Bike Helmets Work! (Pedcast)


Child's HelmetChild's Helmet


-Doc Smo here.  Welcome to another pedcast… the podcast that brings parents useful information that spans from diapers to the diploma.

-For those who are listening to their first pedcast, I am Dr Paul Smolen a general pediatrician in Charlotte NC with 30 years of experience.

-I started this blog for the benefit of my patience, to expand our conversations beyond  the office.

-The podcast format is portable and convenient for both parents to use.  Listen ON the website or download them for portable use.  Free and easy. Listen when YOU have time!  That’s the idea.

-Recently,  I had an experience with one of my patients that I thought everyone should hear about so it will the focus of today’s talk.

-With the family’s permission, I am going to tell you about what happened to one of my patients as it relates to an important pediatric topic, accident prevention.

-If you think about it, a large part of what a pediatrician does is discuss things that children can do to make their lives healthier.

-During checkups, I try very hard to make sure I review some dos and don’ts  every child should hear, from their doctor ,when it comes to safety.

-You’ve heard me talk before about the fact that injuries are THE MAJOR health problem that children have.

-Accidental trauma dwarfs all other diseases in childhood.

-Medical science keeps picking off major diseases like leukemia, meningitis, and congenital heart disease but we still have a long way to go when it comes to preventing accidents.

-So, its with that spirit that I try and remind every older child at every checkup to be properly restrained in the car, to learn to swim, never dive head first in muddy water, never roll on anything without a helmet, never do a flip on a trampoline, not to ever ride on a motorized vehicle like a dirt bike or four wheeler, and not to use knives, guns, matches or explosives as toys.

-As I like to tell my patients, if the little voice inside them says “My parents wouldn’t want me doing this, THEN DON”T!”

-So back to the story. This patient had been in a few weeks prior for his checkup and he got “the safety talk”.

-Two weeks later, his family got the call that every parent dreads… “Your child has been hurt in a bad bicycling accident and is being taken to the emergency room by ambulance.”

-Fortunately my patient had been listening to the helmet part of his “safety talk” because he was wearing his bike helmet that day.

-He said he was going medium fast down a hill off road when he skidded and fell on some rocks.

-He remembers the fall, the ride to the ED, and the entire experience at the hospital.

-Take a look at the photo of what happened to his helmet during the crash!

-I am not a neurosurgeon but I have seen enough head injuries to know that, without that helmet, this child would not be here today.

-He was taken off to the ED where he got the full workup… head, neck, and chest CT, neurological and trauma exam.  The full Monte.

-Facial abrasions turned out to be his ONLY INJURIES! Wow. Amazing. Not even a concussion, not a skull fracture, no subdural hematoma or anything.

-Can you imagine his skull taking the kind of impact that helmet took?

-You will hear people claim that bike helmets don’t work—Hogwash. I ‘ve provided links to prove to you that they do and I think my patient’s experience confirms their effectiveness.

-Wearing a helmet reduces a child’s or adult’s chance of a brain injury by 88%.  Yes 88%! That’s effective in my book.

-So here is the bottom line:

Insist that your child wear a helmet if they roll on anything/anywhere.  Just riding in the driveway you say? The asphalt in your driveway is just as hard as the street and can do just as much damage.

Set a good example and make sure your child has a parent for a very long time…wear your helmet when biking or rolling as well.

Make sure your child’s helmet fits properly and, if damaged, it is replaced.  Also, make sure they buckle it! It won’t work if it falls off their head at impact.

If you catch your child without their helmet on, take their bike or whatever away for a few weeks.  You need to send a clear message …no helmet, no bike, or skateboard, or scooter.

Remind your child that their most valuable body part is their head and neck…. Make sure they handle with care.


-So here are a few thing I learned from this terrible experience my patient went through.

Bike helmets work!

Patients sometime listen when we are talking and

Taking the time to talk to kids about what you expect and enforcing basic safety rules can pay off, big time.


-Well, that’s my post for this week.  Thanks for listening.  If you want to get into the conversation, tell your own story, or disagree with me, write into the blog!  I’m all ears.

-Spread the DocSmo word if you think this is valuable. If you want to continue getting your free pediatric  degree,  link to our website and you will get all the new and old content. We have also made it easy to send a post to a friend or relative if you think they might benefit from listening.  Try it out.

-This is Dr Paul Smolen, recording in beautiful studio 1E, that’s the first child’s bedroom, east side of the house, hoping when your child get’s their next head bump, they have a helmet to absorb the thump.


Until next time.

