Child cyclist head injuries in England: the wider context

Original paper
Data to which this commentary refers

In 2002/3 Department of Health data show that just over 2,000 hospital admissions, 550 serious injuries and 10 deaths were associated with head injury suffered by children (under 16 years of age) while cycling in England (Franklin and Chapman, 2005). However, this needs to be seen in the context of cycle ownership and use by 75% of children, which is some 6 million children in England (Sport England, 2003). When injury does occur, cyclists are only slightly more likely to suffer head injury than the average for all activities and much less so than pedestrians.

An estimate that 516 serious injuries had some potential for mitigation by cycle helmets is very much a theoretical upper limit. Of the children covered by the analysis, an unknown proportion were already wearing helmets. Helmet manufacturers are careful to state that their products are no guarantee of effective protection, and independent tests have shown that many helmets do not meet the standards to which they are accredited (BHRF, 1081). Furthermore concern has been expressed that the most serious types of head injury involve rotational forces that cycle helmets do not reduce and in some circumstances might make more likely. (BHRF, 1039)

This caution is reflected by a comparison of adult and child cyclist head injuries from 1995 to 2001 (Cook and Sheikh, 2003). The proportion of adult admissions involving head injury fell by less than that for children. However, whilst adult helmet use increased by 50%, child helmet use was at best static.

The number of cyclists who suffer head injury is small relative to cycle use and also compared with other threats to health and life expectancy. In 2001, over 1.2 million children in the UK were obese (RCP, 2004). Obesity shortens lives by an average of 9 years as well as causing suffering and distress during childhood and beyond (HoCPAC, 2002). Boosting cycle use by children has been described as potentially the most effective single measure to tackle the obesity epidemic (HoCHC, 2004).

Because cycling is the second most frequently undertaken form of physical exercise engaged in by children out of school (Sport England, 2003), quite small changes in cycle use have profound consequences for the overall level of fitness of children, both positively and negatively. Cycle helmet promotion is strongly associated with reductions in cycle use and the perception of cycling as an unsafe activity. It needs to be asked whether it is just a coincidence that since 1994 - a period of unprecedented helmet promotion - there has been a fall in the number of children who cycle and in those who do so frequently. For many of these children cycling has not been replaced by comparable forms of physical activity, and the reduction in cycle use has probably been a key factor leading to the rise in childhood obesity.

Conclusions

The analysis of hospital admissions data in England over 8 years shows that relative to cycle use and other common activities, cycling is not dangerous and the risk of serious head injury is low. The wider benefits of cycling greatly outweigh the risks. The likelihood of head injury when cycling is declining, but this is not associated with the use of cycle helmets, as helmet use in the most vulnerable groups has been declining too. The data provides no evidence of helmet efficacy in cases of serious injury.