A recent piece in the New York Times highlighted the reality that some cities are ditching required bike helmets to encourage bike riding, even here in the US.  Too much of an inconvenience, I guess. Too much of a hassle and impediment. Public planners all over the world don’t want helmets to get in the way of, ummm, health.

And it got me thinking, in places like Europe where cycling is far more mainstream, and where helmet-wearing isn’t, are they just that much more laid back? Are they healthier and/or possibly happier, too?

Does zooming out and thinking of the crowd (better active population, lower BMI, less diabetes, less rules) while avoiding the thought of the catastrophic realities of few individuals (those who suffer harm from traumatic brain injury) make us healthier and happier as a community?

The question of course can only be answered if we agree on a definition of health and if we agree on one for happiness, too. And if we’re not the one whose child is injured.

But just this week three things happened that made me wonder if there are competing goals when I spend time chatting about bike & sports helmets and on using carseats properly, too. The issues are somewhat similar. A study last year found that the majority of parents don’t take pediatricians’ advice with car seats and another found parents are far more lax with booster seats when they carpool, too. And it was these 3 things that got me thinking on this again:

  1. A respected peer pediatrician and I were talking about innovation. I was discussing how I wanted to put information about routine car seat safety and vaccines and sleep tips in video format for families to see before clinic so we could spend time in the exam room on more patient-directed questions. She said, “Oh, I haven’t talked about car seats in clinic for 15 years. There just isn’t time.”
  2. A good friend is living in Europe this year. She mentioned that she was chaperoning her son’s Kindergarten class on a field trip. She was set to drive 4 or more 5 year-olds in her car. And booster seats? No, they weren’t required. The school stated that since they did these field trips so rarely, it would be fine for the children to ride without them.
  3. We’re signing our son up for field trips and after-school trips where he’s riding in a bus with (gasp) no seat belts. After 5+ straight years of judicious, meticulously installed carseats, all of the sudden he’ll be trucking around the interstate free to roam a big yellow bus.

And what I really wonder, and am really asking here, is have we safety-centric pediatricians and parents got it wrong some how? Does all this worry and all this protection not serve us? The rationale and driving force behind my constantly bringing up carseats and boosters in the exam room is that car accidents kill more school-age children than anything else. And car seat safety restraints have saved and improved the lives of countless children. Bike helmets are also proven to reduce the likelihood of serious and even life-threatening traumatic brain injury.

Yet, are we somehow off? Culturally, are we willing to sacrifice the children and adults who will die from accidents where outcomes could have been prevented in exchange for the mental or physical health of the greater group? Should we really ditch the helmets so more people cycle?

Although this is provoking, I’m sincere in bringing this up. I’m with the neurologist who wrote this letter to The New York Times; I believe your child should be restrained rear-facing in a carseat until age 2 and in a booster until 80 pounds.  I just can’t look past the evidence for the convenience. Does it have to become personal first? Do you have care for a child after a traumatic brain injury caused by an improper restraint in a car, or accept the orphaned child in the ER after a horrific crash, or care for the paralyzed child who skateboarded without a helmet like I have?

I must admit, I don’t think this is helicoptering, I think this is using science for sense. But I’d really love to hear your take.