PHILIPPINE PEDIATRIC SOCIETY, INC.

A Specialty Society of the Philippine Medical Association

In the Service of the Filipino Child

PPS Policy Statements Series 2004 Vol. 1 No. 10

Child Helmet Use

Philippine Pediatric Society, Inc.

Filipino children use bicycles, scooters, and skateboards for recreation and play. Adult drivers allow children on
motorcycles and powered scooters out of transport necessity in developing countries. Crashes from these vehicles
are associated with high fatality rates from head injury. Among all road injuries, hospitalization from motorcycle
crashes rank second (11%) to pedestrian-to-vehicle injuries (51%). Forty-four percent of hospitalized motorcycle
injury patients suffered bone fractures, 41% were inflicted with various forms of head injury, 7% experienced joint
dislocation, and 1% had to undergo limb amputation. The length of hospital stay of motorcycle-injury patients
ranged from 5 to 19 days, based on data from three hospitals. This is significantly longer than other forms of injury.
Hospital records show bicycle injuries are the fifth leading cause of road injury, accounting for 3%. Injuries from
bicycles with sidecars (pedicabs) account for 1% of all road injuries. There is a lack of Philippine legislation for
mandatory helmet use among cyclists, skateboarders, and roller-skaters. Laws exist for mandatory motorcycle
helmet use. This policy statement summarizes recommendations for various sectors to promote universal child
helmet use for every ride in open, wheeled vehicles.

Keywords: helmet, motorcycles, skateboarders, roller skaters

URL: http://www.pps.org.ph/policy_statements/helmet.pdf

BACKGROUND Bicycle riding is considered a popular leisure activity among

Motorcycles are the most dangerous form of motorized
transport. Motorcyclists are three times more likely than
passenger car occupants to be injured in a crash and sixteen
times more likely to die. Head injury accounts for the majority
of these deaths.1 According to Metro Manila hospital records,
motorcycle crash injuries are the leading source of vehicle-to-
vehicle accidents. Among all road injuries, hospitalization from
motorcycle crashes rank second (11%) to pedestrian-to-vehicle
injuries (51%). Forty-four percent of hospitalized motorcycle
injury patients suffered bone fractures, 41% were inflicted with
various forms of head injury (cerebral contusions, scalp
abrasions, hematomas), 7% experienced joint dislocation, and
1% had to undergo limb amputation. The length of hospital
stay of motorcycle-injury patients ranged from 5 to 19 days,
based on data from three hospitals, significantly longer than
other forms of injury.2
Parents and adult drivers in low-income countries allow
children on motorcycles and powered scooters more out of
transport necessity than for enjoyment. In developed countries,
current provisions for child safety in motorcycles include proper
fitting child helmets and child riding belts. Some authorities
believe that children should be allowed to ride on a motorcycle
only when they are tall enough to reach the foot bars. Small
children on motorcycles are more likely to be thrown off the
vehicle in a crash. The adult driver’s use of a free hand to restrain
the child in such an event may compromise control of the vehicle.3
persons of all ages. Filipino children also use non-powered
scooters, roller skates, and skateboards for recreation. The
number of children riding bicycles, motorcycles, powered
scooters, non-powered scooters, roller skates, and skateboards
in the Philippines is not known. There is likewise no data on
the frequency of helmet use among Filipino children. Hospital
records show bicycle injuries are the fifth leading cause of road
injury, accounting for 3% of all road injuries. Injuries from
bicycles with sidecars (pedicabs) account for 1% of all road
injuries.2
Majority of the injuries sustained from bicycle crashes are
soft-tissue and musculoskeletal trauma. Serious injuries are
associated with a male rider, high speeds and collisions with
motor vehicles. Head injuries are responsible for most fatalities
and long-term disability. 4 A resurgence in recreational
skateboarding and scooter use in the United States (U.S.)
resulted in an increased number of head injuries. Young children
(below 8 years old ) are at a greater risk for injury from
skateboard and scooter use. Reasons include: poor judgment,
lack of developed motor skills, and high center of gravity
compared to adults.5
Encouraging bicycle riders to wear helmets is the key in
preventing head injuries.4 A properly worn bicycle helmet can
effectively reduce the occurrence of brain injury by 63-88%.
Helmets provide cyclists an equal level of protection from
crashes involving motor vehicles (69%) and crashes from all

