Blog by Simon Lenton, Co-Chair, British Association for Child and Adolescent Public Health.

It was a gorgeous Sunday afternoon. I was at the wheel of a Volvo estate driving through a residential estate, with parked cars on both sides of the road. As I rounded a corner a mother and daughter were crossing the road on bicycles cycling from right to left. Mother in front with daughter behind. The mother had just reached the other side of the road, but her daughter, who I estimated was 8-9 years old, was just reaching the middle of the road. On seeing my approach, the girl put both feet down and stopped in the middle of my lane.

It made me reflect back on the discussions at a recent Child Death Overview Panel (CDOP) where the death of a child was discussed. In that scenario two children were following their father, an 11-year-old followed by a 7-year-old. They were overtaking parked cars when a lorry approached from the other direction. Inexplicably the seven-year-old veered into the side of the HGV and was killed.

The panel heard that visibility was good, the bicycle in good condition, helmets were worn, the boy loved his BMX and was good at stunts, the lorry not speeding and the driver was aware of the cyclists. Nobody could understand why the boy had veered under the lorry.

As a paediatrician I explained recent evidence on the neurophysiology of childhood brain development and that proficient cycling requires not only physical control of the bicycle, but also integration of information from surroundings and then appropriate decision-making.

Bicycle control is very exposure/experience dependent so while most five-year-olds can ride a bike, few are able to use brakes or gears well or use hand signals. Children initially concentrate on balancing in a straight line and will prioritise balance over any other decision-making since not falling off is their primary instinct (which is what the girl did that Sunday).

Younger children find it difficult to integrate information from central vision, which is essential for balance and peripheral vision which is required to detect traffic hazards. It is not unusual to see children stop pedalling and put their feet down when they are unable to simultaneously integrate information from two visual sources.

Estimation of speed and distance is not a skill that reaches adult maturity until approximately 12 years of age (accepting this depends on cycling exposure) and the execution of decisions, once made, is much slower in children than in adults. Response times do not reach adult levels until approximately 14 years of age.

Prefrontal cortex immaturity accounts for some of the irrational decisions that adolescents take. The prefrontal cortex is essential for rational decision-making, inhibiting impulses, weighing up consequences and self-control; it is the last part of the brain to develop and is usually only mature in the early 20s.

So how does this explain the boy's death? He is happily following his father and brother in complete control of his bicycle when he has to pass parked cars. That puts him near the centre of the road, at some point he sees the approach of the HGV. His immature brain cannot integrate the hazard and control of his bicycle simultaneously. He either looked at the HGV rather than the road ahead (and therefore steers in that direction) or prioritises balance over decision-making and loses control when he takes his feet of the pedals. Completely understandable from the neuro-physiological perspective of the developing brain.

The CDOP members then turned their attention to whether this was preventable. How often does this happen? Should seven-year-olds ever cycle on roads? Why is it against the law for them to cycle on paths? Should the father have been cycling behind rather than in front of his boys? How do children become proficient both in bicycle control and real life decision-making in traffic situations? Should we be encouraging children to cycle to school? What is the role of bicycle helmets in preventing RTA injury? Why have cycle injuries not reduced in recent years in parallel to car occupant injuries? What should we recommend next?

All good questions!

Safer cycling. Time to take action.

In 2014 there were 1,775 deaths on UK roads, 797 in cars, 446 pedestrians, 339 motorcyclists and 113 cyclists. Of the cyclists 107 were adults and 6 were children and in addition 3,090 adults and 273 children were seriously injured while cycling. For every one billion miles travelled 35 cyclists were killed compared to just 2 motorists and while there have been substantial decreases in the vehicle deaths in recent years, this downward trend has not been achieved for cyclists.

The benefits of cycling far outweigh the risks. While active travel is currently being promoted to improve mental health and reduce obesity, campaigns may not be successful until common safety concerns have been addressed.

