On Parenting: A Child’s Head Needs Protection from Concussion

Bumps can lead to serious brain injury. So the noggins of active children need to be helmeted.

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My 4-year-old daughter just got her first two-wheeler bike. She's fixated on the purple flower decals. I'm fixated on traumatic brain injury.

Call me a worrywart, but I'd like to see her go through life without some combination of persistent headache, pain, fatigue, vision or hearing problems, memory problems, confusion, sleep disturbances, seizures, depression, altered personality, aggression, and social inappropriateness. Not to mention an increased risk of Alzheimer's and other brain disorders.

Those are all long-term problems caused by traumatic brain injuries. And not by the spend-the-rest-of-your-life-in-a-coma kind of injury most of us associate with head trauma. The horrible problems listed above can result from concussion, also known as mild traumatic brain injury.

Until recently, doctors thought that kids shook off concussions after a few days or weeks, suffering only short-term symptoms such as headaches, nausea, and listlessness. But it's becoming increasingly clear that repeated concussions, spread out over months or years, can lead to devastating symptoms. Multiple concussions within a few hours, days, or weeks are even more dangerous, causing potentially catastrophic or even fatal brain damage. (Traumatic brain injury causes 2,685 deaths and 435,000 emergency room visits each year in kids up to age 14, and about two thirds of soldiers injured in Iraq have suffered traumatic brain injury.) That new understanding puts a new perspective on a weekend spent on the concrete halfpipe at a skate park. Or a kid's after-school jaunts around the neighborhood on a bike or a scooter. Or rolling through the mall on Heelys, those wheeled shoes that were hot a few years ago. Or snowboarding over Christmas break.

A study in the October issue of Injury Prevention found that 10,700 children were hospitalized for bicycle-related injuries in 2003, a rate much higher than expected. Thirty percent had head injuries. Wearing a helmet reduces the risk of brain injury by 85 percent. Yet only 15 to 25 percent of kids wear helmets while biking. Add in the fact that 70 percent of children ride bicycles regularly, and that's a lot of noggins in peril.

"As a pediatric emergency medicine physician, I can tell you that there's not a whole lot we can do when there's serious brain injury that's already occurred," says Gary Smith, a coauthor of the study and director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio. "Wearing a helmet is the single most important thing you can do to prevent an injury when you're on a bicycle."

Clearly, we have to do better, and the ones who are going to do that doing are parents. Smith, the father of two, knows no parent likes to nag. It helps to have local helmet laws, because then parents have some statutory muscle behind the nagging. Let kids pick their own helmets, he says, and be consistent in requiring them, even if the kids are just riding scooters out front. "We've seen many, many children who fall just in their driveway, and end up with very serious injury."

Helmets are not the badge of dorkitude they once were. They're de rigueur for competitive junior snowboarders and skiers, and also at big skateboarding events like the X Games Big Air competition. Still, many of the big riders appear without helmets in videos and promos. The Centers for Disease Control and Prevention says that children (and adults) should wear helmets during any sport in which your head runs the risk of running into something hard. The list includes:

  • Riding a bike, motorcycle, snowmobile, scooter, or ATV.
  • Playing ice hockey, football, or other contact sports.
  • Using in-line skates or riding a skateboard.
  • Skiing or snowboarding.
  • Riding a horse.
  • Batting and running bases in baseball or softball.
  • Here at the Mommy Ministry of Propaganda, I've extolled the virtues of bike helmets so often that my daughter shouts, "That man should wear a helmet!" every time we see an adult bicyclist bareheaded. We'll see if I hang tough when it comes to helmets for skiing, or for pogo-sticking, or whatever other cerebellum-threatening activities my kid takes up in the years to come. Scraped knees I can fix with a SpongeBob bandage. But I'd hate for my kid, or any kid, to have to live with a bolluxed-up brain for the next 70 years because we grown-ups were reluctant to listen to the science and to become anticoncussion police.