Bikes and kids are a natural and winning combination. But all too often, that combination can result in injuries, as some of us know all too well.

Of all recreational sports, bicycle-related injuries are the leading cause of emergency room visits for children. Now, a new study shows just how significant those injuries may be when a child or adolescent has to be hospitalized from a bike accident.

According to the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, about 10,700 children and adolescents, ages 20 and younger, were hospitalized for bicycle-related injuries in the U.S. in 2003, the most recent year for which these statistics are available. The average length of stay was three days and the cost of inpatient hospital care totaled nearly $200 million.  Nearly three quarters of the patients were male and almost all lived in urban areas. The rate of injury was greatest for boys ages 10 to 13. The study was published in the October issue of Injury Prevention.

That's not too surprising to some of us. Just listen to Don Mays, who contributes to this blog, tell his tale of delivering newspapers when he was about 11. "My pant leg got caught in the chain. I took a hard fall and knocked myself out. I had a severe concussion and wound up spending two days in the hospital." Of course, that was before the time when bike helmets were common. Today, he says, "I wouldn't dare venture out without a helmet." Nor would his 9-year-old daughter who just survived a bad tumble unhurt thanks to her helmet. The helmet cracked but she emerged without a scratch.

Perhaps the most significant finding in the recent study was the fact that motor vehicles were involved in approximately 30 percent of bicycle-related hospitalizations. And not surprisingly, motor vehicle accidents increased with the age of the patient. Motor vehicle involvement was as low as 20 percent in incidents involving children under two and double that for adolescents 18 to 20.

One-third of children hospitalized for bicycle-related injuries were diagnosed with traumatic brain injury. Pediatrician Gary Smith, director of the Center for Injury Research and Policy, said that finding was significant because it suggested that injuries could be reduced if there was greater helmet use. Two lessons, he said, should be taken from this study:

• Given the rate of motor-vehicle related injuries, cities should do more to build and encourage the use of bike paths to avoid mixing bikes with motor traffic.
• Given the number of brain injuries, more attention should be focused on promoting helmet use. “Helmet use across the country is dismal,” Smith said. Pointing to studies showing helmets can reduce brain injuries by 85 percent, Smith said: “There are three things a child can do to prevent an injury when riding a bike: wear a helmet, wear a helmet and wear a helmet.”

Consumer Reports rated bicycle helmets in a recent report and included information to help riders learn how to fit a helmet for maximum protection.

Related reading: Recent recalls
While the study above does not mention bike mishaps caused by faulty parts or poorly assembled bikes, it is good to be aware of safety issues and recalls when you are buying a bike. The Consumer Product Safety Commission recently made a number of recalls of bikes and bike parts.

• Reynolds UL bicycle forks
• Procycle Rocky Mountain-Solo bicycles
• 2007 Huffy “Howler” and “Highland” bicycles
• Formula Brake Oro bicycle disc brakes
• REI Novara Afterburner Trailer bicycles