Cook Children’s Health Care System is seeing a steep increase in serious injuries associated with these vehicles, including skull fractures, facial fractures, finger amputations and severe extremity fractures.

According to Cook Children's trauma registry data, injuries surged during the first half of 2026 compared with all of 2025. E-bike-related trauma cases increased 500%, rising from eight to 48 cases, while e-scooter injuries climbed 97%, from 29 to 57 cases. Because the trauma registry captures only the most severe injuries, the total number of emergency department visits is even higher.

This surge also saw a widening age gap: while the age range for these injuries so far in 2026 spans 4 to 17 years, the prior year saw a narrower range of 10 to 16 years for e-bikes and 4 to 17 for e-scooter injuries.

During the first two weeks of summer break alone, Cook Children’s treated 25 patients for e-bike and e-scooter injuries and 16 children for other personal electric vehicles. Many of those patients required admission to the Pediatric Intensive Care Unit (PICU).

“With e-bikes, kids are often not wearing appropriate protective gear or helmets,” said Taylor Louden, M.D., medical director of emergency services at Cook Children’s Medical Center – Fort Worth. “Sadly, we have had children struck by cars while riding on the road because they do not understand basic traffic laws.”

The U.S. Consumer Product Safety Commission (CPSC) recommends that children younger than 12 should not operate any e-bike capable of traveling faster than 10 mph.

Dr. Louden emphasized the importance of proper helmets.

“Always wear a helmet when riding anything with wheels,” said Dr. Louden, “For these faster e-bikes, we recommend a BMX-style helmet with face protection.”

Under the Texas Transportation Code, an e-bike is a bicycle with fully operational pedals, a motor of less than 750 watts, and an assisted top speed of 28 mph or less. Texas classifies e-bikes into three categories. While there are no age restrictions for riding a Class 1 or Class 2 e-bike, riders must be at least 15 years old to operate a Class 3 e-bike.

Sharon Evans, trauma injury prevention manager for Cook Children's, said families should remember that e-bikes and e-scooters are vehicles, not toys.

Evans and Dr. Louden offer the following safety tips for families:

Summer Ride Safety for E-Bikes and E-Scooters

• Adult supervision: Children should not ride these vehicles without direct adult supervision. Children younger than 12 should not operate them.
• Always wear a helmet: Make sure your child wears a properly fitted helmet. Helmets are the most important piece of safety equipment, but not all helmets are designed for e-bikes and e-scooters. Check the safety standards below to ensure children are wearing the appropriate helmet for the vehicle’s speed.
  • CPSC: All bicycle helmets sold in the U.S. must meet this standard. These are best for traditional bicycles and low-speed scooters.
  • ASTM F1952: Provides more protection than a standard bicycle helmet and may be good choice for riders traveling at speeds below 20 mph.
  • NTA 8776: Designed specifically for e-bike and e-scooter riders. This is the preferred choice for riders travelling at speeds above 28 mph.
  • DOT FMVSS-218: Provides the highest level of protection on this list and is best suited for higher speeds above or riding near heavy traffic.
    
• Perform a safety check before every ride:
  • Check the tires. Ensure they are inflated to the recommended pressure listed on the sidewall.
  • Test brake levers. Squeeze the brake levers while rolling the vehicle forward and backward.
  • Inspect vehicle. Check for loose parts or anything that appears damaged or abnormal.
    
• Follow the rules of the road:
  • Always ride on the right, in the same direction as traffic. Use the bike lane when available.
  • Stop and look both ways before entering a street or crossing an intersection.
  • Stop at all intersections.
  • Obey all traffic lights and signs.
  • Stay aware of your surroundings. Do not talk on the phone, text, or wear earbuds while riding.
    
• Night rides: Wear bright, reflective clothing and ensure the e-bike or e-scooter is equipped with light and reflectors.

Related Stories:

• What Parents Needs to Know About E-Bike and E-Scooter Safety
• A Families Guide to Summer Snacks and Hydration
• Heads Up: Helmet Tips for Safer Bicycling
  

Sharon Evans, trauma injury prevention manager for Cook Children's Health Care System, explains that, while these may seem like gifts without much concern, it is important to understand they are vehicles. She offers families tips on how to help their children safely enjoy e-bikes and e-scooters. 

“Always wear a helmet,” emphasizes Evans.

• Always wear a helmet: Make sure you have the right helmet. For e-bikes/e-scooters that go up to 20 mph, a bike helmet is sufficient, but parents may want to invest in a stronger helmet to better protect their children.
• Perform a safety check before each ride:
  • Check the tires. Ensure they are inflated to the recommended pressure on the sidewall.
  • Check brake levers. Squeeze them while rolling the bike forward and backward to ensure the brakes engage and stop the e-bike/e-scooter.
  • Inspect your e-bike/e-scooter for loose nuts or anything that looks abnormal.
• Follow the rules of the road:
  • Always ride on the right, in the same direction as traffic. Use the bike lane if available.
  • top and look both ways before entering a street or crossing an intersection.
  • Stop at all intersections.
  • Obey all traffic lights and traffic signs.
  • Be aware of your surroundings. Do not talk on the phone or text. Do not wear earbuds; you cannot hear what is happening around you.
• Night rides: Make sure you wear bright, reflective clothing. Ensure your e-bike/e-scooter has a light and reflectors.

