Bike helmets: Thinking past the driveway

Photo by Daniel Friedman.

By Vicki Louk Balint

Sixth grader Cathy Horning, 12, of Mesa, rides her bike to Ida Redbird Elementary School in Mesa, and home again, every day. She wears a helmet that fits her perfectly.

But she says she’s one of only two kids at her elementary school who does.

“The kids make fun of me like crazy,” she explains. “They say they’re too popular to wear helmets.”

Every three days a child in the United States is killed while riding a bicycle, according to the C.S. Mott Children’s Hospital National Poll on Children’s Health. Every single day, 100 children are treated in emergency rooms for bicycle-related head injuries.

Pediatric Trauma Coordinator Jim Boise, R.N., CFRN, of Maricopa Medical Center, says that bicycle accidents and/or bicycle accidents involving an automobile account for roughly 10 percent of pediatric trauma cases at MMC. According to the Maricopa County Safe Kids Coalition, head injury is the leading cause of death in bicycle crashes and is the most important determinant of death and permanent disability. Proper helmet use reduces the risk of brain injury by about 90 percent.

Priscilla Horning, Cathy’s mom, can’t figure out why kids would tease her daughter for making the decision to protect her brain. But they do.

Priscilla says her family has a particularly heightened awareness of brain injuries. In the days before helmets were available, an older sibling of Cathy’s fell from a bike and hit her head, breaking her arm and two front teeth and sustaining a concussion. And because Priscilla’s brother survived brain cancer and now runs support groups for victims of brain injury, he’s inundated with information on what happens when kids get hurt.

“He deals with hundreds of people who have survived a bike, motorcycle or car accident, not just those with brain cancer,” says Priscilla. “It’s amazing what you learn.”

For the Hornings, bike helmet use as a health behavior is a given. But for other families, experts say, the tension of making a fashion statement or being “cool” often overrides the safety factor, especially among older kids. Parents who participated in the C.S. Mott poll say that the other barriers to helmet use include the cost, along with the fact that their kids “simply don’t like wearing one.”

David I. Rosenberg, M.D., has spent 25 years on the front lines, taking care of young patients soon after injuries first occur. As a pediatric critical care physician at the Arizona Children’s Center at MMC, Rosenberg sees the outcome of bicycle, all-terrain and other wheeled recreational vehicle accidents when young patients are admitted to the emergency department.

“Generally speaking, the ones who have the worst injuries weren’t using the proper safety devices,” he says. “Being on this end, to see children who come in dead, or with bad neurological injuries who will never be the same…it’s very frustrating as a pediatrician to have kids suffer life-altering trauma that could have been prevented.”

Although the most serious bicycle accidents often involve an automobile, children can sustain critical or even fatal head injuries simply by falling off a bike and hitting a vulnerable area of the skull—just over the ear or just above the spinal cord, for example. “It can be a minor fall,” says Rosenberg, “but a very serious injury.”

Bike helmets protect the head with a strong Styrofoam lining and an outer coating of polycarbon that absorbs a significant portion of the impact so that it is not transmitted to the brain.

Estimates from National Highway Traffic Safety Administration data show that if all kids between the ages of 4 and 15 used a helmet whenever they rode a bike, 40,000 head injuries and about 50,000 scalp and facial injuries could be prevented every year. Helmet use is higher in states where helmet laws exist, according to the C.S. Mott poll; yet only 21 states have them. Arizona does not.

A helmet law would certainly reduce the number of children who are hurt or killed, says injury prevention specialist Tracey Fejt, R.N., but it shouldn’t take a law. “Parents should know that kids can die,” she says. “It’s head injuries we’re talking about. When we’re talking about bikes, scooters, skateboards, roller blades and roller skates, head injury is the number one injury. And we can’t fix your brain. Once it’s injured, it’s injured.”

Fejt organizes outreach programs through her work at Cardon Children’s Medical Center in Mesa, visiting classrooms monthly to educate children on safety issues and prevention. As part of a partnership that incorporates this safety information into the curriculum, schools agree to call themselves “helmet-required schools” and Cardon Children’s provides all students with helmets—free of charge.

Does it work?

When Fejt began working with schools in 2008 with assistance from the Arizona Department of Transportation’s Safe Routes to School program, the percentage of kids using helmets was very low. “I had maybe a one percent rate of kids wearing helmets. And now we’re at 70. Am I going to reach everyone? Probably not. You’re going to always have those kids who think they’re 10 feet tall and bullet proof and don’t need helmets. But a lot of kids there wouldn’t have been in helmets if I hadn’t been here.”

Cathy Horning has been brainstorming ways to increase the number of kids at her school who wear bike helmets. Among her ideas: working with the student council to do a fundraiser to buy and decorate helmets, talking to her principal about a helmet rule for the school, maybe convincing just one or two popular kids to wear helmets in hopes they’d start a trend. “It’s really important to the school and to Arizona,” she says. “I don’t want anyone to get hurt.”

Priscilla is proud of her youngest daughter; she only wishes that parents would see the issue with the same clarity and concern as Cathy does. “People really don’t think past the driveway,” she says. “It is fun to have the wind blow in your hair—but it’s not worth it. If you hit a crack or dip in the road or try to avoid a car and you fall and hit your head on the curb, it could be the last thing you ever do.”

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