A recent piece in the New York Times highlighted the reality that some cities are ditching required bike helmets to encourage bike riding, even here in the US. Too much of an inconvenience, I guess. Too much of a hassle and impediment. Public planners all over the world don’t want helmets to get in the way of, ummm, health.
And it got me thinking, in places like Europe where cycling is far more mainstream, and where helmet-wearing isn’t, are they just that much more laid back? Are they healthier and/or possibly happier, too?
Does zooming out and thinking of the crowd (better active population, lower BMI, less diabetes, less rules) while avoiding the thought of the catastrophic realities of few individuals (those who suffer harm from traumatic brain injury) make us healthier and happier as a community?
The question of course can only be answered if we agree on a definition of health and if we agree on one for happiness, too. And if we’re not the one whose child is injured.
But just this week three things happened that made me wonder if there are competing goals when I spend time chatting about bike & sports helmets and on using carseats properly, too. The issues are somewhat similar. A study last year found that the majority of parents don’t take pediatricians’ advice with car seats and another found parents are far more lax with booster seats when they carpool, too. And it was these 3 things that got me thinking on this again:
- A respected peer pediatrician and I were talking about innovation. I was discussing how I wanted to put information about routine car seat safety and vaccines and sleep tips in video format for families to see before clinic so we could spend time in the exam room on more patient-directed questions. She said, “Oh, I haven’t talked about car seats in clinic for 15 years. There just isn’t time.”
- A good friend is living in Europe this year. She mentioned that she was chaperoning her son’s Kindergarten class on a field trip. She was set to drive 4 or more 5 year-olds in her car. And booster seats? No, they weren’t required. The school stated that since they did these field trips so rarely, it would be fine for the children to ride without them.
- We’re signing our son up for field trips and after-school trips where he’s riding in a bus with (gasp) no seat belts. After 5+ straight years of judicious, meticulously installed carseats, all of the sudden he’ll be trucking around the interstate free to roam a big yellow bus.
And what I really wonder, and am really asking here, is have we safety-centric pediatricians and parents got it wrong some how? Does all this worry and all this protection not serve us? The rationale and driving force behind my constantly bringing up carseats and boosters in the exam room is that car accidents kill more school-age children than anything else. And car seat safety restraints have saved and improved the lives of countless children. Bike helmets are also proven to reduce the likelihood of serious and even life-threatening traumatic brain injury.
Yet, are we somehow off? Culturally, are we willing to sacrifice the children and adults who will die from accidents where outcomes could have been prevented in exchange for the mental or physical health of the greater group? Should we really ditch the helmets so more people cycle?
Although this is provoking, I’m sincere in bringing this up. I’m with the neurologist who wrote this letter to The New York Times; I believe your child should be restrained rear-facing in a carseat until age 2 and in a booster until 80 pounds. I just can’t look past the evidence for the convenience. Does it have to become personal first? Do you have care for a child after a traumatic brain injury caused by an improper restraint in a car, or accept the orphaned child in the ER after a horrific crash, or care for the paralyzed child who skateboarded without a helmet like I have?
I must admit, I don’t think this is helicoptering, I think this is using science for sense. But I’d really love to hear your take.
There’s a big difference between the car seat argument, and the bike helmet argument: getting people on their bikes is good for their health, while getting them into their cars is not. If people are going to use cars (for convenience, for necessity) then they should do it as safely as they possibly can.
I have been thinking about bike helmet laws for a few years and have changed my mind recently. Here’s why: changing the law so that people are not legally obliged to wear helmets is not the same as telling them not to wear helmets. Helmets are still recommended; just not enforced. And here’s another reason why: helmet laws aren’t enforced anyway. In Vancouver, BC, where I live, there are strict helmet laws. Still, people who don’t want to wear helmets, don’t wear them – and that’s a lot of people. The police have far better things to do than ticket them, and since they don’t have license plates, it’s easy to avoid tickets.
