AAP updates recommendations for helmet use

The AAP this week updated a policy statement on helmets in biking, snow sports and other activities, recommending that all children and adult caregivers wear sport-appropriate helmets.

The policy statement was accompanied by a technical report in Pediatrics.

According to the AAP, injury rates from recreational sports among participants aged 5 years or older are highest for children aged 5 through 14 years, and adolescents and young adults aged 15 through 24 years.

Bicycle riding is one of the leading causes of sports-related head injuries in pediatrics, resulting in an estimated 26,000 ED visits annually.

Lois K. Lee, MD, MPH, FAAP, FACEP, a senior associate in pediatrics in the division of emergency medicine at Boston Children’s Hospital, associate professor of pediatrics and emergency medicine at Harvard Medical School, and a member of the AAP’s Council on Injury, Violence and Poison Prevention, co-authored the policy statement and technical report. Lee told Healio that the policy statement on helmets was “up for review,” and the council decided to target preventing head injuries in recreational sports in particular.

“This would include bicycling but also other popular sports, including horseback riding and snow sports such as skiing and snowboarding,” Lee said.

The policy statement cites a 2016 CDC study in the Journal of Safety Research on bicycle helmet use among American children who were aged 5 through 17 years in 2012, which found that only 42% of the surveyed children always wore a helmet and 31% never wore a helmet. Another national study, published in 2017 in The Permanente Journal, found that among skateboarders and snowboarders younger than age 18 years, 52% of those who were injured were not wearing helmets.

“Although there are no recent data on this, it is likely teenagers are less likely than school-age children to wear helmets,” Lee said. “So, pediatricians and practitioners should engage teens, as well as their parents, in the importance of wearing a helmet every time they ride a bicycle or participate in a specific sport.”

For example, Lee said, a bicycle rider never knows about the safety behavior of fellow bicyclists or motor vehicle drivers around them, “or about the rock or crack in the road you may never see.” She added that different activities usually require different helmets.

“Helmet type should match the recreational activity,” Lee said. “So, bicycle helmets should only be worn for bicycling, not for skiing, for example. [A] multisport helmet can be used for a variety of sports, including bicycling.”

The authors suggest disposing of helmets that are more than 5 years old or have been involved in a crash, and encouraging parents and guardians to wear helmets to “model safe behavior,” according to Lee. The policy statement also recommends promoting helmet use by encouraging children to choose and decorate their own helmet “to reflect their individuality.” Adding reflective stickers or lights can increase a child’s visibility on the road, the authors said.

“Additionally, clinicians should be aware of their state and municipal laws regarding helmet use, especially for bicycle riding,” Lee said. “Legislation has demonstrated effectiveness in increasing helmet use and decreasing head injuries and deaths related to bicycle vs. motor vehicle crashes.”

Lee said practitioners should engage teens and parents in “the importance of wearing a helmet every time they ride a bicycle or participate in a specific sport.”

“We know you can’t avoid all crashes, but we do know you can avoid serious head injury by wearing a helmet,” Lee said.

References:

Jewett A, et al. J Safety Res. 2016;doi:10.1016/j.jsr.2016.09.001.

Lee L, et al. Pediatrics. 2022;doi:10.1542/peds.2022-058878.

Sadeghian H, et al. Perm J. 2017;doi:10.7812/TPP/16-161.