Injury prevention efforts related to bicycle riding are often aimed at school-age children. Preschool children also ride bicycles, and information about injuries in this age group is lacking. Powell and associates reviewed information from the National Pediatric Trauma Registry (NPTR) regarding bicycle injuries to compare injuries in children less than five years of age with injuries among children five to 14 years of age.

Because the NPTR data deal mainly with children admitted to hospitals, the study includes a high proportion of children with severe injuries. Tricycle-related injuries are not designated separately in this registry. Five percent of the bicycle-associated injuries occurred in children younger than five years. Few of these children were wearing helmets. A motor vehicle was involved in 31 percent of injuries to young children. Sixty-eight percent of young children were injured in falls from bicycles. The proportion of accidents occurring in nonstreet locations such as a driveway, garage, sidewalk or yard was significantly higher among children younger than five years. Almost one half of these younger children sustained head trauma.

Young children appeared to have an anatomic injury pattern similar to that of older children, with head injury being the most common severe injury. Hospitalized preschool cyclists had trauma scores and rates of operating room use similar to those of older children. The value of helmets in limiting bicycling injuries has been clearly established.

The authors conclude that young children sustained severe injuries, frequently involving the head, at a rate similar to that of older children. Accidents often occurred in nonstreet locations. Helmets are indicated for use by all children who ride bicycles and probably by children who ride tricycles. Establishing the “helmet habit” at a young age is a good idea; however, further study is needed to evaluate the efficacy of helmets in preventing serious head injury in young cyclists and to determine whether helmet use at a young age will result in continued use during adolescence and adulthood.