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Bicycle injuries in children: Prevention

Anne C Gill, DrPH, MS, RN
Section Editor
Jan E Drutz, MD
Deputy Editor
Mary M Torchia, MD


Bicycles were first marketed in the United States during the 1830s, but were too expensive for most people to buy. With the advent of the "safety bicycle" in the 1880s, bicycles became affordable, and bicycling became a national pastime. It is estimated that 44.3 million children and youth younger than 21 years ride bicycles in the United States [1]. Bicycles result in more childhood injuries than any other consumer product except the automobile [2,3].

This topic review will describe the epidemiology of bicycle injuries, review strategies for prevention of bicycle injuries in children, and define the clinician's role in bicycle safety. General principles of injury prevention are discussed separately. (See "Overview of pediatric injury prevention: Epidemiology; history; application".)


The term "pedal cycle" is defined by the International Classification of Diseases [4] as any road transport vehicle operated solely by pedals. A pedal cycle includes a bicycle, unicycle, or tricycle. Toys that a child straddles and propels with his or her feet are not pedal cycles and will not be discussed in this topic review.

A pedal cyclist is any person riding on a pedal cycle or riding in an attachment to such a vehicle. Although pedal cycle is the common language used in injury surveillance and reporting, the word "bicycle" will be used in this report unless specified otherwise.


Epidemiology — According to the Centers for Disease Control and Prevention (CDC), in 2013, 238,337 children ≤19 years of age sustained injuries associated with bicycles [5]. Children between the ages of 5 and 14 years are at the highest risk for bicycle injury [2,6]. Bicycle injuries in children typically are caused by falls or collision with a fixed or moving object. Serious injuries and fatalities are usually caused by collisions with motor vehicles [7-9]. Bicycle riding accounts for approximately 6 percent of fatal injuries and 5 percent of nonfatal injuries sustained during transportation to or from school [10].


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