AAP Updates Helmet Recommendations for Bikes and Some Sports

From a neighborhood bike ride to a child engaged in competitive sports, helmets save lives and significantly reduce the risk of traumatic brain injuries.

Father helping his son to wear a cycling helmet
Photo: Getty

The science has spoken. Having your child wear a helmet while biking or playing certain sports is a no-brainer.

The American Academy of Pediatrics (AAP) issued an updated policy statement on Monday, which will appear in the September 2022 issue of Pediatrics.

"The evidence is clear: helmets save lives and significantly reduce the risks of severe injury," Lois K. Lee, M.D., MPH, FAAP, lead author of the statement, written by the AAP Council on Injury, Violence, and Poison Prevention, said in a press release. "And yet sports-related injuries make up a substantial proportion of all traumatic brain injuries. As a pediatric emergency medicine physician, I advise all my patients—and their parents—to wear helmets."

The AAP cited injury rates from recreational sports, which were highest in participants ages 5 to 24. The organization also pointed to research that showed that bike riding causes an estimated 26,000 emergency department visits annually and is a leading culprit of sports-related pediatric head injuries.

But the AAP also noted data from 2012 that indicated that only 42% of children ages 5 to 17 said they always wore a helmet while bike riding and 31% never did.

Snow sports like skiing and snowboarding are one of the most common ways a child sustains a head injury while participating in recreational sports, according to the AAP. Wearing a helmet while enjoying these activities can lower the risk of a traumatic brain injury. Yet, another national study of skateboarders and snowboarders under the age of 18 found that more than half (52%) of pediatric patients injured weren't wearing a helmet.

The AAP also lists ice skating and equestrian sports as activities with a higher risk of head injury.

With all of this in mind, here are some of the AAP's top recommendations in the policy statement.

  • Children, teenagers, and adult caregivers should always wear a correctly fitting helmet while participating in recreational sports, including but not limited to: bicycling, snow sports, ice skates, and equestrian sports. Since not all helmets are made the same, the AAP says the helmet should be designed for the sport in which they are participating.
  • Children can choose their own helmets and decorate them to reflect their unique personalities and interests. The AAP hopes this option promotes wearing helmets. Bonus points for adding reflective stickers and lights to bike helmets, which can increase riders' visibility.
  • Any helmet that was involved in a crash or that is damaged or outgrown should be replaced. The AAP advised people to avoid using second-hand helmets when possible.
  • The AAP is recruiting pediatricians to be part of the team. The organization encouraged its members to give parents and patients information on the importance of helmet-wearing during sports and recreational activities.
  • Public education and advocacy should include legislation and regulations surrounding helmet use during sports, similar to what we currently have for child safety restraint and motor vehicle laws.
  • The AAP is stressing the need for more studies on the barriers that may prevent helmet use to aid in developing interventions for high-risk populations.

"We love to see children out on bikes and enjoying physical activities of all kinds," Dr. Lee said in the release. "Make helmets part of your routine, like requiring seatbelts, and encourage kids to personalize their helmet and make it fun. Families who wear helmets together are safer together."

Here are some additional tips from a pediatrician on how to keep children safe using helmets.

Get Fitted For Helmets

Different activities have different helmets. When it comes to biking, experts say the front rim should be low on the forehead.

"The helmet should only [be] one to two finger widths above the eye," says Whitney Casares, M.D., MPH, FAAP, the founder and CEO of the Modern Mamas Club, an app for busy working parents. "The side straps on the right and left should form a 'Y' that meets right below the years. The chin strap should be snug enough so that only one finger-width can fit between the chin and the strap."

Going to a local sports equipment or bike shop can ensure your child has the appropriate helmet and fit.

Be a (Role) Model

Kids may find wearing helmets to be a hassle. Dr. Casares agrees with Dr. Lee—adults can lead by example. Whether you're bike riding or skateboarding with your child, be sure to put your helmet on, too.

"If the grown-ups in a kid's life wear a helmet, the kid is much more likely to follow suit," Dr. Casares.

Know What to Do Post-Accident

Regardless of how safe you are, accidents happen—the helmet is there to protect against the worst outcomes. If your child is in an accident while biking or engaging in sports, Dr. Casares says the first step is to make sure they're in a safe place. Then, assess the severity of their injury.

"You may need to perform basic first aid for cuts and scrapes or seek immediate medical care for loss of consciousness, possible broken bones, or other serious issues," says Dr. Casares.

If the helmet is damaged, be sure to get a new one.

Engaging in sports and recreational activities can be fun. Wearing a helmet may seem inconvenient to a child, but remember, it helps keep their head in the game.

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