A proposal for the mandatory inclusion of helmets with new children's bicycles.

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Abstract
To reduce bicycle-related head injuries in children, we propose new regulations be established that mandate the inclusion of approved helmets with the sale of all new children's bicycles. Currently, purchasing a helmet is a separate economic decision that acts as a barrier to helmet ownership and use. The inclusion of a helmet with the bicycle would markedly increase helmet ownership. The increased demand would reduce the manufacturing cost per helmet, so the cost of the bicycle with the helmet would be lower than the current retail price of the two separately. This proposal could potentially be implemented by federal or state legislation, a Consumer Product Safety Commission regulation, or voluntary adoption of a practice or standard by bicycle manufacturers. Increased helmet ownership is necessary but not sufficient to raise helmet use rates. The increased ownership generated by this proposal, complemented by enhanced educational, promotional, and legal interventions, is probably the most practical and cost-effective public health strategy available to increase helmet usage and prevent bicycle-related head injuries in children.