Relatively new evidence from a number of sources suggests that unsupervised children are developmentally not ready to mix with other motorised transport until approximately 14 years of age. Cycling safely with other road users is a complex process requiring:

  • Motor readiness - the neurological integration of motor, sensory, visual and balance skills.
  • Visual-sensory readiness-traffic awareness - children find it difficult to integrate information from central vision, which is essential for balance and peripheral vision which is required to detect traffic hazards.
  • Cognitive readiness – the estimation of speed and distance is not a skill that reaches adult maturity until approximately 12 years of age and the execution of decisions, once made, is much slower in children than in adults.

Whilst most sports realise the importance of practice and training to create mastery of the game, similar thinking has not been consistently applied to cycling proficiency, so many children do not have an opportunity to truly master cycling before riding on the roads.

Gear Change. A bold vision for cycling and walking.

Published in early August 2020 and accompanied by a £2 billion investment which hopes to transform England into an increasingly active transport society. All 20 key recommendations are summarised in the appendix, which is a good place to start reading! They can be distilled down further as follows:

  • cyclists must be separated from vehicles;
  • cyclist must be separated from pedestrians;
  • cyclist must be treated as vehicles;
  • routes must support local travel routes;
  • routes must join together in logical and intuitive ways;
  • ideally designed by cyclists!

The capital investment will be overseen by a new national cycling and walking commissioner working with a commissioning body and inspectorate called Active Travel England which will:

  • hold the budget,
  • approve schemes,
  • inspect schemes,
  • be responsible for training, good practice, knowledge sharing,
  • inspect highway authorities, and
  • review major planning applications

Almost all of the recommendations have implications for Local Authorities and Public Health departments. Active Travel England’s assessment of Local Authority’s performance on active travel will influence the funding it receives for other forms of transport.

These roles for local authorities include:

  • planning the new cycling infrastructure that separates cyclists from other road users
  • creating safe routes to bus and train stations with either bicycle parking or capacity for trains and buses to carry bicycles
  • safe cycle storage in communities with cycling integrated into new business or residential plans
  • better coordination of deliveries including increasing numbers of cargo bikes to replace some van journeys
  • cycle training to provide bicycle proficiency
  • enforcement for moving traffic offences transferred from the police to local authorities.

GPs will be encouraged to refer patients as part of personalised social prescribing to cycle schemes in places where there is safe cycling infrastructure but also poor levels of health and physical activity.

The intention is to establish a national e-bike support programme, which could include loans, subsidies, or other financial incentives, using the learning from other schemes in the UK and abroad for e-bikes, adapted e-bikes and other e-vehicles.

50% of primary schoolchildren and 25% of secondary school children arrive at school by car. The ambition is to make walking and cycling the safest option with segregated walking and cycling options and possibly closures of roads and parking restrictions around schools during peak periods.

Agenda to improve cycling safety for children

Parents.

  • Always accompany children when cycling on roads with other traffic.
  • Cycle behind, not in front when accompanying children.
  • Insist that children wear helmets, especially when first learning to ride.

Local planners.

  • Plan ‘Safe Routes to School’ and where possible, separate cycle routes physically from other traffic.
  • Reduce vehicles or speed limits on the approach to schools to less than 15 miles an hour at the beginning or end of the school day.
  • Promote active travel throughout the local community to reduce vehicles on roads.

Nationally.

  • Cycling should be considered a sport and cycle training/proficiency included within the school curriculum.
  • It should be legal for children up to 16 years of age and their parents/carers to cycle on pavements when there is no segregated cycle lane.
  • Further investment in dedicated cycle-ways, separate from traffic or cycle lanes on widened footpaths (rather than painted cycle lanes in roads), particularly in areas of high traffic density is required.

The aim should be to minimise road traffic injuries involving children and young people in ways that create co-benefits for other members of society, increasing opportunities for active travel, reducing air pollution, creating more green space to play and reducing dependence on motor vehicles.

References

Ellis, J. Bicycle safety education for children from a developmental and learning perspective (Report No. DOT HS 811 880). Washington, DC: National Highway Traffic Safety Administration (2014).

