visits to the emergency department for traumatic brain injuries, according to the U.S. Centers for Disease Control and Prevention.

Sharon Evans, trauma injury prevention coordinator at Cook Children’s, hears a variety of excuses from helmet resisters. Teens and children often don’t wear helmets because their parents don’t enforce the rule, she said. Or they think they’re invincible and won’t ever fall.   

“It goes back to ‘It won’t happen to me,’” she said. “For the most part, there are way more broken bones. But when they have a head injury, it’s bad.”

As director of Neurotrauma at Cook Children’s, Daniel Hansen, M.D. has seen skull fractures, severe concussions, brain bruising, and bleeding in and around the brain in bicycle riders who crashed without the protection of a helmet.

“These injuries very often involve kids going downhill and flipping over the handlebar and hitting their heads,” Dr. Hansen said. “We do have the unfortunate instance where we have some auto versus bicycle accidents, but it’s usually children getting out of control going down a hill that was a little bit bigger than their skill level.”

Dr. Hansen pointed out that helmets are designed to absorb the force of impact when a cyclist’s head hits the pavement or other hard surface. If the helmet breaks in a bad fall, he said, it worked as intended.  

Helmets should be replaced if they’re damaged or if they’ve been in an accident, which could cause the interior foam to shift.

Cook Children’s is spreading the message, “Falls are Brutal. Protect your Noodle,” to educate North Texans about the importance of wearing the right-sized helmet. A helmet that fits correctly will feel snug but not uncomfortable.  A few other key points:

  • Helmets that passed federal safety standards in testing will say “U.S. Consumer Product Safety Commission certified” on the label.
  • Helmets should be worn in a level position just above the eyebrows.
  • If the helmet rocks backward and forward or side to side, adjust the straps. No more than two fingers should fit under the buckled chin strap.    
  • Never ride without a helmet.

Dr. Hansen said his three children have been trained in the helmet habit.  bike helmet safety

“Start your kids off early with the idea that it’s just part of what you do when you’re on a bike, and it’s not an option. It’s not an accessory. A helmet is part of the bike,” he said.

“Helmets might seem at times like an inconvenience, especially in the hot Texas summers. They might sometimes seem like an unnecessary expense,” he said. “But when you’re thinking about the value of a child’s life or the expense of a hospital admission or the inconvenience of recovering from a bad head injury, it’s really a very small price to pay to keep someone you love safe.” 

If a child takes a bad fall, Dr. Hansen said, parents should watch for signs of head trauma. The child might be inconsolable from pain; unable to move normally or to say what happened; lose consciousness or appear to have a seizure. Call 911 if you’re concerned.  

Most patients recover well from head injuries after bicycle accidents, he said. But lingering effects can include restrictions on sports activities, weakness, memory problems and speech difficulty. 

“We certainly see a couple of kids a year who are pretty devastated from their falls,” he said.

Evans hopes helmet use someday becomes as automatic and widespread as seatbelts. Cook Children’s has given away more than 250 free helmets to hospitalized patients and at community events in collaboration with the Fort Worth Fire Department and Fort Worth Firefighter Charities.

For more information, go to Bicycle Safety (

About Cook Children's

Cook Children’s Health Care System embraces an inspiring Promise – to improve the health of every child through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community. Our not-for-profit organization is comprised of nine companies, including our Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan, Health Services Inc., Child Study Center and Health Foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. For 100 years, we’ve worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties. We combine the art of caring with leading technology and extraordinary collaboration to provide exceptional care for every child. This has earned Cook Children’s a strong, far-reaching reputation with patients traveling from around the country and the globe to receive life-saving pediatric care. For more information, visit