All-terrain vehicles (ATVs) are a big draw for adventure-loving kids, but a new study warns that the thrill ride can often land children in the ER.

U.S. data shows that nearly 280,000 children were treated over a 25-year period for head and neck injuries caused by ATV accidents. That’s about 31 children each day — and nearly half of them were younger than 12, the researchers reported.

“I think it largely confirmed what we were concerned about, which was how frequent these injuries were occurring and how serious they were,” said Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

The fact that 46% of ATV-related head and neck injuries among kids occurred among those aged 12 or younger was particularly worrisome, Smith said.

“These are large, powerful machines. They’re designed for off-road use. By definition, when you take this type of powerful machine off road, it requires an advanced degree of coordination, strength and moment-to-moment decision-making on uneven terrain,” Smith said. “And a child at 12 years of age just simply doesn’t possess that degree of skill. They just developmentally aren’t ready.”

That’s true even for the lighter, smaller ATVs designed for kids, Smith added.

The study looked at data from the U.S. National Electronic Injury Surveillance System to research injuries over a 25-year period, from 1990 through 2014. Over that time, rates of injuries were consistent from 1990 to 1997, increased sharply (by almost 143%) from 1997 to 2007, and then dropped by 37% from 2007 to 2014.

It was unclear whether the drop was because of reduced injuries or whether it was because more people were using urgent care facilities instead of emergency rooms, a statistic observed by the Consumer Product Safety Commission, according to the study. Limitations of the study include that it looked at data only for injuries treated at emergency departments and not at urgent care centers or individual doctor’s offices.

The study concluded that though numbers had decreased, ATV-related head and neck injuries remained common and can have serious medical outcomes. Long-term impacts of traumatic brain injury can include difficulty concentrating, sleeping and controlling impulses, as well as other thinking impairments, Smith said.

Smith and his colleagues discuss their findings in this video:

Their findings were published Aug. 10 in the journal Clinical Pediatrics.

An ATV is an off-road, motorized vehicle with low-pressure tires, a straddle seat and handlebars. Laws for who can drive them vary from as young as age 8 to age 18 and over, depending on the state, the researchers said.

Some local jurisdictions are also changing traffic laws to allow ATVs on roadways, which Smith suggests is not safe because they are designed for off-road use. Their tires can make them harder to steer at high speeds and their design makes them less steady around corners, Smith explained.

To reduce ATV injuries among children, parents can ensure their kids are wearing a properly fitted helmet and following the manufacturer’s guidelines for the number of people who ride the vehicle at one time, said Torine Creppy, president of Safe Kids Worldwide, in Washington, D.C.

“Generally, [youth] under the age of 16 should not operate or ride on ATVs due to the safety risk,” Creppy said.

“If a family chooses to let their child ride on an ATV, it’s important that they wear a helmet first and that if they’re under the age of 16 that they’re on a child’s ATV,” Creppy added.

The annual economic costs of pediatric ATV deaths and injuries is nearly $1 billion, according to the study.

Smith recommends parents follow the American Academy of Pediatrics’ recommendations about ATV use. This includes not driving until age 16, wearing a helmet designed for motorcycle use, and never driving with a passenger on board.

“We really need to do a much better job on a national level to have uniform requirements across the country, to require children to be older and to have the skills that are needed to operate the machine safely,” Smith said. “The injury rates among children are much higher than adults, and it’s because of their developmental immaturity and their inability to operate an ATV safely.”

More information

For more on how to safely operate an ATV, head to the ATV Safety Institute.