Clendon J. Submission to the NZ Transport and Industrial Relations Committee: Proposed Law Change to Allow Cycling on the Footpath (2016).

Lenton SW, Finlay FO. Public health approaches to safer cycling for children based on developmental and physiological readiness - implications for practice. (2018)

Further information

Cycling UK. Road safety and cycling overview (2017)

Cycling UK. Road safety strategies (2017)

Sustrans. Moving the nation manifesto (2018)

Education Act 1996. Section 508A - “A Local Authority in England must prepare, for each academic year, a document containing their strategy to promote the use of sustainable modes of travel to meet the school travel needs of their area”.

For further inspiration from around Europe see https://www.streetfilms.org

Appendix: Summary principles for cycle infrastructure design.

  1. Cycle infrastructure should be accessible to everyone from 8 to 80 and beyond: it should be planned and designed for everyone. The opportunity to cycle in our towns and cities should be universal. The ability to deliver a right to cycle requires infrastructure and routes which are accessible to all regardless of age, gender, ethnicity or disability and does not create hazards for vulnerable pedestrians. Improvements to highways should always seek to enhance accessibility for all Accessible cycle infrastructure Credit: Wheels for Wellbeing Appendix Summary principles for cycle infrastructure design The following summary principles form an integral part of the guidance on cycle infrastructure design (contained in Local Transport Note 1/20).
  2. Cycles must be treated as vehicles and not as pedestrians. On urban streets, cyclists must be physically separated from pedestrians and should not share space with pedestrians. Where cycle routes cross pavements, a physically segregated track should always be provided. At crossings and junctions, cyclists should not share the space used by pedestrians but should be provided with a separate parallel route. Shared use routes in streets with high pedestrian or cyclist flows should not be used. Instead, in these sorts of spaces distinct tracks for cyclists should be made, using sloping, pedestrian-friendly kerbs and/or different surfacing. Shared use routes away from streets may be appropriate in locations such as canal towpaths, paths through housing estates, parks and other green spaces, including in cities. Where cycle routes use such paths in built-up areas, you should try to separate them from pedestrians, perhaps with levels or a kerb. Dedicated cycle facility in area with high pedestrian flows Credit: PJA 41.
  3. Cyclists must be physically separated and protected from high volume motor traffic, both at junctions and on the stretches of road between them. Protection can be achieved either by creating physically separated cycle facilities, or by the closure of roads to through motor traffic using bollards, planters or other physical barriers (with access, Blue Badge holders, buses and so on still allowed). Segregated facilities can be implemented with full kerb segregation or light segregation (for example with wands, stepped kerbs, planters etc.) On roads with high volumes of motor traffic or high speeds, cycle routes indicated only with road markings or cycle symbols should not be used as people will perceive them to be unacceptable for safe cycling Cycle lane incorporating light segregation with flexible wands.
  4. Side street routes, if closed to through traffic to avoid rat running, can be an alternative to segregated facilities or closures on main roads – but only if they are truly direct. For directness it will often be necessary to mix the two, with stretches of routes on back streets joined to segregated routes on main roads and across junctions where there is no sufficiently direct side street. Routes that are not direct or that see significant volumes of rat-running traffic will not be used and should not be provided.
  5. Cycle infrastructure should be designed for significant numbers of cyclists, and for non-standard cycles. Our aim is that thousands of cyclists a day will use many of these schemes. We also want to see increasing numbers of cargo bikes to replace some van journeys Cycle routes must be accessible to recumbents, trikes, handcycles, and other cycles used by disabled cyclists. Many current tracks and lanes are too narrow or constrained to meet these objectives. To allow faster cyclists to overtake, and make room for nonstandard bikes, cycle tracks should ideally be 2 metres wide in each direction, or 3 to 4m (depending on cycle flows) for bidirectional tracks though there may have to be exceptions.
