Fun vs. Safety: Understanding the Risks of Children Riding All-Terrain Vehicles

I never want to be a party pooper. There are many fun things for kids to do. As a pediatric intensivist, however, I have a habit of being more critical of some fun activities. One such activity that I am more critical of is children riding all-terrain vehicles (ATVs).

ATVs can definitely be a fun and exciting way to explore off-road terrain, but they also come with certain risks. Unfortunately, some of these risks can be life-threatening or cause long-standing disabilities. I am not averse to those who wish to have their children ride them, but I do think that it is important to do so with the understanding of the potential consequences.

The Risks Associated with ATV Riding

As per the Consumer Product Safety Commission (CPSC), Off-highway vehicle-related (OHV) injuries and deaths are significant public health issues in the United States, of which ATVs are a part of this category. Here are some statistics from CPSC's latest report of deaths and injuries involving OHVs with more than 2 wheels (published in November 2021):

Off-Highway-Vehicle-Related Fatalities Reported

• As of September 2021, the year 2018 is the most recent year of reporting for fatalities that CPSC considers complete. CPSC staff is aware of 2,211 deaths associated with Off-Highway Vehicles (OHVs) that resulted from 2,156 incidents during the 3-year period from 2016 through 2018.

• Of the OHVs involved in those 2,211 reported deaths, CPSC staff classifies 1,591 as All-Terrain Vehicles (ATVs), 506 as Recreational Off-Highway Vehicles (ROVs), and 47 as Utility-Terrain Vehicles (UTVs). For the remaining 67 deaths, CPSC staff does not know the vehicle classification, but staff concludes that the vehicle is either an ROV or UTV.

• CPSC staff divided these 2,211 reported deaths across various age groups: under 12 years (6%), 12-15 (7%), 16-24 (15%), 25-34 (15%), 35-44 (13%) 45-54 (15%) and 55+ (29%). Children under 12 represent about half (48%) of the fatalities among the combined under-16 age group.

• CPSC staff observed that OHV overturns and/or collisions (e.g., with other vehicles or stationary objects, such as trees) were the most common fatality hazards.

Off-Highway-Vehicle-Related Emergency Department-Treated Injury Estimates

• Over the full 5-year period from 2016 through 2020, CPSC staff estimates that there were 526,900 emergency department-treated injuries associated with OHVs (ATVs, ROVs, and/or UTVs) in the United States. This corresponds to an estimated annual average of 105,400 emergency department-treated injuries over the period.

• Although these estimated injuries do not trend in a single direction over the period, there is a statistically significant decrease estimated from 115,500 in 2016, to 95,000 in 2018, followed by a significant increase to an estimated 112,300 in 2020.

• CPSC staff divided injuries during the 2016 through 2020 period across various age groups: under 12 years (13%), 12-15 (13%), 16-24 (23%), 25-34 (20%), 35-44 (13%) 45-54 (9%) and 55+ (8%). This distribution of estimated injuries appears to be more heavily weighted toward younger ages than the distribution of reported fatalities.

• In the most recent year 2020 estimated OHV-related emergency department-treated injuries for all ages, CPSC staff found that:

• The most common diagnoses were fractures (30%) and contusions/abrasions (18%).
• The affected body parts were primarily: the head and neck (30%), the arm (shoulders to fingertips, 30%), the torso (20%), and the leg (20%).
• Victims were more frequently identified as male (68%) than female (32%).
• Most were treated and released (78%) or hospitalized (19%).
• Hospitalizations (meaning cases treated and admitted or transferred to another hospital) were found significantly increased in the year 2020, compared with the 4 prior years.

Types of ATV-Related Injuries

Some of the most concerning injuries associated with riding ATVs include head and spinal cord injuries, broken bones, burns, abrasions and lacerations, crush injuries, and suffocation to name some major injury concerns. With regard to head and neck injuries, the worst-case scenarios include bleeding and/or swelling in the brain caused by trauma to the head which can result in death or, if the child survives, severe neurologic damage. But, there can be a spectrum of severity of head injury from no injury to what I just described. Injuries to the neck can result in spinal cord injuries which may subsequently result in paralysis if the injury to the spinal cord is severe enough. Furthermore, collisions and falls from ATVs can result in broken bones, particularly in the arms and legs. Burns can develop from coming in contact with the hot parts of the vehicle (as parts of the ATV can become very hot during operation). In the event of an accident, riders may also suffer cuts and scrapes from contact with rough or sharp terrain. Crush injuries can occur if the vehicle overturns and lands on an individual because ATVs can weigh hundreds of pounds and can easily crush limbs or the entire body, especially with children. Finally, suffocation can happen if a child is trapped underneath an overturned ATV as well because the weight of the vehicle can prevent them from breathing as it rests on their chest.

Stating this list of possible injuries that can take place from an ATV accident is not meant to sensationalize the severity of the potential injuries or scare anyone. It is meant to provide transparency so that an educated decision can be made as to decide to let or not let your child ride an ATV. If the decision is to allow your child to ride an ATV, it is imperative to try to mitigate the risks by taking safety precautions.

Tips for Safe ATV Riding

It's important for riders to take safety precautions when riding ATVs, including wearing appropriate safety gear, riding within their skill level, and following all safety guidelines and regulations. The CPSC has some recommended safety tips for riding ATVs:

• Get hands-on training from a qualified instructor, e.g., in an ATV Safety Institute (ASI) course

• Never ride with more passengers than there are seats. Most ATVs are designed for one rider

• Never ride on public roads, except to cross, where permitted by law

• Avoid drinking alcohol before or while driving an ATV, because alcohol can impair judgment and response time

• Stay off paved roads

• Riders younger than 16 should drive only age-appropriate youth models, and never adult models

• Always wear a helmet and other protective gear, such as eye protection, boots, gloves, long pants, and a long-sleeved shirt

While these safety tips can help reduce the risk of severe injury from ATV accidents, they cannot remove the risk entirely.

Promoting Safe Recreation

I have concerns about children riding ATVs because of injuries that I have personally seen, as a pediatric intensivist, and seeing the national statistics on injuries resulting from ATV accidents. The most severe injuries that result are based on the various traumas that a body sustains after falling from an ATV or being struck or crushed by an ATV. Some of these injuries can be life-threatening or life-altering, depending upon the severity of the injury or injuries. There may be multiple types of injuries for any given accident. With these concerns in mind, there are many fun things that kids can do and I would never try to be a party pooper. But, without judgment, I feel compelled as a pediatrician to promote safe recreation for kids. One needs to really consider the risks of letting a child ride an ATV before allowing them to ride one.

How do you feel about children riding ATVs?