• bicycle
• cyclist
• head injury
• helmet

Few people are in any doubt that cycling has enormous health benefit to children, especially when there are increasing concerns among health professionals about the sedentary lifestyle of children and the impact such inactivity has on the incidence of obesity, type 2 diabetes, and other adverse health outcomes.^1,2 Cycling is a useful form of regular exercise, but this activity must be carried out safely with measures to minimise the risk of injury. Many injuries sustained by children from bicycle accidents arise from loss of attention or poor coordination; others are caused by failure to avoid obstacles such as drains, or undertaking stunts.

Each year more than 50 young people aged 15 years and under are killed in cycling related accidents, with 70–80% of these deaths caused by traumatic brain injury.³ The evidence suggests that children are at greater risk to head injury than adults.⁴ Hospital based figures show that more than 100 000 British children each year are injured in cycling accidents, although many of these are relatively minor injuries that do not require hospital admission.⁵ Approximately 1000 children a year receive a moderate or severe brain injury from cycle accidents that leads to permanent neurological disability with problems such as cerebral palsy, epilepsy, or significant learning difficulties which will affect education, everyday living, and quality of life.⁶