The toddler’s mother later described what happened the way people describe a car crash. Sirens. Parents fumbling for their phones. And a few feet away, the boy who had been riding, weeping and shaking, a child himself, seeing what his bike had done. The toddler arrived in our pediatric trauma bay via Medflight.
We are a pediatric surgeon and a pediatric trauma nurse practitioner. We want to be very clear about what happened on that playground, because we keep hearing it called an accident. It was not. It was a crash, the predictable result of handing a motor vehicle to a child.
E-bike-related emergency department visits in Massachusetts more than doubled in the first half of this year, according to the state Department of Public Health. School let out, and visits increased. So far this summer we have cared for children with bleeding livers and ruptured spleens, punctured lungs, broken femurs, fractured spines, and brains swelling inside skulls that struck pavement at 30 miles per hour. Some of those children will not get all of themselves back.
These are not the injuries of childhood bike riding. We know what those look like: a wrist fracture, a chin that needs four stitches, gravel in a knee. What we are seeing now is motor vehicle trauma, and it arrives in bodies that weigh 80 pounds.
We are the ones who meet these kids’ parents in the corridor while the resuscitation is still going on, and we have learned to watch their faces for the moment they understand. It is almost always the same sentence: “I had no idea this could happen.” We are the ones who come out of the operating room to explain why we had to remove a child’s spleen, why the next 24 hours will decide what kind of life a 9-year-old has. And we are the ones who call at two weeks and at three months and hear what a brain injury has done to a family that thought their son had simply gone out to meet his friends.
The word “e-bike” is misleading. The bicycles we grew up on were lighter than most e-bikes and went as fast as our legs could push them. Today’s e-bikes weigh more than a traditional bike and hit 20 to 30 miles per hour with a twist of the wrist. Some go faster. Physics does not care that we call it a bike. Double the speed and you quadruple the energy, and in a crash that energy goes into a child.
The problem is not just age. It is development.
The part of the brain that governs judgment, impulse control, and the ability to see three seconds into the future is not finished until a person hits their mid-twenties. Adolescents overestimate their own competence and underestimate risk. They are slower to recognize a hazard and less practiced at deciding what to do in the half-second they have. This is not a character flaw, and it is not a parenting failure. It is biology, and it is why society doesn’t let a 13-year-old drive a car or a motorcycle. We should stop pretending an e-bike is meaningfully different.
Listen to that boy again: It’s too fast. He was right, and he understood it only in the moment it stopped mattering. The price of that discovery was paid by a toddler who never saw it coming.
Massachusetts is closer to acting than many states. The Legislature deserves credit for advancing the Ride Safe Act, which proposes regulation of these devices by speed, setting a minimum age for the faster machines, and possibly closing the gap in crash reporting that has kept these injuries invisible. Massachusetts should finish the job. Three things would save children’s lives: a reasonable minimum age and speed limit, as New Jersey has already done for motorized bicycles; an enforced helmet requirement for every rider on every motorized device; and a ban on motorized devices on sidewalks and playgrounds, where toddlers who cannot yet run are learning to walk.
We are not asking anyone to Bubble Wrap their children. We want them outside, on wheels, getting exercise, taking the ordinary risks that make a childhood. But a motorized bike is a vehicle, and it should be treated like one, with an age requirement, a proper helmet, and rules about where it can go.