So, my take is: educate people that helmets are a really, really good idea; but don’t force them to wear them. Encourage as many people as possible to ride bikes, because it’s a fantastic form of exercise, it’s fun, and it doesn’t consume gasoline or create pollution.
Having said all of that, I do think children should wear helmets. I haven’t quite thought through why I have a double standard on that one. I just know my daughter and I will be wearing our lids.
If the booster seat until 80lbs was a law when I was growing up, I would have been driving a car using a booster seat. I didn’t hit 80lbs until I turned 17.
I recognize increased risks in some behaviors, but we cannot control the world, and who wants to live in terror all the time that something may happen. We need to accept that risk is a part of living. There is such a thing as too safe. We see that kids are afraid to play these days.
At the same time, my kids wear helmets when they ride bikes. But if parents pick up my 7 year old without her booster seat, I don’t worry too much. (They’re required until the age of 8 where I live).
I also transitioned my 4 year old to a booster seat about 6 months early because her carseat broke.
Graeme Gibson says
You make so many great points in your post, and it is difficult to believe that regulation has to be forced in the areas of safety helmets, booster seats and the like. The fact that a person of science has to lobby for better regulation amazes me.
It could speak to the fact that “science” has become politicized to the extent that people ignore common sense.
I’d like to know what you suggest the next step is: More regulation or more education?
As a father of two, I know I am making different decisions with the types of sports I will let my children play. These types of decisions and many of the things your brought up simply seem like good parenting, which may ultimately be the source of the issues.
It’s 80lbs OR 4’9″ – if you didn’t meet those criteria by age 17, you might have a hard time driving without a booster and pedal extenders.
Similar to this post, my husband and I have been struggling with the concept of “safe enough”. We fly to see our families multiple times a year. We always buy a plane seat for our son so he can be buckled in to his car seat, even when he was an infant. The FAA strongly encourages, but does not require, an approved child restraint system (CRS) for all children under 40 pounds.
Now my son is 3 years old and he weighs enough to use the FAA approved CARES Harness. I rented one to try out for our most recent trip but it turns out that our aircraft was one of the older types that required the CARES Harness to go over the tray table of the person behind us. We’d already checked the car seat so we didn’t have a backup option. We ended up just using the regular lap belt for my son but I knew if anything happened I wouldn’t forgive myself for it.
I have not looked up the statistics, but I assume that severe accidents while riding bikes and being in cars are much more prevalent than while flying in a plane but it still exists.
I wonder if there’s a benefit with the government requiring certain safety standards to be met. At that point, it’s no longer the parent’s sole responsibility to make sure their child is safe, it become a wider problem that multiple industries work to solve. For example, child car seats and how they attach to cars continue to get better. Would that have happened if there weren’t rules about car seat safety? If the FAA actually required children under 40 lbs to use a CRS, would there be more of a market for better ways to secure our child while flying?
I believe all children should have access to and wear a properly fit helmet every time they ride thier bike, skateboard, scooter or other wheels of choice.
Seattle Children’s is hosting their last free bike and multi-sport helmet fitting and giveaway of the year Saturday, October 20th from 10 a.m. to 1 p.m. at Seattle Children’s Mill Creek Clinic.
Families are more than welcome to bring their helmets for a fit check by trained staff or get a new properly fit helmet.