Related Stories:  

Gifts from the Heart: A Child Life Specialist's Guide to Kid-Approved Homemade Presents 

The Ultimate Holiday Safety Checklist 

Know When to Use Telemedicine, Urgent Care, or the ER for Kids 

Electronic scooters are often considered vehicles and must adhere to traffic regulations and local ordinances. Some cities have adopted ordinances specific to e-bikes and e-scooters.

Sharon Evans, trauma injury prevention manager, offers parents tips on how families can safely enjoy their e-bikes and e-scooters.

• Always wear a helmet: Make sure you have the right helmet. For e-bikes/e-scooters that go up to 20 mph, a bike helmet is sufficient, but parents may want to invest in a stronger helmet to protect their children better.
• Perform a safety check before each ride:
  • Check the tires. Ensure they are inflated to the recommended pressure on the sidewall.
  • Check brake levers. Squeeze them while rolling the bike forward and backward to ensure the brakes engage and stop the e-bike/e-scooter.
  • Inspect your e-bike/e-scooter for loose nuts or anything that looks abnormal.
• Follow the rules of the road:
  • Always ride on the right, in the same direction as traffic. Use the bike lane if available.
  • top and look both ways before entering a street or crossing an intersection.
  • Stop at all intersections.
  • Obey all traffic lights and traffic signs.
  • Be aware of your surroundings. Do not talk on the phone or text. Do not wear earbuds; you cannot hear what is happening around you.
• Night rides: Make sure you wear bright, reflective clothing. Ensure your e-bike/e-scooter has a light and reflectors.

“While we are ecstatic that children are finding ways to get exercise and enjoy being outside, we want to remind parents to make sure that kids are protected while having fun,” said Kara Starnes, D.O., medical director of Urgent Care at Cook Children's.

Helmets are a Must for Fun on Wheels

ATV and dirt bike crashes are a common occurrence during summer. Over Memorial Day Weekend, the emergency department in Fort Worth saw 10 injuries related to motorcycles, dirt bikes, ATVs and skating.

Always ensure your child wears a properly fitted helmet to avoid head injuries. Adult supervision is essential when a child is riding any motorized vehicle, and children should never ride on ATVs or dirt bikes designed for adults.

“Please supervise your children on motorized vehicles,” Taylor Louden, M.D., medical director of Pediatric Emergency Medicine at Cook Children’s Medical Center – Fort Worth said. “They should always be wearing their seat belt and appropriate safety gear. The start of summer is a great time to check your kids’ safety gear and make sure helmets fit appropriately and are in good condition.”

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.

Water Safety: A Constant Vigilance

Drowning is the leading cause of accidental death for children ages 1 to 4, and the second leading cause for kids 1-14 in Texas. Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger. These tragedies highlight the importance of constant supervision around water.

Sharon Evans, trauma injury prevention coordinator at Cook Children's, emphasizes, "There's no off-season for drownings. A moment of inattention can be devastating."

Unplanned swim time is a major culprit, with roughly 70% of drownings at Cook Children's occurring when parents weren't expecting their child to be near water.

Layers of Protection: Keeping Curious Toddlers Safe

Multiple safety measures, known as "layers of protection," can significantly reduce drowning risks. Fencing around pools with self-latching gates, preferably 5-feet high, is crucial. Door and window alarms can alert you if a child exits the house unsupervised. Remember, young children are naturally curious, so removing pool toys and floats when not in use minimizes temptation. For above-ground pools, make sure to remove the ladder when the pool is unsupervised. Consider using a pool surface alarm for added security.

Cook Children's has developed the "Lifeguard Your Child" campaign to raise awareness about childhood injury prevention. Through this initiative, you can find resources like free swim lessons, safety videos, and loaner life jacket stations at lakes across North Texas. Visit lifeguardyourchild.org for more information.

Sun Safety: Protecting Young Skin

Sunburns are not just uncomfortable; they can increase a child's risk of skin cancer later in life. Zinc oxide-based sunscreen is best whenever your child is outdoors. Covering skin with SPF is another way to protect your child’s skin. Apply sunscreen generously 30 minutes before sun exposure and reapply every two hours, or more often after swimming or sweating. Protective clothing, hats with wide brims, and sunglasses that block UV rays offer additional defense.

Hydration: Keeping Cool and Healthy

Dehydration can lead to nausea, dizziness, headache, or even heat stroke. Encourage frequent sips of water throughout the day, even if your child doesn't feel thirsty. Avoid sugary drinks that can worsen dehydration.

Your child’s urine colors can range from clear to dark yellow to orange, depending on how hydrated they are. To tell if your child is dehydrated, read this article from Celina D. Cepeda, M.D., a nephrologist at Cook Children’s Medical Center – Prosper.

