NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

More than 70 percent of children between the ages of 5 and 14 ride bicycles. In-line skating and skateboarding are also very popular among this age group. Although a great form of exercise, riding a bike, in-line skating, or skateboarding without protective gear can be dangerous. Next to motor vehicle-related injuries, bicycles injure more children than any other consumer product, according to the National SAFE KIDS Campaign.

The most common (and often most serious) injury sustained with a bike, on in-line skates, scooters, or while skateboarding, is a head injury. Head injuries are the leading cause of death and disability in these types of crashes. Wearing a helmet can reduce the risk of death or injury and reduce the severity of the injury in the event of a crash. However, even with aggressive bicycle helmet programs and laws, no more than 25 percent of children riding bicycles reportedly wear helmets.

Wearing a helmet whenever riding a bicycle, in-line skates, or a skateboard should be an automatic habit. Helmets should fit properly on your childs head and also be fastened correctly. A properly-fastened and fitting helmet does not move around on the head.

The Importance of the Right Helmet:

Children and adults should always wear helmets when riding bicycles. According to the National Center for Injury Prevention and Control (part of the Centers for Disease Control, CDC), bicycle helmets have been shown to reduce the risk of head injury by as much as 85 percent.

Among children, 75 percent of bicycle-related fatalities could have been prevented if all children on bicycles wore helmets. Some states have bicycle helmet legislation requiring helmets to be worn.

In 1998, nearly 362,000 children ages 14 and under were treated in the US for bicycle-related injuries and 203 died form this type of injury.

Although helmets can cost between $13 and $50, they can save money by possibly preventing a visit to your childs physician or the emergency room. When shopping for a helmet, take your child with you - a child will be more likely to wear a helmet if he/she picks it out. Helmets should meet the following requirements:

• The helmet should be approved by the American National Standards Institute (ANSI), the American Society for Testing and Materials (ASTM), the US Consumer Product Safety Commission (CPSC). Approved helmets meet stringent safety standards.
  
  
• Your child should like his/her helmet (bright-colored helmets with stickers are very popular). This will increase the likelihood that he/she will wear it consistently.
  
  
• The helmet should fit your the head so that when the straps are snug, the helmet does not move around on the head.

Proper helmet wear:

Helmets come with sponge pads to adjust the fit on your childs head. A properly-fitted helmet should meet the following requirements:

• The helmet should fit snug, not moving on the head.
  
  
• The front edge of the helmet should be two finger widths above the eyebrows.
  
  
• Front and back straps of the helmet should form a V just below the ear.
  
  
• Front straps should be vertical and the rear straps should be flat.
  
  
• The chinstrap should be snug when your child opens his/her mouth (one finger should fit between the chin and chin strap when the mouth is closed).

Road rules:

Since most bicycle crashes occur because the child breaks a traffic rule, it is important to teach your child the traffic and road rules. Besides wearing a bicycle helmet, teach your child the following traffic and road rules:

• Stop before riding into traffic from a driveway, sidewalk, parking lot, or other street.
  
  
• Look left, right, and left again to check for cars.
  
  
• If the road is clear, enter.
  
  
• Ride on the far right of the road, with traffic.
  
  
• Ride so cars can see you, wearing brightly colored clothes, especially at night.
  
  
• Obey all traffic signals and stop signs.
  
  
• Look back and yield to traffic coming from behind before turning left.
  
  
• Ride bicycles in single file.
  
  
• Look for uneven pavement or other surface problems.

In-line skates:

Even experienced in-line skaters can crash and sustain injuries. The following recommendations were derived from the National Safety Council and the US Consumer Product Safety Commission (CPSC):

• Always wear protective gear, such as elbow and kneepads, gloves, helmets, and wrist guards.
  
  
• Buy durable skates with proper ankle support.
  
  
• Always warm up your muscles before skating by skating slowly for five minutes or more.
  
  
• Skate with knees slightly bent to maintain balance.
  
  
• Practice stopping, which is done by bringing the foot with the heelstop forward until the heelstop is level with the toes of the other foot, bend the front knee, and lift the front foots toes.
  
  
• Always skate on the right side of sidewalks and other paths.
  
  
• Pass on the left and warn others that you are passing.
  
  
• Avoid skating in the street, especially where there is a lot of traffic.
  
  
• Look for uneven pavement or other surface problems.
  
  
• Check your skates regularly for wear and tear. Make sure the wheels are tightened.

Skateboards:

Skateboards should never be used on surface streets. Even experienced skateboarders can fall, so learning how to fall safely can help reduce the risk of severe injuries. The following are recommendations from the National Safety Council regarding how to fall correctly:

• When losing your balance, crouch down on the skateboard so your fall is short.
• Try to land on fleshy parts of your body when falling.
• Try to roll as you fall, which prevents your arms from absorbing all the force.
• Try to relax, rather than remaining stiff, when falling.

When riding a skateboard, children should obey all traffic rules. Other safety precautions to take when skateboarding include the following:

• Wear protective gear such as helmets, padding, and closed-toe and slip-resistant shoes.
  
  
• Check the skateboard for wear and tear.
  
  
• Only allow one person per skateboard.
  
  
• Do not hitch rides from bicycles, cars, or other vehicles.
  
  
• Carefully practice tricks in designated skateboarding areas.

Scooters:

Although scooters have been around since the 1950s, the popular new scooters are often made of lightweight aluminum, weighing less than 10 pounds. They have quickly risen in popularity and are the cause of more and more emergency room visits. Health officials have seen a dramatic increase in scooter-related accidents and injuries. Most of the injuries occur among boys under the age of 15. The most common injuries are fractures or dislocations to the arm or hand, followed by cuts, bruises, strains, and sprains. Almost half of all injuries tend to occur to the arm or hand, while about one-fourth are to the head and another fourth to the leg or foot. Deaths directly related to scooter accidents have also occurred.

The Centers for Disease Control and Prevention (CDC) recommends the same precautions for scooters as for bicycling and in-line skating. It is thought that many injuries might be prevented or reduced in severity if protective equipment is worn. Helmets can prevent 85 percent of head injuries, elbow pads can prevent 82 percent of elbow injuries, and knee pads can prevent 32 percent of knee injuries. Although wrist guards are effective in preventing injuries among in-line skaters, the protection they provide against injury for scooter riders is unknown, as wrist guards may make it difficult to grip the scooter handle and steer it.

Based on evidence of injury prevention effectiveness for other related activities, the following recommendations may help to prevent scooter-related injuries:

• Wear an approved helmet that meets safety standards.
  
  
• Use knee and elbow pads.
  
  
• Ride scooters on smooth, paved surfaces without traffic, and avoid streets andsurfaces with water, sand, gravel or dirt.
  
  
• Do not ride scooters at night.
  
  
• Young children should not use scooters without close supervision.