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Don't Be Hardheaded and Wear Your Helmet by Guest Blogger, Lilian Bui

Lilian Bui is an MD/MPH candidate at Northwestern University's Feinberg School of Medicine



“Do you wear your helmet when you bike?” I was asked this question during medical school interviews by several pediatricians. As a novice bike rider of only two years, I cannot imagine biking without my helmet, but it was certainly a fair question to ask. According to one study, less than half of adults and children who ride bikes reported always wearing a helmet1.


Bicycle-associated injuries are a common non-fatal pediatric injury that can be prevented with practices like helmet wearing. Between 2010 and 2016, bicycle-associated injuries accounted for 10.2 percent of all sport or recreational TBI-related emergency department visits among boys and 6.8 percent among girls2. In 2020, there were 136,765 nonfatal bicycle-associated injuries in children ages 0-19 in the United States3. This is an increase from 2018 and 2019, likely due to more children riding bikes during the pandemic. Children between the ages of 5 and 14 are particularly likely to experience nonfatal injuries, with nearly 15,000 more children in this age group injured in 2020 than in 20193.


Bicycle-associated injuries can have devastating consequences. These include traumatic brain injuries, bone fractures, facial injuries, and trauma to internal organs4.


Fortunately, bicycle-associated injuries can be prevented in several ways.

1. Well-fitting helmets should always be worn while riding a bike.

a. Children who wear helmets have a lower risk of severe head injuries in crashes with motor vehicles5.

b. The helmet should fit snugly, and the chin strap should be tightened so that no more than two fingers fit between the chin and the strap. It should be replaced after a crash6.

c. Adults can set a good example. Children are more likely to always wear helmets when the adults in their lives always wear helmets1.

2. Children should wear bright-colored clothing so they can be seen by others on the road.

3. When sitting on the bike, children should be able to extend their legs fully to reach the pedals in the lowest position.

a. Proper seat height can prevent knee injury and low back pain7.

4. For older children who may be biking alongside cars and other cyclists, they should know the traffic rules and signaling conventions.

a. In Chicago, the majority of crashes occurred at intersections8.

b. These could possibly be prevented with adherence to the order of traffic, staying to the right and in bike lanes whenever possible, and using hand signals to communicate with other people on the road.


Biking is a fun and amazing physical activity for heart and lung health9. With any fun activity though, safety must still be prioritized. It is important that we encourage and promote safe biking habits among children and adults so that injuries do not keep anyone from experiencing the pure simple joy of riding a bike.


1. Jewett A, Beck LF, Taylor C, Baldwin G. Bicycle helmet use among persons 5 years and older in the United States, 2012. Journal of Safety Research. 2016;59:1-7.

2. Sarmiento K, Thomas KE, Daugherty J, et al. Emergency Department Visits for Sports- and Recreation-Related Traumatic Brain Injuries Among Children — United States, 2010–2016. Vol. 68. 2019:237-242. Morbidity and Mortality Weekly Report. March 15, 2019.

3. Prevention CfDCa. Web-based Injury Statistics Query and Reporting System (WISQARS). 2020.

4. Gilna GP, Stoler J, Saberi RA, et al. Analyzing pediatric bicycle injuries using geo-demographic data. . Journal of Pediatric Surgery. 2022;57(5):915-917.

5. Strotmeyer SJ, Behr C, Fabio A, Gaines BA. Bike helmets prevent pediatric head injury in serious bicycle crashes with motor vehicles. Injury Epidemiology. 2020;7(1)doi:10.1186/s40621-020-00249-y

7. Leavitt TG, Vincent HK. Simple Seat Height Adjustment in Bike Fitting Can Reduce Injury Risk. Current Sports Medicine Reports. 2016;15(3):130. doi:10.1249/JSR.0000000000000254

8. Transportation CDo. City of Chicago 2012 Bicycle Crash Analysis: 2005-2010 Crash Data Summary Report and Recommendations. 2012.

9. Oja P, Titze S, Bauman A, et al. Health benefits of cycling: a systematic review. Scandinavian Journal of Medicine & Science in Sports. 2011;21(4):496-509.


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