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.

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.  

“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 (cookchildrens.org)

Last month alone, eight children were taken to Cook Children’s Emergency Department after being hit by cars while walking or riding bicycles. The same number of children were injured in February.

“Over the past couple years, we’ve seen the numbers increase,” said Sharon Evans, Trauma/Injury Prevention Coordinator at Cook Children’s. “We can’t say why this is happening, but we do know children do not have the cognitive skills to cross a street safely by themselves until they are at least 10.”

According to a new study released by the University of Iowa, 10 may still be too young. Researchers suggest children may not have the perceptual judgment or motor skills needed to safely cross a street until they are 14 years old. The study used virtual reality to simulate a busy street. Then, children, ages 6 to 14, were asked to cross multiple times.

The results show the children, up to their early teenage years, had a difficult time deciding when to cross the street. The study also evaluated how often the children were involved in an accident during the simulation.

Accident rates from the study:

· 6 year olds – 8%

· 8 year olds – 6%

· 12 year olds – 2%

So what do parents need to know?

Do not allow children under the age of 10 to cross the street by themselves. Even better, wait until they are a teenager and able to confidently know when to safely cross.

Cook Children’s recommends teaching these behaviors before allowing a child of any age to cross the street alone:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing. Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

“When I visit children who have suffered pedestrian injuries, the most common thing they tell me is that they thought the driver saw them,” explained Evans. “It’s important to teach your children that just because they see a driver, it doesn’t mean the driver sees them. They need to make eye contact with the driver and wait for the driver to stop and signal to them before attempting to cross the street.”

Last year, the Cook Children's Trauma team saw 22 children, either biking or walking, who were hit by cars from August through the month of October. Eight children were hit by cars in September and 10 in October. 

But with school already started, so are the dangers of kids and cars.

Already, a teen was hit in front of a high school in Crowley. The injuries seem to be minor, but it places an emphasis on how vulnerable children are near or even in front of schools.

More children are hit by cars during September than any other month of the year, according to Safe Kids Worldwide.

“Children do not have the cognitive skills to be crossing streets safely alone until at least age 10,” said Sharon Evans, Trauma/Injury Prevention outreach coordinator at Cook Children’s. “They haven’t yet developed the depth perception or the ability to maturely judge the speed of an object.”

Kids age 10 and younger should not walk or ride bicycles, scooters or skateboards alone to school because they:

• Are easily distracted by friends and toys.
• Can’t determine the direction of sounds. Some children may be listening for sounds and may not realize that some newer model electric/hybrid may not make much of a sound at all.
• Can’t judge the speed or distance of a moving vehicle.
• Don’t understand how long it takes a vehicle to stop.
• Have too narrow a field of vision.

Even when kids reach age 10, it’s still best for parents to accompany them to school whenever possible.

Teaching Your Child Pedestrian Safety

“When I visit children who have suffered pedestrian injuries, the most common thing they tell me is that they thought the driver saw them,” explained Evans. “It’s important to teach your children that just because they see a driver, it doesn’t mean the driver sees them. They need to make eye contact with the driver and wait for the driver to stop and signal to them before attempting to cross the street.”

While teaching your children to ride their bikes or walk to school, don’t forget to tell them to cross only at crosswalks; look left, right and then left again; and to watch for cars that are turning or backing up. The best way to teach your child pedestrian and bike safety is to be a good role model yourself. It’s also a good idea to encourage your children to wear bright clothing and reflectors when they’re walking before dawn or after dusk.

"It’s important for parents to remember they are the most important models of proper pedestrian behavior for children," said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. "Parents should also make sure they follow the rules when they are driving in school zones, including going the speed limit at all times through the zone and not texting or talking on the phone."

Safe Kids recommend teaching your kids these safe behaviors:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing. Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

Practice safe behaviors:

• Don’t allow a child under age 10 to cross streets alone as he may not be able to fully appreciate the speed of cars on the road.
• Require children to carry a flashlight at night, dawn and dusk. Add retro-reflective materials to children’s clothing so that a child can be seen by motorists, even in the dark.
• Don’t let kids play in driveways, unfenced yards, streets or parking lots. Drivers may not see or anticipate children playing.

Interactive Infographic: How to not get hit by a car - Safe Kids Worldwide

With an average of 44 kids getting hit while walking every day in the U.S., it’s time for action. HOW TO NOT GET HIT BY A CAR is a fun new interactive infographic that guides walkers through seven common ways kids get hit by cars, and seven ways to avoid it. Parents and kids alike give it great reviews; not only do they think it’s fun to experience the action, they can usually relate to it. Try it out and see if you make any of the common mistakes when you cross the street.

Try the interactive infographic from Safe Kids

For more information

Whether it is the correct use of a child passenger seat, drowning prevention education in the schools, or providing a better awareness of poison hazards to new moms, we are working to create safe homes and communities for children.

• Bicycle safety
• Car safety
• Safe Kids Tarrant County
• CARE Team
• Drowning prevention
• Human trafficking
• Oral health prevention
• Poison prevention
• Sexting
• TV and furniture tip-overs