finalized April 2004 41

PPS Policy Statement
other causes (68%). Helmets likewise reduce facial injuries to
upper and mid areas by 65%. Helmets work by dissipating the
sharp energy of a blow over a larger surface area.6-9 In the 0-15
year old age group, bicycle helmets decrease the risk of head
injury by a factor of 0.4 and the risk of concussion by a factor
of 0.6.10 However, individuals with poorly fitting (i.e. too loose)
or improperly worn helmets (i.e. worn on the back of the head
“bonnet style”) have a 1.96-fold increased risk of head injury
compared with those whose helmets fit well.11
There are several existing standards regarding the
manufacture of bicycle and motorcycle helmets. The Snell
Memorial Foundation has released several standards for
protective headgear. In their publications, they describe how
helmets should be constructed including the type of materials
to be used, the dimensions, and the testing to be done to get
the helmet certified. They also include special instructions to
helmet users.12,13
Community-wide helmet promotion campaigns combined
with legislation have a positive impact on public helmet use
and the consequent reduction in head injuries.14 In Canada,
higher rates of head injury in children were observed in regions
without mandatory helmet legislation compared to regions with
legislation.15 In the U.S., the State of Arkansas repealed their
mandatory adult helmet law in 1997. Since then, a 6-year
retrospective review revealed a corresponding increase in non-
helmeted crash fatality rate, higher admission rate from non-
helmeted motorcycle crash survivors, and increased use of
hospital resources.16 In Thailand, the enforcement of a helmet
act for motorcyclists resulted in a five-fold increase in helmet
wearers, 41.4% reduction in head injuries, and 20.8% death rate
reduction.17 The United Nations Children’s Fund (UNICEF)
counts helmet use as among several cost-effective and
sustainable measures in reducing traffic deaths in developing
countries.18,19
In the Philippines, helmet use by motorcycle riders is
mandatory and violators are charged a fine.20 Unfortunately,
there are no laws or regulations that require children to wear
motorcycle or bicycle helmets.21 Legislation for the mandatory
use of bicycle helmets is pending in the Senate as of August
2003. Senate Bill Number 1027 is entitled: An act to protect
consumers by promulgating uniform manufacturing standards
for bicycle helmets and promoting its use. It has undergone a
first reading at the Senate and has been referred to the
Committees on Trade and Commerce and Finance.22 Legislation
promoting the use of helmets when using skateboards, scooters
and roller skates is not yet available.
RECOMMENDATIONS
Role of Parents, Guardians, and Caregivers (referred to as
Parents)
1. Parents should fit their children with appropriate
helmets when riding motorcycles, motorized scooters,
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Child Helmet Use
bicycles, non-powered scooters, skateboards, roller
skates, roller shoes, and other forms of open/wheeled
vehicles. Helmets should fit the head snugly and be
worn properly over the head.
2. Parents should only allow their children to wear roller
shoes in designated areas, provided that helmets are
used.
3. Parents should not allow their children to ride on
bicycle handlebars.
4. Parents should not allow children below nine years of
age to ride as passengers on motorcycles and
motorized scooters.
5. Parents should closely supervise children below nine
years of age when riding on skateboards, non-powered
scooters, and roller skates; and when using roller
shoes.
6. Parents should caution child riders to stay away from
motorized traffic.
7. Parents should provide proper instructions
concerning traffic and road safety.
8. Parents should be reminded of the advantages of the
use of protective gear designed for cycling,
skateboarding, roller blading, etc.
9. Parents should always wear helmets when cycling to
serve as role models for their children.
Role of Government Agencies
1. The national and local government, particularly the
barangay officials, should implement existing laws
concerning the use of helmets.
2. Local ordinances must be passed concerning the use
of helmets and the minimum age requirement for
children to be allowed to ride bicycles.
3. The Bureau of Product Standards of the Department
of Trade and Industry should set local standards for
the manufacture of helmets used for bicycles,
motorcycles, etc.
4. The national and local government should provide
pathways for non-motorized vehicles.
5. The Local Council for the Protection of Children
should exercise their authority in implementing
programs and pushing for legislation concerning child
safety.
6. The Department of Education should integrate road
safety in their curriculum, including helmet use.
7. The national and local government should
disseminate through tri-media any new laws/revisions
of existing laws pertaining to public road safety.
8. The national and local government should launch
information campaigns regarding the consequences
of not wearing helmets.
Role of Physicians
1. Physicians should advise parents regarding proper
safety measures for children when riding bicycles,
Child Helmet Use