  6. Consideration of the opportunities to improve provision for cycling will be an expectation of any future local highway schemes funded by Government. To receive Government funding for local highways investment where the main element is not cycling or walking, there will be a presumption that schemes must deliver or improve cycling infrastructure to the standards in the Local Transport Note, unless it can be shown that there is little or no need for cycling in the particular highway scheme. Any new cycling infrastructure must be in line with this national guidance. The approach of continuous improvement is recognised in both the National Planning Policy Framework and Local Cycling and Walking Infrastructure Plan Guidance. Cycle infrastructure requirements should be embedded in local authority planning, design and highways adoption policies and processes.
  7. Largely cosmetic interventions which bring few or no benefits for cycling or walking will not be funded from any cycling or walking budget. Too many schemes badged as being for cycling or walking do little more than prettify the status quo, such as installing nicer-looking pavements and road surfaces but doing little or nothing to restrict through traffic or provide safe space for cycling. Schemes whose main purpose and/or effect is aesthetic improvement of the public realm must be funded from other budgets.
  8. Cycle infrastructure must join together, or join other facilities together by taking a holistic, connected network approach which recognises the importance of nodes, links and areas that are good for cycling. Routes should be planned holistically as part of a network. Isolated stretches of provision, even if it is good are of little value. Developing a connected network is more than lines on a map. It is about taking local people on a journey with you in order to understand who currently cycles, where they go and why they go there and, more importantly, who does not currently cycle and why Example of isolated cycle lane provision.
  9. Cycle parking must be included in substantial schemes, particularly in city centres, trip generators and (securely) in areas with flats where people cannot store their bikes at home. Parking should be provided in sufficient amounts at the places where people actually want to go. Cycle parking should be pleasant, sufficient and convenient to allow people to cycle for commuting and utility journeys and to know that there will be both short or long-term parking at their destinations. Cycle parking should consider the needs of all potential users and the range of cycles which will use the facilities. The provision of other services such as maintenance facilities will improve the experience for users and deter cycle thef.t Example of wayfinding signs for cyclists.
  10. Schemes must be legible and understandable. Cyclists, pedestrians and motorists alike must be in no doubt where the cycle route runs, where the pedestrian and vehicle space is and where each different kind of user is supposed to be. Some schemes deliberately create confusion or ambiguity with, for instance, only minimal signs in a paved area to show that cycling is permitted. This is another way of managing cyclist-pedestrian interactions that inhibits cycling and is not suitable for places with large numbers of cyclists and pedestrians.
  11. Schemes must be clearly and comprehensively signposted and labelled. Users must feel like they are being guided along a route. They should not have to stop to consult maps or phones. Directions should be provided at every decision point and sometimes in between for reassurance. Signs should be clear, easily visible and legible.
  12. Major 'iconic' items, such as overbridges must form part of wider, properly thought-through schemes. There is sometimes a temptation to build costly showpiece structures in isolation without thinking enough about the purpose they truly serve and the roads and routes which lead to them. We will only support such things when they overcome a major barrier on a desire line which cannot safely be crossed in other ways, and where they form an essential, properly-connected part of a wider network of good, safe routes.
  13. As important as building a route itself is maintaining it properly afterwards. Road markings get dug up by utility contractors, ignored in repaints or just worn away; tarmac is allowed to crack and part; tracks and lanes are seldom or never swept, leaving them scattered with debris and broken glass. In winter, cycle lanes are usually the last place to be cleared of snow and ice, if they are cleared at all. Routes must be properly maintained and swept frequently for debris and broken glass. Route proposals should always include a clear programme of maintenance Poor road surface conditions within a cycle lane.
  14. Surfaces must be hard, smooth, level, durable, permeable and safe in all weathers. Surface materials should be easy to maintain, for example asphalt and other materials highlighted in Chapter 15. Materials such as brick and stone should generally be avoided on cycle routes. They are expensive, yet often quickly become dirty, ugly, broken and rough to ride on under the impacts of vehicles and can be slippery in wet weather. Exceptions will be allowed for streets of special heritage value. Level changes on the main route such as raised tables and humps are not necessary if the guidance on reducing traffic volumes and/or creating separated space has been properly followed. Side road entry treatments such as raised tables across the mouth of side roads can reduce the speed of vehicles turning in and out of the junction improving safety for cyclists and can help pedestrians. Materials such as loose gravel should also be avoided.
