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AAP updates helmet recommendations

AAP updates helmet recommendations

Pediatricians encourage parents to be helmet role models for kids

The American Academy of Pediatrics (AAP) released new guidelines for sports helmet use today. The academy published its updated policy — which recommends kids wear properly fitted helmets during all wheeled and high speed, high injury risk sports and that parents model routine use of helmets — in the just published September 2022 issue of the journal Pediatrics

Preventing thousands of serious injuries

According to the Washington State Department of Health, several thousands adults and children experience a traumatic brain injury or facial injury from a fall while bicycling, snowboarding or participating in other recreational sports each year in this state. An abundance of research shows that many of these injuries could have been prevented with use of a properly-fitted helmet according to the AAP’s new policy statement and accompanying technical report. The report was written by the AAP Council on Injury, Violence, and Poison Prevention.

This policy statement, which was last updated in 2001, urges pediatrician to help attain universal helmet use among children and teens for every ride or incidence of wheeled or high impact, high speed sporting activity by advising parents on obtaining property fitted helmets. It goes further in recommending parent be models for their kids by using helmets consistently and properly.

Saving lives

“The evidence is clear: helmets save lives and significantly reduce the risks of severe injury,” said Lois K. Lee, MD, MPH, FAAP, lead author of the statement and report entitled “Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports.” 

“And yet sports-related injuries make up a substantial proportion of all traumatic brain injuries,” Lee wrote. “As a pediatric emergency medicine physician, I advise all my patients – and their parents — to wear helmets.”

According to the AAP, research shows that injury rates from recreational sports among participants 5 years and older are highest for children ages 5 through 14 years and youth 15 through 24 years. The academy says bicycle riding is one of the leading causes of sport-related head injuries in pediatrics, resulting in tens of thousands of emergency department visits annually. 

Helmets reduce risk

The academy and Harborview Injury and Prevention Research Center in Seattle both point  out that helmets have been shown to reduce bike rider risk of traumatic brain injury substantially. Helmet use decreases the risk of head injuries by about 85% and facial injuries by about 65% among bicyclists, according to the AAP release. Researchers at Harborview and at AAP stress helmet fit is paramount to reduced chance of injury. 

For information about correct helmet fit visit the research center’s bike safety/helmet fit information page. Seattle Children’s Hospital’s Safety and Injury Prevention  also offers fit assistance. The program travels throughout Washington state to provide free helmet and life jacket fittings and to teach parents and kids how to look for proper fit as new helmets are acquired.

In its release, the AAP noted a 2012 study of U.S. bicycle helmet use among children ages 5 through 17 which found that only 42% always wore a helmet, and 31% never wore a helmet. A national study of skateboarders and snowboarders younger than 18 found that 52% of children injured were not wearing helmets.

Wear a helmet whether it’s mandated or not

The new guidelines promote laws that require helmet use for cyclists. In Washington, state bicycle laws do not require cyclists to wear a helmet. However, many counties and cities do require helmets. King County is no longer one of them. The county repealed its 29-year-old mandatory bike helmet law in February 2022 in an effort to address disproportionate ticketing of cyclists of color. Even so, county and city officials and the state’s largest biking advocacy and education group, Cascade Bicycle Club, all recommend wearing a helmet whenever riding a bike. 

Snow sports, including skiing and snowboarding, are a leading cause of recreational sport-related head injury, and the risk of traumatic brain injury rises if the participant is not wearing a helmet. Ice skating and equestrian sports are also associated with risks of head injury, according to AAP.

The AAP’s new guidelines are as follows: 
  • Children, teens and their adult caregivers should always wear a sport-appropriate and correctly fitting sport helmet during participation in recreational sports, including, but not limited to, bicycling, snow sports, ice skating, and equestrian sports. Because of the differences in engineering, helmet types should match the sport for which they are designed.
  • To promote helmet use, children can be encouraged to choose their own helmet and decorate it to reflect their individuality. Reflective stickers and lights can also be added to increase visibility of the child when bicycling on the road.
  • The helmet should be replaced if involved in a crash, damaged, or outgrown. It’s best to avoid using previously owned helmets, if possible.
  • Pediatricians should inform parents and patients of the importance of wearing helmets during recreational activities and sports, including discussing age- and sport-appropriate helmet use.
  • Public education and advocacy should include comprehensive and consistent legislation and regulations regarding helmet use in sports, comparable to child safety restraint laws and motor vehicles.
  • Studies focused on health inequities as related to injuries and barriers to helmet use should be conducted to inform interventions in high-risk populations.

Additional resources for parents can be found at AAP’s articles:

“We love to see children out on bikes and enjoying physical activities of all kinds,” Dr Lee said. “Make helmets part of your routine, like requiring seat belts and encourage kids to personalize their helmet and make it fun. Families who wear helmets together are safer together.”

Reach the full policy statement at Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports.” 

More at Seattle’s Child:

Great, safe routes to bike or scoot with kids in Seattle

Bike around and island


About the Author

Cheryl Murfin

Cheryl Murfin is managing editor at Seattle's Child. She is also a certified doula, lactation educator for and a certified AWA writing workshop facilitator at