motorcycles, skateboards, roller skates, and roller
shoes.
2. Physicians should serve as advocates for legislation
requiring proper helmet use in children riding all forms
of open, wheeled vehicles.
3. Physicians should also advocate for the strict
implementation of rules regarding the use of helmets.
Document prepared by Committee on Policy Statements
Chairperson: Carmencita David-Padilla, MD
Co-chairpersons: Aurora Bauzon, MD; Irma Makalinao, MD
Members: Cynthia Cuayo-Juico, MD; Nerissa Dando, MD
Health Policy Consultant: Marilyn Lorenzo, RN, DRPH
Adviser: Joel Elises, MD
Council on Community Service and Child Advocacy Directors:
Genesis Rivera, MD; Noreen Chua MD; Alejandro Menardo, MD;
May Montellano, MD
Research Associates: Vicente Jose Velez, Jr., MD; Maria Giselle Velez,
MD; Debbierey Bongar, MD; Aizel de la Paz, MD; Lady Christine
Ong Sio, MD
ACKNOWLEDGEMENTS
Participants of the Round Table Discussion on
Transportation Safety Policy Statements (19 February 2004):
Mrs. Yolanda Dumlao - Section Chief, LGOO V – Children’s Concerns
Section, National Barangay Operations Office – ILND
Engr. Solita Genota – Head, Project Evaluation Division, Department of
Public Works and Highways
Ms. Corazon Japson - Supervising Transport Development Officer,
Department of Transportation and Communication
Mr. Herminio Naval - Head – Road Safety Unit, Traffic Operation Center,
Metropolitan Manila Development Authority
Mrs. Wilma Tabuzo - OIC, Assistant Division Chief, LGOO VI, National
Barangay Operations Office – ILND
Mr. Maximo Tapongot – Assistant Head – Road Safety Unit, Traffic
Operation Center, Metropolitan Manila Development Authority
Joel Elises, MD – President, Philippine Pediatric Society
Estrella Paje-Villar, MD – Vice President, Philippine Pediatric Society
Jocelyn Yambao-Franco, MD – Treasurer, Philippine Pediatric Society
Genesis Rivera, MD – Director, Council on Community Service and
Child Advocacy, Philippine Pediatric Society
Marilyn Lorenzo, RN, DRPH – Director, Institute of Health Policy and
Development Studies, National Institutes of Health
Carmencita David-Padilla, MD – Chairperson, Committee on Policy
Statements, Philippine Pediatric Society
Cynthia Cuayo-Juico, MD – Member, Committee on Policy Statements,
Philippine Pediatric Society
Nerissa Dando, MD – Member, Committee on Policy Statements,
Philippine Pediatric Society
Aizel de la Paz, MD – Research Associate, Committee on Policy
Statements, Philippine Pediatric Society
Lady Christine Ong Sio, MD – Research Associate, Committee on Policy
Statements, Philippine Pediatric Society
The Committee on Policy Statements recognizes the contribution of
the following:
PPS Advisory Board
PPS Council on Administrative Affairs
PPS Policy Statement
PPS Council on Community Service and Child Advocacy
PPS Council on Research and Publications
PPS Council on Subspecialties and Sections
PPS Council on Training and Continuing Pediatric Education
PPS Bicol Chapter
PPS Cebu Central/Eastern Visayas Chapter
PPS Central Luzon Chapter
PPS North Central Mindanao Chapter
PPS Northeastern Luzon Chapter
PPS Northern Luzon Chapter
PPS Southern Tagalog Chapter
Child Neurology Society of the Philippines, Inc.
Pediatric Infectious Disease Society of the Philippines, Inc.
Philippine Academy of Pediatric Pulmonologists, Inc.
Philippine Society for Developmental and Behavioral Pediatrics, Inc.
Philippine Society of Allergy, Asthma, and Immunology, Inc.
Philippine Society of Pediatric Metabolism and Endocrinology, Inc.
Philippine Society of Pediatric Oncology, Inc.
Philippine Society of Pediatric Surgeons, Inc.
Department of Health – Child Health Program
Department of Health – Health Policy Development and Planning
Bureau
REFERENCES
1. Branas CC, Knudson MM. State helmet laws and
motorcycle rider death rates. LDI issue brief. 2001; 7: 1-4.
2. Vibal TM, Regidor JR. Traffic accident analysis through
hospital records. National Center for Transportation
Studies, University of the Philippines, Diliman, Quezon
City. Available at http://www.google.com/
search?q=cache:Sonh9yK89CUJ:www.up-ncts.org.ph/
a c a d e m i c / t h e s i s / v i b a l 2 -
03.pdf+Traffic+Accident+Analysis+Through+Hospital+
Records&hl=en&ie=UTF-8. Accessed on September 22,
2003.
3. Friedman A. Riding motorcycles with child passengers.
Available at http://www.motorcyclecruiser.com/
streetsurvival/ridingwithkids/. Accessed on September 4,
2003.
4. Thompson MJ, Rivara FP. Bicycle-related injuries. Am Fam
Physician. 2001; 15: 2007-14.
5. American Academy of Pediatrics. Skateboard and scooter
injuries. Pediatrics. 2002;109:542-3.
6. American Academy of Pediatrics. Bicycle helmets.
Pediatrics. 2001;108:1030-2.
7. Thompson DC, Rivara FP, Thompson R. Helmets for
preventing head and facial injuries in bicyclists. Cochrane
Database Syst Rev. 2000; 2:CD001855.
8. Thompson DC, Rivara FP, Thompson RS. Effectiveness of
bicycle safety helmets in preventing head injuries. A case-
control study. JAMA. 1996;276:1968-73.
9. Thompson DC, Thompson RS, Rivara FP, Wolf ME. A case-
control study of the effectiveness of bicycle safety helmets
in preventing facial injury. Am J Public Health. 1990;80:1471-
4.
10. Larsen LB. The importance of the use of bicycle helmets
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PPS Policy Statement Child Helmet Use

