There is nothing like a long bike ride or a cool swim on a hot summer day. But behind everyday summer activities like picnics, parties and outdoor sports, lurk health risks for children, including injuries from bikes, pools and even the heat of summer itself.

Each year pediatricians’ offices and emergency rooms across the country receive a steady flow of patients with head injuries caused by bicycles — the most common summer ailment, according to Garry Gardner, MD, a primary care pediatrician in Darien, Ill., and chair of the American Academy of Pediatrics (AAP) National Committee on Injury, Violence and Poison Prevention.

More than 500,000 people visit the emergency room annually as a result of bicycle-related injuries, according to the CDC, and about 700 people die from these injuries. In 2001, 59% of bike-related emergency room visits involved children.

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It is not uncommon to see concussions and even skull fractures in children who take tumbles from bikes, Gardner said. In addition to head trauma, musculoskeletal injuries such as sprains, strains and fractures, and injuries to internal organs are also common.

 “Most often, children fall off the bike or crash into something,” Robert N. Sutter, DO, an assistant professor of family medicine at the University of Texas Southwestern in Dallas, told Clinical Advisor. He added that the riskiest times for children to ride are at sunrise or dusk and in the dark.

The simplest way to prevent head injuries is to encourage proper protective gear. “Every summer I see bicycle injuries that would not have happened if the child was wearing a helmet,” Gardener said. He added that educating parents and children about wearing properly fitted helmets and bike safety can go a long way.

Burn risks

Backyard fireworks, particularly sparklers, are another common cause of pediatric summer injuries. While most people acknowledge that explosive fireworks can be dangerous, many think nothing of handing a sparkler to a young child.

The blazing tip of a sparkler can reach temperatures as high as 1,000°F. When children run or play “swords” with lit sparklers, there is huge potential for a child to poke himself, herself or another child in the eye, according to Gardner.

For caregivers who insist that they cannot give up summer pyrotechnics, clinicians should recommend lodging lit sparklers in the ground, and emphasize that it is inappropriate for children to handle any type of firework on any occasion.

Buckling up for safety

Summer vacations and road trips are another cause for concern, as they raise the chance of a motor vehicle crash — the number one cause of morbidity in children aged older than 4 years.

Making sure children ride safely is the best way to prevent serious motor vehicle injuries. This spring the AAP issued new recommendations for child safety restraints in vehicle. These guidelines recommend that children ride in rear-facing seats until aged 2 years, or until they exceed the height or weight requirement listed on safety seats. The growing number of obese children requires special transportation considerations, for which the AAP offers guidance.

Additionally, parents should be aware that each time a child transitions to a new safety restraint—from car seat to booster seat, or from booster to seat belt — the level of safety is reduced, Gardner said. Often parents view this progression as positive, a sign that their child is advancing through milestones, but each new step should be delayed as long as possible.

Swimming accidents

No conversation about summer safety is complete without a discussion about drowning, the leading cause of death in children aged younger than 4 years.

More than one in five people who die from drowning each year are children younger than 14 years, according to the CDC. And for every child who dies, another four are treated for injuries related to near drowning.

Although many parents know it’s important to be vigilant when it comes to large, in-ground swimming pools, an often-overlooked hazard is small wading pools, according to Gardner. These tiny pools often have soft rubber sides, which allow toddlers to lean over the edge of the pool and fall in.

“The important message is supervision,” Gardner said. An adult or responsible teenager should watch children near any body of water, whether it’s the backyard pool or a lake. When it comes to young children, the key is “touch supervision,” during which the person watching could literally reach out and grab a young child if he or she were to fall into the water.

Adults should designate at least one spotter to watch children whenever a water activity is planned. Often there will be so many children running around at the beach or public pool that it can be hard to keep track of everyone — particularly if the adults get distracted. Spotters should switch every half hour to maintain vigilance.


Clinicians should encourage patients to come in for check-ups before beginning a summer exercise program or recreational sports whenever possible. This provides an opportunity to discuss potential safety hazards, Sutter said.

Well-child and sick visits are another opportunity to speak with parents and children about safety, Gardner added. If a child is coming in to have stitches removed or is being seen for a swollen joint, bruise or scrape, these provide perfect teaching moments to talk about safety.