West Side Pediatrics

Are Electric Bikes (E-Bikes) Safe for Children?

Phyllis Agran, MD, FAAP
Answer
Biking is a great way to get to and from school and other activities. It is good exercise, and it's fun when children are ready. Now, electric bikes (e-bikes) of all sizes and speeds are growing more popular.

We see more kids riding e-bikes on sidewalks, paths and in the street. But how do you know if your child is ready to ride an e-bike?

Read on to learn more about how old your child needs to be to ride an e-bike and tips to keep in mind when choosing one.

What is an e-bike?
E-bikes look like regular bikes. However, they include an electric motor and a rechargeable battery. Electric bikes are also faster, heavier and have two or three wheels and pedals.

Types of e-bikes
Class 1: the bike motor only works when the rider is pedaling and it can reach speeds up to 20 mph

Class 2: includes a throttle that allows the rider to use the bike motor without pedaling or with pedaling. It can reach speeds up to 20 mph

Class 3: may or may not have a throttle but can reach speeds up to 28 mph or more

Removing or unlocking the speed limiter on an e-bike is not recommended. It can be dangerous and cause damage to the bike.

Should your child ride an e-bike?
Just as they learn to walk and bike safely, they need to know how to safely operate an e -bike before they pedal off on their own. E-bikes require different skills and extra training. And many states and even some communities have regulations on who can or cannot ride e-bikes.

The first step is to find out whether there are laws or rules about how old a person must be to operate e-bikes. Check the vehicle code in your state and regulations in your community. Confirm whether the rules apply to all classes of e-bikes. Some areas also have stricter laws for the faster (class 3) e-bikes.

Keep in mind: The Consumer Product Safety Commission recommends that children age 9 through 12 years should not operate any product that travels faster than 10 mph.

What about my teenager?
E-bikes may be motorized, but they are not considered motor vehicles at this time.

Even so, if your teen is 16 years of age or older and has a learning permit or driver's license, they can still benefit from instruction to help them ride an e-bike safely. Check with your city and school district to see if there are training courses. Some school districts require training for the e-biker to have a school parking permit.

Other e-bike safety risks
If your child is old enough to safely operate an e-bike, keep in mind:.

There is a higher risk of severe injury and death for riders of e-bikes than for regular bike users.

E-bikes were reported as the reason for about 53,000 emergency department visits and caused 104 deaths from 2017-2022. In 2022 alone, e bikes were linked to 24,400 emergency department visits.

Motor vehicle crashes and bike control issues were the top hazards associated with e-bike fatalities.

E-bike batteries can cause fires. The e-bike battery powers the motor but it must be charged often. Parents should keep in mind that a rechargeable e-bike battery presents a higher risk of fire and explosion. Always be present when charging the e-bike battery. Never charge any battery while you are sleeping, and only use the charger that is recommended. (Find more battery safety tips here.)

Electric bikes need extra care. Routine maintenance of an e-bike is not the same as for a regular bike. Make sure you and your child know what is required to keep the e-bike operating properly. This includes reading the user manual, learning about warnings and instructions and performing recommended safety checks.

Follow the rules of the road on an e bike
Remember, all bikers of all ages whether using an e-bike or not should follow the basic rules of the road:

Ride on the right, in the same direction as traffic using bike lanes when available.

Stop and look both ways before entering the street.

Stop at all intersections, whether marked or unmarked.

Respect traffic lights and stop signs.

Wear a bicycle helmet that fits properly and is approved by the Consumer Product Safety Commission. (Find details about which helmet to choose for which activity here.)

Pay attention to your surroundings. Do not talk on the cell phone, text or wear ear buds or headphones while riding.

Discourage kids from taking passengers on the back of the e-bike.

Do not operate the e bike if you are drinking or using substances or taking medications that can interfere with your ability to be a safe biker.

Alert others such as pedestrians that you are approaching. They may not hear you.

Follow safety rules when towing bicycle trailers.

Remember
Children must first understand how to be safe pedestrians and then learn to be safe bicycle riders. Proper safety education and training are important to ride a regular bike. But riding a regular bike does not ensure that they are safe to operate an e-bike. E-bike riding requires even more training and skills. The rider should be mature enough to make safe choices.

West Side Pediatrics will be closed to in-person appointments on Monday 1/26. We will be offering Telehealth appointments for appropriate cases.
The office phones will still be open 8am-5pm, with our nurse triage service taking over at 5pm.
Please stay safe and warm!

A new study in JAMA shows that vitamin K shot refusal has nearly doubled since 2017. About 200,000 babies born between 2017-2024 didn't receive this simple, life-saving intervention.

Just yesterday, a pediatric ER physician shared a case with me. A 16-day-old girl brought in for seizures. Bulging fontanelle. A brain scan showing massive bleeding into the ventricles and brain tissue. Her parents had declined the vitamin K shot at birth. Despite emergency vitamin K administration and neurosurgery to evacuate the bleeding, she didn't survive. (Some details have been changed to protect the family's privacy.)

This is not fearmongering. This is reality.

The vitamin K shot is not a vaccine. It's a vitamin supplement - the same vitamin K found in spinach and kale. It simply gives babies a nutrient they critically lack at birth.

Babies are born with dangerously low vitamin K levels. Very little crosses the placenta during pregnancy, and breast milk contains almost none. This isn't a flaw in breastfeeding; it's just biology.

No, mom can't fix this through diet or supplements. I know this feels counterintuitive, but even when breastfeeding mothers eat tons of leafy greens or take vitamin K supplements, it barely changes the amount in their breast milk. Our bodies just don't transfer it efficiently that way.

Without enough vitamin K, babies can't clot their blood properly. This can lead to bleeding anywhere in the body - but bleeding in the brain is what we really worry about. It can happen suddenly, without warning, anytime in the first six months of life.

Babies who don't receive the shot are 81 times more likely to develop late-onset bleeding. And late-onset vitamin K deficiency bleeding has a mortality rate of 20-50%.

The reason most of us have never seen this is precisely because the shot works. It's been standard practice since 1961. We've prevented this tragedy so effectively that people have forgotten it exists.

What about oral vitamin K drops? I get why this sounds appealing - drops instead of a shot. But there are real problems. First, newborns' digestive systems are immature and absorption is unpredictable - some babies absorb it well, others don't, and you have no way of knowing which category your baby falls into. Second, babies can spit up the drops or not swallow the full dose. Third - oral vitamin K requires multiple doses over several weeks or months. Miss even one dose and protection drops significantly. Studies from Europe found that while oral vitamin K might help prevent early bleeding, it's far less effective at preventing late-onset bleeding, which is the most deadly kind.

I understand the instinct to question everything when it comes to your newborn. That protective instinct is good. But this particular intervention - one shot, one time, of a vitamin - has been protecting babies for over 60 years.

The consequences of refusing it are rare. But when they happen, they're catastrophic.

https://www.nbcnews.com/health/kids-health/parents-refusing-vitamin-k-shots-newborns-study-finds-rcna247580
https://jamanetwork.com/journals/jama/fullarticle/2842444