for head injuries among injured bicyclists aged 0-15
years. Ugeskr Laeger. 2002;164:5115-9.
11. Rivara FP, Astley SJ, Clarren SK, Thompson DC,
Thompson RS. Fit of bicycle safety helmets and risk of
head injuries in children. Inj Prev. 1999;5:194-7.
12. 2000 Standard for protective headgear: for use with
motorcycles and other motorized vehicles. Snell Memorial
Foundation, Inc. Available at www.smf.org. Accessed
on January 23, 2004.
13. 1995 Standard for protective headgear: for use in
bicycling. Snell Memorial Foundation, Inc. Available at
www.smf.org. Accessed on January 23, 2004.
14. Coffman S. Bicycle injuries and safety helmets in children.
Review of Research. Orthop Nurs. 2003; 22: 9-15.
15. MacPherson AK, To TM, MacArthur C, Chipman ML,
Wright JG, Parkin PC. Impact of mandatory helmet
legislation on bicycle-related head injuries in children: a
population-based study. Pediatrics. 2002;110:e60.
16. Bledsoe GH, Schexnayder SM, Carey MJ, Dobbins WN,
Gibson WD, Hindman JW, Collins T, Wallace BH, Cone
JB, Ferrer TJ. The negative impact of the repeal of the
Arkansas motorcycle helmet law. J Trauma. 2002;53:1078-
87.
17. Ichikawa M, Chadbunchachai W, Marui E. Effect of
helmet act for motorcyclists in Thailand. Accid Anal Prev.
2003;35:183-9.
18. United Nations Children’s Fund. Child traffic deaths in
developing countries. Available at www.unicef.org.uk/
news/Presscentre/injurytraffic.pdf. Accessed on August
28, 2003.
19. Forjuoh SN. Traffic-related injury prevention
interventions for low-income countries. Inj Control Saf
Promot. 2003;10:109-18.
20. Land Transportation Office. Fines. Available at http://
www.lto.gov.ph/fines2.html. Accessed on September 4,
2003.
21. Safe Kids Philippines. Laws and regulations. Available
at http://66.151.110.88/tier3.cfm?content_item_id=7912
&folder_id=1762. Accessed on January 23, 2004.
22. Philippine Senate. SBN-1027, entitled: An act to protect
consumers by promulgating uniform manufacturing
standards for bicycle helmets and promoting its use.
Status Report. Available at http://www.senate.gov.ph/
bills_res/ibmon/sbn-1027.htm. Accessed on January 23,
2004.

The publication of the Policy Statements of the Philippine Pediatric Society, Inc. is part of an advocacy
for the provision of quality health care to children. The recommendations contained in this publication
do not dictate an exclusive course of procedures to be followed but may be used as a springboard for the
creation of additional policies. Furthermore, information contained in the policies is not intended to be
used as a substitute for the medical care and advice of physicians. Nuances and pecularities in individual
cases or particular communities may entail differences in the specific approach. All information is based
on the current state of knowledge. Changes may be made in this publication at any time.

The activities of the Committee on Policy Statements were partly supported by educational grants from Dumex, Mead Johnson, and Nestle.

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