Prevent Injuries With Proper Sports Helmet Fitting

Study Shows Most Lack Skill

Dr. Gregory Parkinson spent the better part of a decade completing his medical training and now is a practicing pediatrician, yet he says it took him about 12 years before he learned how to put his bicycle helmet on properly.

The light bulb moment came when he was on vacation and got help from a man renting bicycles.

Now Dr. Parkinson is on a quest of sorts to show kids and parents how to master this task.

In a new study reported in the medical journal Pediatrics, Dr. Parkinson shows that an overwhelming majority of children, adolescents, and parents cannot properly fit a bicycle helmet.

"I don't think anyone was surprised that helmets are somewhat difficult to fit," Dr. Parkinson says. "I strongly suspected that the majority would have difficulty. I didn't think 96 percent would have difficulty."

Virtually everyone agrees that wearing a helmet while riding a bike, scooter, skateboard, or while in-line skating is good practice.

According to the US Consumer Product Safety Commission (CPSC), about 900 people - including more than 200 children - are killed every year in bicycle-related accidents, and about 60 percent of these fatalities involve head injuries.

According to the latest statistics available, about 4,000 head injuries resulted from in-line skating. And in 1999, an estimated 59,000 skateboard injuries occurred, about 7 percent of them involving the head.

"We know that helmets prevent head injury, and we want more people to wear them," says CPSC spokesman Ken Giles.

The CPSC states that wearing a helmet can reduce the risk of head injury from bicycle accidents by up to 85 percent. But that is only if you are wearing it properly.

Pediatrician Takes The Initiative

To find out how many people were wearing helmets correctly, Dr. Parkinson launched a study in his own private practice in Falmouth, Mass. He recruited 395 families, with 479 children in those families.

While at their regular pediatric visit, the participants filled out a questionnaire and then were timed while they tried to fit a helmet. Dr. Parkinson and his staff then evaluated how they did.

Eighty-eight percent of the children involved owned a bicycle helmet. Almost three-quarters of cyclists responded that they "always" or "almost always" used a helmet, while 69 percent of in-line skaters, 58 percent of scooter riders, and 50 percent of skateboarders provided this response.

Teenagers were less likely than younger children to wear a helmet.

Almost all (90 percent) felt it was easy or pretty easy to fit a helmet.

However, only 4 percent of the participants passed the test. When the parent alone fitted the helmet, nobody passed.

The three main difficulties were the helmet resting too high on the forehead, improper strap positions, and excessive movement of the helmet from the front to the back of the head.

Why is it that so few are getting it right?

"There are a number of reasons," Dr. Parkinson explains, "but the main one is having someone who knows how spending the time to teach you. Traditionally this has been done well in bicycle shops, but the majority of helmets are purchased elsewhere. It's not unusual to get more help fitting a pair of shoes than a helmet."

A common problem is the straps, which often are not adjusted correctly. Dr. Parkinson suggests helmet manufacturers could "devise a new system" making them easier to adjust.

Guidelines Made Simple

Dr. Parkinson revisited guidelines issued by the Harvard Research Center in Seattle, which published the original study on helmet effectiveness.

He then developed his own mantra: Be a Bike Helmet MVP.

M: Move it down the forehead (less than two fingers' width above the brow).

V: The straps should make a "V" around the ear.

P: Pull the chinstraps snugly.


"If you can do those three things in that order, it substantially improves safety," Dr. Parkinson says.

The key is to do them in order. The MVP slogan is now on posters in schools throughout Dr. Parkinson's town.

Dr. Parkinson suggests that once the straps are adjusted well, parents should tie them in place with a rubber band. They will not have to be adjusted more than once each year, even for kids, he says.

The CPSC agrees that if helmets are effective, they have to cover the skull as completely as possible.

"Some people wear it sunbonnet style, kind of pushed up and on the back of head, and that's just not effective," Mr. Giles says. "It has to be flat on the head. The straps should make a V around the ears and the straps should be snug."

Always consult your child's physician for more information.

September 2003

Prevent Injuries With Proper Sports Helmet Fitting

Pediatrician Takes The Initiative

Guidelines Made Simple

Buying the Right Helmet

Road Rules Explained

Online Resources

Buying the Right Helmet

When shopping for a helmet, take your child with you - a child will be more likely to wear a helmet if he/she picks it out. Helmets should meet the following requirements:

The helmet should be approved by the American National Standards Institute (ANSI), the American Society for Testing and Materials (ASTM), or the US Consumer Product Safety Commission (CPSC). Approved helmets meet stringent safety standards.

Your child should like his/her helmet (bright-colored helmets with stickers are very popular). This will increase the likelihood that he/she will wear it consistently

The helmet should fit your child's head so that when the straps are snug, the helmet does not move around on the head.

Some helmets are multi-sport, which can be used for inline-skating, skateboarding, bicycling, or other wheel sports. Helmets that specifically are called "bicycle helmets" are designed only for that sport. Helmets come in many sizes and varieties, including many infant sizes.

Road Rules Explained

Since most bicycle crashes occur because the child breaks a traffic rule, it is important to teach your child the traffic and road rules.

Besides wearing a bicycle helmet, teach your child the following traffic and road rules:

Special Note: Try to avoid letting your child ride his/her bicycle, in-line skates, or skateboard during non-daylight hours or during bad weather. If your child does ride at night, make sure his/her bicycle has a headlight, flashing taillight, and reflectors.

Always consult your child's physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Academy of Pediatrics

Bicycle Helmet Safety Institute

Centers for Disease Control and Prevention (CDC)

National Institute of Child Health and Human Development (NICHD)

National Institute of Health (NIH)

National Library of Medicine, at NIH

US Consumer Product Safety Commission