Improper helmet fit increases the risk of head injury.  These authors set out to determine the proportion of children (ages 4-18) who wear helmets when bicycling, skateboarding, and scootering – and how many of these helmet-wearers have proper-fitting helmets. 

A pediatric practice in Cape Cod telephoned parents of 473 patients and their siblings 1-2 days prior to these patients’ scheduled well-child visits.  They were asked to bring their child’s helmet with them to the visit.  Once in the office, parents and teens were also asked to complete a questionnaire about helmet use and to demonstrate how the helmet was worn.  Eighty-four percent of eligible families participated.  

Helmet assessment data included: (a) Condition of the helmet (e.g., certification; no history of helmet injury; an intact plastic cover), (b) Room (less than two finger breadths in front and side of helmet; size of helmet as compared to head circumference),  (c) Strap (e.g., a “V” around the ear; clip below ear; helmet front pulls down over forehead when mouth opens), (d) Stability (e.g., helmet rests less than 2 fingerbreadths above brow; helmet moves less than 1 inch from side-to-side, and front-to-back).

Helmet use for bicycling (“always” or “almost always”) was 73% for bicycling, 69% for in-line skating, 58% for scootering, and 50% for skateboarding.  Teens are less likely than younger children to wear helmets.  Only 4% passed every aspect of helmet fit.  Most common problems were:  (1) helmet resting position was too high on the forehead, (2) there was an improper strap position, and (3) there was excessive movement from front to back of the head. 

(Parkinson GW, Hike KE.  Pediatrics 2003; 112(2):320-323.)

Comment:  One of the authors’ conclusions was that pediatricians’ offices were practical places to assess helmets.  I wonder if having a “helmet-fitting” day at school would be a good idea each spring.  Perhaps any student that bikes to school can have a helmet assessment.  The assessment protocol in this project was modified from one published by Thompson DC et al in H.M.O. Pract. (1997, vol 11, p. 25).        – H.T.