Smo Notes:

Persaud N, et al “Nonuse of bicycle helmets and risk of fatal head injury: A proportional mortality, case-control study” CMAJ 2012; DOI :10.1503/cmaj.120988.

From the desk of Doc Smo: More on Injury Prevention (article)

Many of you are probably aware that I attended and graduated from Rutgers Medical School. When I was there, Rutgers was a very young start-up medical school attached to a prestigious old university named Rutgers. Since my graduation, the school received a major endowment from the Robert Wood Johnson foundation (RWJF) of Johnson and Johnson fame. Since then, they have changed the name from Rutgers to—you guessed it—the Robert Wood Johnson School of Medicine. In addition to funding my alma mater, The Robert Wood Johnson Foundation supports a lot of health policy research. My interest in the Robert Wood Johnson Foundation brings us to today’s memo.


I recently read about a new policy study that was supported by the RWJF, which took a close look at various state laws with respect to child and adult safety.  The report is called: “The Facts Hurt: A State-by-State Injury Prevention Policy Report.” After grading each state on the strength of their laws, the researchers overlaid this data on the actual accident rates each state has suffered in the recent past. Did they find that states with strong safety laws had lower accidental injury rates…? You bet they did. While the correlation is not perfect, I think you will see if you look at their data that states with strong safety laws tend to have less accidental injury. The strictest laws are found in California and New York, and they have the lowest rates of accidents. The weakest laws are found in Montana, Ohio, Idaho, Kentucky, North and South Dakota, and South Carolina. All these states scored in either the worst or next to worst accident rates.


The point is that accident prevention, either by parents or by state legislatures, does make a difference in protecting both children and adults from accidental injury. Enforcing seatbelt, helmet, drunk driving, sports safety, and dating violence laws do have a positive impact on our health. Yes, these laws do encroach on some personal freedoms, but in my opinion this is a small price to pay when we are talking about protecting our children, neighbors, and fellow citizens from serious harm.  Take a little time to copy and past the link below and browse the report.   I think you will be glad you did.

From the Desk of Doc Smo – Getting the Dose Right!

In the era of computerized medical records, robotic surgery where surgeons don’t touch their patients, ICD-9 databases gathering statistics on millions of people in real time, I guess it is time to give up some of the “old ways” such as measuring medicine with a teaspoon. How twentieth century can you get? Teaspoons can be quite variable in volume. Johnny and Janie’s dose of medicine shouldn’t depend on your silverware pattern, should it? This is one of the conclusions of a task force called PROTECT (Prevention of Overdose and Treatment Errors in Children Task Force). They are strongly recommending that all pediatricians, pharmaceutical companies, and parents begin immediately prescribing and delivering liquid medications in metric volumes only! Teaspoons and tablespoons are out and milliliters are in. Furthermore, they recommend that we deliver medicines with a metric syringe rather than the less accurate measuring cups that come with so many medications used by children.


I know that we cling to the familiar; such behavior is human nature and gives our world more predictability. But when the health and safety of our children are at stake, it is time to change. As the task force points out, unintentional medication errors are a big problem in a society of 350 million people. Check out the statistics that they have gathered:


• Over 70,000 emergency department (ED) visits result from unintentional medication overdoses among children under the age of 18;
• One out of every 180 two-year-olds is treated in an ED for an unintentional medication overdose;
• Over 80% of ED visits among children under the age of 12 are due to unsupervised children taking medications on their own, and 10% of ED visits in this age group are due to medication errors;
• Over-the-counter medications are involved in approximately one-third of ED visits among children under the age of 12 [1].

Source cited below


Pharmacists got past their archaic system of measuring in drams, minims, and grains, so parents and doctors should be able to go metric in the 21st century. Put away those teaspoons and get out a good metric syringe to measure your child’s medicine. As we are learning, even medicines that are readily available like acetaminophen and ibuprofen may not be so benign, especially for children and especially at the wrong dose.


Check out other task force recommendations at the link that I have provided from the CDC.

From the Desk of Doc Smo- Children and the Risk of Drowning (article)

As any of my patients will tell you, I am big on swim lessons for children. I think it is terrible if a child reaches adult life and doesn’t know how to swim well enough to be safe around water.  Because of my enthusiasm for formal swim lessons for children, I read with interest an article that I saw in the February edition of Pediatrics, the journal from the Academy of Pediatrics. The authors studied the rate of hospital admission for near drowning in the US for the past 16 years. They found that during this period of time, there has been a dramatic 49% decline in hospitalizations for children who almost drowned. This must mean that children in the past 16 years have become better equipped to stay safe around water, probably because more children have access to formal swimming lessons. Great news for children.