Learn more about the event and how to properly fit a helmet at https://MakeSureTheHelmetFits.org
Sean Kuhlmeyer says
As a personal injury lawyer I can tell you from personal experience (actually the experience of my clients), that helmet laws, seat belt laws, and other reasonable safety regulations save lives and prevent injuries. The problem with reversing ground on mandatory helmet laws, is that it sacrifices the health of a few for the convenience of the majority. They can create any argument against helmet laws they want, ie, helmets are too expensive for the poor, they discourage bike use, were trying to increase public health, etc, etc, but these are false arguments, because in the end, bike use on public property is a privilege that the public has the right to reasonably regulate. When the public costs of the increased injuries (lifetime care for a quadriplegic on Medicare), and society’s responsibility to regulate public behavior, are considered, there really is no issue as to whether these laws make sense. There are also a host of positive ‘ripple effects’ that happen when a helmet law is passed: people’s helmet use goes up because bike shops push them “you are required to ride with a helmet”, cops give them away (and ticket for failure to use them), basically public education goes up and use follows; the same applies to seat belt laws. Again as a PI lawyer, I think it would be an interesting case, to go after a city that had a kid helmet law, then repealed it and an un-helmeted kid got hurt; a city might actually be increasing their liability by repealing the law. Finally it’s just plain stupid to favor a policy that you know is going to result in increased injuries. As a PI lawyer, I hate seeing people get injured, especially kids, and especially easily preventable injuries, and I’m sure as a kid doctor, you hate seeing that too…
Shameless self-promotion: Check out my blog for lessons I’ve learned the hard way being a PI lawyer: : http://www.seanthelawyer.com – Legal Information That Will Change And Save Your Life.
PS: We don’t have seat-belts on school buses because of the increased costs to manufacture them, another false argument, and a reason I’ll never let my son ride a school bus: https://www.msnbc.msn.com/id/40820669/ns/us_news-life/t/why-your-childs-school-bus-has-no-seat-belts/
PPS: Europeans just have a different attitude about safety. Half my family lives in France and sometimes I just shake my head!….
K. Bell says
Two critical distinction, which go hand-in-hand, between more bike friendly cities and Seattle in particular is the extent of supportive infrastructure. If Seattle had more separated bike facilities, helmets would cease to be critical. Think of biking on the Burke Gilman Trail versus in traffic downtown. While helmets are helpful during all kinds of collisions, they are most important when a bicyclist is struck by a motor vehicle. Therefore it is a faifly chicken and egg argument whether more poeple would bike if there were no helmet law or if we will build the infrastructure necessary to reduce the need for helmet use and encourage biking for all.
Anj Fabina says
If you are concerned about safety restraints on a bus, you can ask Transportation to fit your child with a restraint harness that hooks into a restraint system at four points.
They are usually used for children with behavioral problems, but they function very well as safety restraints. In terms of safety, they are safer than most vehicular safety restraints except for an infant seat with five point restraints.
Ann Soutter says
I just remember, years ago when I was an OR Nurse, doing an organ harvest on a beautiful 6 year old, who was hit on his bike, with his bike helmet held in his hands by the straps.
This is a story that I have told my son, now a teenager. He doesn’t wear a helmet riding his bike to high school, but when we go out on long trail rides, he straps his on just like his Dad and I do.
How can you not try to protect your child any ways possible?
Broad Jim says
I just remember when my friend Hellion went in a function with his family and his infant baby. unfortunatly he had a serious accident while they were driving thier car. In this accident Hellion and his wife had some inuries but thier infant baby who have seat in a infant car seat was escape any serious accident. Such car seats for baby are the best option for baby security when you are travelling with your infants.
I believe 60% of a subcontinent are infected with HIV/AIDS because it’s difficult to change cultural perceptions about safety. It’s difficult to alter behavior based on theoretical risk if they feel it somehow infringes on their lifestyle.
I believe we covered some similar thought processes in the vaccine series as well.
