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Keeping kids safe on scooters and skateboards

Each month we see at least 10 to 20 scooter or skateboard injuries in the Emergency Department at Yale-New Haven Children's Hospital. The most common injuries by far are fractures of the forearm, but more serious injuries can and do occur. Just this spring, a 12-year-old girl was hospitalized for several days for a brain hemorrhage after falling off her scooter. Fortunately, she made a good recovery.

For a young child, this is a painful and frightening experience that all too often might have been prevented. Children who use scooters tend to be between eight to 10, while skateboard users tend to be older, in their early teens, and are mostly male.

Safety guidelines issued
The trend in injuries prompted the American Academy of Pediatrics (AAP) this spring to issue safety guidelines based on past AAP recommendations for bicycle and inline skating use. In general, they recommend:

• Children younger than five should not ride skateboards and those age six to 10 should be closely supervised while skateboarding.
• Children younger than eight are at greater risk of injury than older children on scooters and should not use them.

Why all the injuries?
I would agree with the AAP recommendations that children wear all protective gear when using a scooter or skateboard. Scooters have the appearance of being safe. They are simple machines, relatively small and lightweight. You see smaller plastic versions marketed to very young children, which is very scary. Perhaps that's why children are less likely to wear helmets or wrist or knee pads when on a scooter.

When used on a flat surface, scooters don't go very fast. But they will go every bit downhill as fast as a bicycle. That's where we see the injuries occurring. Scooters have no brakes and the only option if you are going too fast is to jump off or fall.

In our ED, we've seen children who've lost teeth when the scooter handle goes into their mouths. Another boy landed on the top of his head, requiring many stitches to close the large wound. Still another child got hit by a car when he could not stop and went into the street.

Are skateboard parks the answer?
The AAP suggests towns and cities build skateboard parks so children can use skateboards and scooters there. I can't agree that this idea is the total solution. While it would eliminate the risk of collisions with cars, it would not address the issue of falls. What would help, which the AAP doesn't address, would be increased adult supervision, wherever and whenever scooters or skateboards are used. That would help stop children who are too young from using the scooters or skateboards and provide a more controlled atmosphere for children who do use them.

More parental supervision needed
Since many parents don't have experiences of their own using scooters, they tend to let the child take the scooter and go with it. You wouldn't do that with a bicycle the first day out. And according to the studies, that's when a lot of the injuries are occurring. Kids don't have the experience using them and can quickly get in over their heads and fall. What's worse is they are more likely not to be wearing safety equipment.

If your child has a scooter or skateboard, discuss the importance of safety before they use them, just like you would with a bike. Because there is no scooter at home doesn't mean your child won't use one at a friend's house. Helmets, knee pads and wrist pads must be worn at all times. Start slow on the grass or level surface the first time instead of at the top of a hill. Don't use them near or on busy roads.

The AAP also suggests that pediatricians discuss this during annual physicals with children and parents. Given the multitude of issues that already must be addressed, this is probably not practical. So it's up to parents really to make sure their children know how to use scooters and skateboards, whether in their own driveways or at a friend's house.

With proper education, we can make a dent in the tens of thousands of children getting hurt every year. Down the road, scooters may fade in popularity or they may remain popular. Either way, parents should take steps now to minimize risk and add to their child's fun.

Dr. Bechtel is an attending physician in the Emergency Department of Yale-New Haven Children's Hospital, trauma coordinator for the Pediatric Emergency Department and assistant professor of pediatrics at Yale University School of Medicine.