Fishing Fun Without the Hooks

Fishing is a popular summer activity, but fish hooks can pose a safety risk. Teach children to handle hooks with care and supervise them closely while fishing. Consider using barbless hooks to minimize injury if a hook snags on skin.

RELATED:

• A Cautionary Tale: The Misadventures of Summer & Top Injuries Seen at Cook Children’s
• Should My Child Ride ATVs? Cook Children's Experts Weigh In 
• Sunburn Relief at Home, When to See a Pediatrician 
• Pediatrician Shares Top Beach Vacation Health Tips 
• Heads Up: Helmet Tips for Safer Bicycling 
• Teen Driver? What to Know Before They Go This Summer 

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)

Dr. Guirola is one of the select group of Cook Children’s doctors who have undergone and completed rigorous training to earn ImPACT credentials. Used by the world’s leading sports authorities, ImPACT is the most widely recognized science-based concussion and evaluation program available today. Cook Children’s has 26 credentialed doctors in nine locations to evaluate a child’s progress on returning to the playing field.

“There’s no evidence that helmets alter concussion risk for young football players,” said Ricardo Guirola, M.D., M.Ed., who specializes in sports medicine. “Helmets do play a protective role in decreasing the risk of fractures, intracranial injuries and oral injuries.”

The recalled helmets were manufactured by Xenith and the U.S. Consumer Product Safety Commission reports that the shells of the helmets can crack, posing a risk of head injuries. Xenith has released a statement saying they have corrected the issue on all helmets manufactured since March 2016. The serial number is printed on a white sticker inside the top of the helmet. For a list of the serial numbers included, visit www.xenith.com/recall.

Along with helmets, Dr. Guirola says young athletes shouldn’t depend on helmet attachments with claims of protecting from head injuries such as bumpers, pads and sensors.

“At this time, there have been no well-controlled studies show that helmets or third-party attachments prevent or reduce the severity of concussions,” Dr. Guirola said.

Awareness regarding the potential negative effects of concussions has increased dramatically in recent years, said Carla Hearl Morton, Ph.D., a pediatric neuropsychologist and also a member of the ImPACT program.

“As we learn more about concussions, guidelines for how best to treat athletes continue to evolve,” Morton said. “Most athletic trainers and coaches have completed several hours of education regarding how to manage a concussion immediately after it occurs. Regardless of any recommendations they may provide, it is a good idea to notify your child’s primary care physician so that his or her doctor can document the concussion in your child’s medical record, provide guidance in the acute phase of recovery, and better coordinate care if symptoms persist.”

To learn more about Cook Children’s ImPACT program, click here.

About the source

Ricardo Guirola, M.D., specializes in Rheumatology and Sports Medicine. Dr. Guirola takes care of athletes and being part of their active and directed therapy. As part of his education, Dr. Guirola obtained a Master's of Education. He uses those skills to teach families, students, residents, nurses and other physicians. Outside of his medical practice, Dr. Guirola spends times with family, runs and plays soccer and tennis.

This morning I seriously had a discussion with my 6 year old about how many times he can wear shorts without washing.

Him: “They don't look dirty.”Me: “But you sweat and they smell.”Him: “Mom only my head sweats.”

Ya right!

Today clean shorts are on my child. I won the battle, but my chances of winning the war against a smelly boy unlikely.

 And that's OK. 

As parents we all have battles with our kids, but I can’t help but wonder which ones are really worth the fight.  Which ones are worth the effort to bend your child to your way of thinking?

Some are easy. No brainers.  When it comes to safety we can feel confident that making our child sit in a car seat, wear a bike helmet or learn street safety are worthy the battle.

But others can sometimes seem less clear.  How important is it to have them eat healthy or go to bed on time or take a bath.  It may depend upon the day, or whether we are tired or whether our child is merely protesting or an epic meltdown is in process.

There are a couple I believe are worth the effort. 

Healthy foods and no sugar containing drinks should be fought for.  You will not succeed every time, but I see parents who have made the choice to take a stand on this and their success can and should be duplicated.

Teaching your children to be respectful and kind to others in words and actions is also worth it.  This can take daily and sometimes hourly intervention to achieve (Siblings fighting anyone? At my house just having them walk upstairs together without pushing sometimes requires serious parental guidance).  

Remind yourself parenting is not a sprint, it is a long journey.  Your kids will not remember every lesson, every time.  But trust me, they are learning and the lessons that you make a priority will stick.

So, as you can see clean shorts is not on this list, but still I tell my boys, no teacher wants to have a smelly kid in class.  That has worked for me so far.

Happy mom adventures to all of you this summer.

Dr C

About the author

Vanessa Charette, M.D., has been a pediatrician at Cook Children's for 10 years and is located in Fort Worth. Dr. Charette embraces the many components that contribute to health nutrition, physical activity, emotional, psychological stresses and the environment. As your pediatrician she will spend time with you discussing nutrition, child development and take the time to address any concerns you have about your child's health.