I am heartened to see this improvement, but I won’t be happy until the decline is 100%. There are so many things in life over which we have no control, but prevention of drowning in children is probably not one of them. I can’t tell you how many instances I have been the physician of record during near drowning events. It is a horrible experience for everyone involved, but especially for the family of the child.


Here is what you can do to make sure your family doesn’t endure such pain. Make sure you maintain extremely close supervision over very young children around bathtubs, ponds, and pools, and enroll them in formal swimming lessons beginning at 4-5 years of age and not stopping the lessons until your child is a strong swimmer. By “strong swimmer,” I mean they should be able to swim long distances in deep water and know the Dos and Don’ts around water. You can also reinforce the rules about never swimming alone, never diving in water where you don’t know where the bottom is, using approved flotation devices when boating or swimming in open water, and swimming with great caution in open water, especially where there might be currents that are dangerous.


If you are one of those parents who thinks you can teach your children to be safe swimmers on your own, think again. I believe every child deserves formal swimming lessons taught by someone who is trained to do so. If you are one of those parents who does not know how to swim yourself, make especially sure you don’t let your own fear of water get in the way of your child learning to swim. Not only are non-swimmers at great risk around water, but they are also missing out on one of life’s truly fun activities.

From the Desk of DocSmo- Teen Driving Safety

This week is National Teen Driver Safety Week (October 16th-22nd), an attempt to improve our awareness of the dangers young drivers face as well as giving parents ideas on how to reduce their young drivers’ chances of being injured in a car.  It is very tragic that on average 8 children a day die in preventable automobile accidents.  These are young, healthy, energetic, bright adolescents who die before their adult lives even begin.

During my pediatric career, I have witnessed improvement in both car safety and in the teaching of driving skills to teens.  I am a big fan of the graduated driver’s license.  My children benefited from the slow introduction of driving skills.   I also think  that automotive engineers have done a wonderful job over the past 30 years of improving the safety of cars.  I have seen teens walk away from crashes that would have surely killed a generation ago, protected by airbags, safety cages, restraint systems, and anti-roll technology.   My first car didn’t have a seat belt!

The highlight of National Teen Driver Safety Week campaign is to get parents more involved in teaching safe driving to their children.  Here are some suggestions for improving your teen’s driving skills:

-Drive with your teen as much as possible, the more the better.  Practice makes perfect.

-Be very clear about your expectations for your teen’s driving.  Lay out the rules and write them down. Make a formal agreement and get everyone to sign it.  Make sure your agreement addresses your teen’s car privileges as well as financial contributions to driving, cell phone use while driving, calling home when away from home, driving after dark, radio use while driving, driving non family members, and the consequences of driving infractions or breaking house rules.

– Share your rules with other parents.  Having similar rules for your child’s friends will make them easier for everyone to enforce.

-Lead by example.  Set a good example for your children by being a safe driver yourself.  Never drink and drive.  Be defensive in your driving.  Wear your seat belt and make sure your passengers do as well.  Don’t drive when you are too tired.

I am now going to share with you something that I invented that I think helped when my children were learning to drive.  I realized that the more I reminded (nagged)  my children to follow the rules the more they ignored me.  My reminders, instead of reinforcing the messages of safe driving, seemed only to emotionally agitate my children.  I therefore decided to communicate with them using “hand signals” to remind them of my safe driving tips.  Here are Dr Smolen’s hand signals for safe driving:

– “1 finger then  10”.   Meaning- stay 1 car length back for every 10 miles per hour.  Example- 3 car lengths back at 30 mph.

– “Repeated downward hand motion”.  Meaning- Don’t drive too fast.  Stay BELOW the speed limit.

– “The double head turn with fingers pointing both ways.”  Meaning-  Look twice before you pull out into oncoming traffic.

-“Shake head no with phone to ear”- Meaning- No talking, texting, surfing or anything else with the phone while driving.

– “2 fingers pointing from eyes”- Meaning-  Keep your eyes on the road!

Feel free not only to use my hand signal method of communication with your young driver, but also to add your own variations.  It was actually fun to talk to my children with just hand signals and have them know exactly what I was talking about.  I am posting some web resources for you to check out if you want to read more on this subject.  You can find a sample driving agreement to use as a starting point on the CDC website.  Good luck and happy driving.

Slow Down:

Pay Attention:

No Cell:

Look Two Ways:

1 per 10:


CDC – Teen Driving – Parents Are the Key Homepage

Get Behind National Teen Driver Safety Week (NTDSW)

CDC – Teen Driving – Graduated Driver Licensing – Parents Are the Key