What I find most annoying about the carseat and sports/bike helmet laws are arguments the adults make about the bad old days. In the bad old days they rode shotgun without a seatbelt, never sat in a carseat themselves. Thing is that these laws were inspired by many avoidable deaths and injuries. Things weren’t perfect in the bad old days, and being on the positive side of a statistic yourself doesn’t lessen the risk for someone else. The other thing is that kids — my kids especially — spend a LOT more time in a car than I did until about age 27. My rides in a car were short and relatively infrequent in the bad old days. Cars were constructed differently, there were fewer of them on the road, and kids stayed closer to home. According to my cars trip computer, my kids spent 43 hours in the car in the past 6 weeks. They attend school walking distance or 2 miles away. All lessons are within 5 miles. However, school (when we drive), playdate, groceries, outings, visits to grandma, errands, park, etc etc etc mean that they are in the car at least 1x per day, if not 2. Even short trips, 15 minutes to piano and back, add up over time. One might say that they are safe because these trips are close to home and in 25-35 mph zones. Yup. And that’s the radius and speed where most accidents take place. I wouldn’t set my poorly restrained 40lb child against a 20 mph collision. Easing up on carseat laws equates to allowing child neglect.
The helmet debate when it comes to children baffles me even more. I’ve already replaced the helmet for one of my children after a bad fall. She somersaulted over her handlebars and cracked the back of her head right on the pavement. Total freak accident for a proficient rider. What would have been blood, stitches, at least a concussion if not worse, was a headache that last 15-20 minutes and some road rash. It’s amazing and a blessing to see 2.5 inches of foam save your child’s life. Of the many falls my kids has experienced, this was the first time she fell on her head and I’m so grateful some bizarre bravado or false nostalgia didn’t interfere with her safety.
Wendy Sue Swanson, MD, MBE says
The nostalgia and “Oh, I did fine and I never had a seat belt” arguments make absolutely no sense to me, either. They represent the numbers (meaning most people do very well in a large population) but they also represent good-old-fashioned-good-luck.
I rolled around in the back of my family’s station wagon at times, too. But thank goodness no dumb driver crossed the median while I did…
And yes, it is exquisitely difficult to alter behavior based on theoretic risk. This is true for all of us, I suppose. But I’m still perplexed by my inability to convince families to keep their children rear-facing until 2 years old at times in clinic. Even though it’s theoretic, the data is so convincing to me (children are 75% less likely to die when rear-facing versus forward facing before the age of 2 years) but parents still wince and tell me even though I’ve explained it to them, they know their child really likes to face the front. Just don’t get it. And will keep working on it.
Over the weekend I was thinking of who I could enlist to help me understand it better. And was thinking of calling BJ Fogg—he’s a prof at Stanford who studies and has developed a model on behavior change. https://www.behaviormodel.org/
And I think I may sign up for one of his 15 minute calls…
A report from abroad…we had a great time on the field trip you mentioned. and the kids all seemed to expect to be in car seats despite what I have been told! And I think every kid did have a car seat in the end – one was in the front seat, so it was far from perfect, but it was better than I thought it would be! And lots of kids are wearing helmets while riding their bikes, but they don’t seem to wear them when riding on their parents bikes. So strange!
Then there is the issue of flu shots – they only give them to people here who have some sort of indication or special need. I am about to get to work to get them for my kids. Wish me luck!
Julie Graham says
This is obviously a very interesting discussion- with many replies. There is a fine balance between our individual responsibility and government intervention. I often times feel that government regulation can be such a hinder to our normal lives and life just has its risks. However, good point has already been made that when tragedies and accidents happen to you, it becomes quite a different story.
My following comment may be somewhat of a different approach but is on my mind because of a recent event. I was driving down a neighborhood street and saw a young child being physically abused by an adult- quite possibly a parent and most certainly someone in close relationship to the child. My stomach dropped and I felt sick. Young children (particularly infants in regards to car seats) are innocent and unable to protect themselves. While it would be my hope that every parent had the best interest at heart for their children, there are parents who do not and I sense that there is more of that behavior that goes on than anybody would wish for. Do we have a duty to help protect the innocent through laws and regulations (child labor laws as an ex) or look the other way and say it isn’t my child? This may seem drastic and yes, there is a wide scale and it can be difficult to draw the line, but think about it. Young children don’t know any better about making a decision to wear a helmet and many parents fail on their responsibility whether it be a lack of understanding on their part or just negligence.
see also car seats for special needs