MONDAY BRIEFS: quick mussing on child related research.

The journal of the American Academy of Pediatrics just published a fascinating examination of emergency room visits for concussions from 2001 to 2005 in 100 US hospitals among kids aged 8 to 19. The authors were particularly interested in examining the role of sports in concussion-related ER visits.

- Of 502,784 concussions among 8-19 years old, 50% were sports related injuries.

- Among pre-high school kids (8-13 y old), 58% of all concussions were sports related.

- Among high school kids (14-19y old), 46% of concussions were sports related.

Which sports sends the most kids to the hospital for concussions?

Here is a graph showing the % of all sports related concussions accounted by each sport/activity for8-13 year old kids:

As you can see above, for kids age 8-13, cycling accounted for the highest percentage of sports related concussions (18%), football was a close second, accounting for about 10% of all sports related brain injuries.

Now here is the same graph for older teens (14 to 19 years old):

In older teens, football is, by far, responsible for more concussions than any other activity or sport: football accounted for close to 40% of all sports related concussions. Basketball and Soccer each accounted for over 10% of sports related concussions. In contrast, cycling accounted for just over 5% of concussions among these older kids.

What’s a parent to do?

Before you put your kid’s bike on craigslist, there is something you need to know about these data. Cycling could be considered the “most dangerous sport” for young kids as so far as it is responsible for the highest percentage of sports related brain injuries. However, cycling is also extremely popular, with millions of kids riding bikes every year. This popularity could explain why cycling accounts for so many ER visits. So the data presented today doesn’t help us understand the “probability of injury” when participating in each sport, which I would consider a better definition of “dangerous”. Let me give you an example with FABRICATED DATA. Imagine that cycling results in 1 brain injury for every 100,000 ‘child bike user hours’ (for every 100,000 hours that a child is riding a bike, one child will have a brain injury). In contrast, snowboarding may result in 1 brain injury for every 1,000 snowboarding hours. In this scenario, the risk of experiencing a brain injury is significantly higher when snowboarding than when cycling. Specifically, you could argue that snowboarding is 100 times more dangerous than cycling. Yet, because cycling is significantly more popular (in terms of use) than snowboarding, cycling would send more people to the hospital. (Again these last statements are based on a hypothetical case with fabricated data. I don’t really know if snowboarding is more dangerous than cycling.)

So the graphics presented above tell us which sports and activities are sending the most people to the hospital, but not necessarily which sport/activity is the “most dangerous” in terms of the probability of injury to the participants.

What would I do? I would likely minimize (but not forbid) cycling in my kids until they are 13, and I would enforce a” no exceptions helmets on at all times” policy when they ride their bikes. If my kid decides he wants to play football, I would enforce a 1-2 concussion limit, because the danger of a catastrophic event (e.g., “second impact syndrome”) increases dramatically after you experience a concussion. Here is a wonderful website about youth sports concussion by the CDC.

The reference:
Bakhos, L., Lockhart, G., Myers, R., & Linakis, J. (2010). Emergency Department Visits for Concussion in Young Child Athletes PEDIATRICS, 126 (3) DOI: 10.1542/peds.2009-3101

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7 Responses to Kids & Bikes: Are cycling and football the most dangerous sports for children?

  1. Andrea says:

    Thanks for this review. My twins are currently riding their bikes to school just a few blocks away (4th grade), but I’m now considering making them walk. They will hate me for it at first but I think the less they are on their bike the less chances are they will be in an accident. Am I over reacting?

    Thanks, Andrea.

    • Hi Andrea, thanks for the comment. I think the issue is that although we know cycling in kids under 13 is “dangerous” (by which I mean it is responsible for most sports related concussions), we truly don’t know HOW dangerous it is compared to other activities. So we have to make a decision about risk vs. rewards. Most parents who let their kids play full contact football know the risks but decide that the risks out weight the benefits in terms of life experiences, or enjoyment, etc. We do this all the time, including every time we get in our car and drive. We know we may die in a car accident, but we do so because the benefit (wanting that coconut macaroon from whole foods) out weights the risk. So I don’t think you are over reacting. You are limiting the risk because you think that the benefits of the activity (biking to school every morning) does not out weight the risks.

  2. Caroline says:

    Sorry, but I think Andrea is over-reacting. Cycling, apart from being fun, encourages children to lead a healthy lifestyle. Inactivity in the long-term probably presents more risks to children than cycling. Understanding risks is also not just about eliminating them but about managing or minimizing them. So we should be thinking about how we can make cycling more safe for children. So I will not ban my children from cycling or even minimize it. I will actively encourage it so long as I know the route is safe and they are wearing helmets. I will also supervise them and teach them to cycle safely.

  3. Kira says:

    Thanks for the info. I am not a fan of my boys playing football, and this review gives me some ammunition. However, it seems that even if you invoke a rule about concussions, some go undetected. So, that’s an area where I’m not willing to take the risk. With cycling, we have a helmet rule and are still on training wheels :) , so I feel less concerned.

    • @Kira, you are correct that many concussions go undetected. So yes, there is a risk in having a 1-2 concussion rule but I think it’s still better than having no rule at all. Now regarding bikes, it is likely that most of those ER visits were kids who were wearing helmets. I had 2 concussions when racing competitive in college, both with helmets on. Although helmets provide significant protection against catastrophic trauma (skull fractures, etc), their ability to protect against concussions is more limited.

      @Caroline, you bring an excellent point. If the choice is between having my kids ride their bikes vs. staying home eating chips and playing video games, I would take riding the bike every time. But this should not be the choice. The choice should be between having your kids spend the afternoon at soccer practice vs. riding their bikes. In such a case, I would take soccer practice (although I may change my mind if I see the data in injury risk instead of total injuries).

  4. Virginia says:

    Wow!! while our kids fall and get up and try again, we get more scared. Ok. let’s say we burn all bikes and eliminate this “danger” what shall we do when something else takes it’s place?, shall we eliminate cause number two too?. It is very sad when kids get badly hurt but when it’s going to happen will happen even if they are JUST watching the football game (maybe someone could kick the ball towards them!).
    Anyway, if you say: no bikes, you could get hurt!, most likely they will have a motorbike when they grow up and you can not longer control them.

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