E-bike injuries surge among children as experts urge pediatric counseling on safe riding

Electric bicycle (e-bike) injuries are increasing rapidly among children, and pediatricians are well positioned to help families understand the risks before a crash occurs, according to new research and its lead author.^1,2

The statewide California study, published in Trauma Surgery & Acute Care Open, found that e-bike injuries rose from just 2 reported collisions in 2018 to 1,566 in 2024. Compared with riders of traditional bicycles, e-bike riders were younger, more likely to sustain moderate-to-severe injuries, and disproportionately represented among children aged 14 years and younger.

John Austin, MD, a general surgery resident at the University of California San Diego and first author of the study, said the findings highlight an opportunity for pediatricians to discuss safe riding practices with families before children begin using e-bikes.

Why are e-bike injuries increasing among children?

Austin said the growing popularity of e-bikes has changed the injury patterns clinicians are seeing.

"Our study demonstrates that more children are riding e-bikes, and as a result, more children are also getting injured riding e-bikes," he said.

Unlike traditional bicycles, e-bikes can travel at substantially higher speeds and are heavier, increasing the potential for more severe crashes.

"So now, e-bikes, when compared to bicycles, are much faster. They're much heavier, and as a result, there's the capability to involve in both single and multi-vehicle accidents, and the results of these accidents can be more severe than your regular traditional pedal bicycles," Austin said.

The study identified 4,035 e-bike collisions between 2018 and 2024. Moderate-to-severe injuries occurred in 15.8% of e-bike crashes compared with 11.9% of traditional bicycle crashes, and e-bike riders were significantly more likely to be 14 years or younger.

What should pediatricians discuss with families considering an e-bike?

Austin said counseling should begin by understanding why a family wants an e-bike and how the child plans to use it.

"I think it's important in these conversations to begin by assessing why a family is buying their child an e-bike, and also the family's own understanding of what that particular e-bike's capabilities are," he said.

He encouraged pediatricians to individualize recommendations based on a child's maturity, riding experience, and environment.

"It's a very different conversation if you're talking to, say, an experienced 16-year-old who's used to riding their bike to home, to school, to other activities day in, day out vs someone who's buying their 12-year-old an item that they believe will be fun for them," Austin said.

He added that discussions may range from reinforcing safe riding behaviors to recommending that families delay e-bike use until a child is older.

What injuries are clinicians seeing after e-bike crashes?

Although fractures and orthopedic injuries remain common, Austin said the most concerning injuries often involve high-energy trauma.

"Two types of injuries that we do see quite a bit related to e-bikes that are devastating potentially are your multi-system organ traumas... or severe head trauma," he said. "Right, if you crash and hit the asphalt at 20 plus miles an hour, and you're not wearing a helmet, the outcomes are devastating and sometimes fatal."

He cautioned, however, that conversations with families should balance risk communication with practical guidance.

"I don't think it's necessarily productive to scare or threaten every family who wants an e-bike with the possibility of horrible injury or death," Austin said. "But that being said, it is important to convey the severity of not having basic safety equipment, not following traffic laws, or just being unready to ride a bike that fast."

How can pediatricians help prevent e-bike injuries?

Austin said well-child visits provide an opportunity to incorporate e-bike safety into routine anticipatory guidance.

"On the medicine side, it relies on providers performing safety checks as part of a good social history during a well-child visit," he said. "If they find out they have a bike, does a child have a helmet? Do they have reflective gear, appropriate lighting? Where is a child riding?"

The study authors also called for coordinated prevention efforts, including rider education, helmet promotion, standardized e-bike classification, and policies addressing minimum age requirements and safer riding environments.

What role do pediatricians play in improving e-bike safety?

Austin believes pediatricians are uniquely positioned to advocate for safer riding habits throughout childhood and adolescence.

"Pediatricians have a critical role in ensuring the safety and well-being of their patients," he said. "They will have the particular ability to be both a safe space and also a clear advocate for safe riding practices, helmet use, protective gear, appropriate transportation."

He also emphasized the need for continued research and public policy efforts as e-bike use expands.

"I think critically overall, what we can agree on is that I want the community to continue raising this question of how we safely ride e-bikes and collect data on e-bike usage and accidents because it's through data-driven evidence that we can produce the most effective interventions," Austin said.

References

1. Austin J, Perkins L, Haines LN, Kobayashi L, Berndtson AE, Weaver JL, et al. An exponential increase in e-bike injuries in California. Trauma Surgery & Acute Care Open. 2026;11:e002099. https://doi.org/10.1136/tsaco-2025-002099

2. UC San Diego. UC San Diego Study Finds An Exponential Increase in E-Bike Injuries in California. Newswise. Press Release. July 20, 2026. Accessed July 30, 2026. https://www.newswise.com/articles/uc-san-diego-study-finds-an-exponential-increase-in-e-bike-injuries-in-california/?sc=dwrecomm&xy=10069478&wt=dw_r_20072026