How safe are children when transported by bicycle?

Objectives: With the increasing popularity of cycling generally and availability of new bicycle child carriers, there is an emerging interest in the safety of child bicycle passengers and riders. However, very little is known about the nature and extent of injuries to child bicycle riders and passengers. The aim of this study was to enhance our understanding of child safety in bike transportation and to identify injury patterns and outcomes.

Method: Analyses of Victorian hospital data (emergency department presentations and hospital admissions) were undertaken to describe and compare injury outcomes among children aged 0-3 years, 4-6 years, and 7-10 years on bicycles. Data over the 15-year period, July 1, 1999, to June 30, 2014, were examined.

Results: A total of 17,859 emergency department presentations and 4,794 hospitalizations were reported for child cyclists under the age of 10 years. The rate of emergency department presentations and hospital admissions per 100,000 population decreased by 1.5% (-2.8 to -0.2%) and 5.0% (-6.5 to -3.4%), respectively. For emergency department presentations, the most commonly injured body parts included the head (34.9%), elbows and forearms (14.6%), and wrist and hands (16.3%). For hospital admissions, the head was again the most commonly injured body region (36.5%), followed by the elbow and forearm (26.7%) and shoulder and upper arm (9.1%). Comparisons of injured body regions between age groups revealed that children aged 3 and under were significantly more likely to sustain injuries to the head that required hospital admissions compared to older age groups. In contrast, older children, between the ages of 7 and 10 years, were significantly more likely to sustain injuries to either the arms, wrists, or hands. Further analysis of the nature of injury revealed that children aged 3 and under had a significantly higher number of open wound injuries compared to older children.

Conclusion: This article provides an exploratory and broad overview of the magnitude and severity of injuries among child bike riders and passengers and highlights that younger children are more likely to sustain head injuries compared to older children. This is likely the result of very young children being passengers on bicycles who are constrained in a seat or trailer with little protection or opportunity to mitigate injuries.

Highlights: • Analyses of injury data to understand the nature and extent of injuries to children on bikes as passengers and riders. • Child cyclist injuries as a significant safety issue within Victoria, Australia. • Young children aged 0-3 years experienced significantly more head injuries compared to older children.