  15. Trials can help achieve change and ensure a permanent scheme is right first time. This will avoid spending time, money and effort modifying a scheme that does not perform as anticipated. If there is dispute about the impact of a road change, we recommend trialing it with temporary materials. If it works, it can be made permanent through appropriate materials. If it does not, it can be easily and quickly removed or changed. However, it is important that the scheme is designed correctly at the beginning, to maximise the chances of it working.
  16. Access control measures, such as chicane barriers and dismount signs, should not be used. They reduce the usability of a route for everyone, and may exclude people riding nonstandard cycles and cargo bikes. They reduce the capacity of a route as well as the directness and comfort. Schemes should not be designed in such a way that access controls, obstructions and barriers are even necessary; pedestrians and cyclists should be kept separate with clear, delineated routes as outlined in the principles above. Barriers to cycling along a shared-use route (note yellow sign is not permitted in TSRGD).
  17. The simplest, cheapest interventions can be the most effective. Perhaps the single most important tool to promote cycling may be the humble bollard, used to prevent through traffic. It is relatively inexpensive and can be erected quickly. With a Traffic Order in place to restrict use of the road by motor traffic, such low-cost modal filters can increase safety by reducing through traffic, while retaining cycle and pedestrian access. Provided they have real effect, swift, pragmatic interventions are preferred overly elaborate and costly ones. Bollards used to create modal filter, preventing through traffic.
  18. Cycle routes must flow, feeling direct and logical. Users should not feel as if they are having to double back on themselves, turn unnecessarily, or go the long way round. Often, cycling schemes – when crossing a main road, for instance – require cyclists to make a series of ninety-degree turns to carry out a movement that a motor vehicle at the same location could do without turning at all. Schemes should be based on a proper understanding of how people actually behave rather than how they might be expected to behave.
  19. Schemes must be easy and comfortable to ride. Cycling is a physical effort. Schemes should not impose constant stopping and starting or unnecessary level changes. Traffic calming measures such as road humps are mainly installed to reduce traffic speeds, but if through traffic is no longer present on the street or in the segregated lane, they are not necessary. If traffic calming measures are needed, they should always be designed so that they are not inaccessible to people on tandems and tricycles. Example of kerb-segregated cycle track.
  20. All designers of cycle schemes must experience the roads as a cyclist. Ideally, all schemes would be designed by people who cycle regularly. But in every case, those who design schemes should travel through the area on a cycle to understand how it feels – and experience some of the failings described above, to understand why they do not work. The most effective way to gain this understanding is to get out and cycle the route and observe users’ behaviour.
  21. Schemes must be consistent. A scheme is only as good as its weakest point. Strenuous efforts should be made to avoid inconsistent provision, such as a track going from the road to the pavement and then back on to the road, or a track which suddenly vanishes.
  22. When to break these principles. In rare cases, where it is absolutely unavoidable, a short stretch of less good provision rather than jettison an entire route which is otherwise good will be appropriate. But in most instances it is not absolutely unavoidable and exceptions will be rare.

Bringing it all together - Making the case for change to get schemes delivered A clear stakeholder engagement plan to articulate the case for change can take time but will increase political and public acceptance of a scheme at an early stage.

Before any specific proposal is put forward, the ground must be carefully prepared, with the public persuaded of the need for change and an attractive alternative to the status quo laid out that people can get interested in – this should relate proposals to things that affect people’s lives directly, not just technical proposals and show why there’s a problem to fix. Articulate a clear vision of what you want a place to look like.

Work out every technical aspect of a proposal thoroughly and in detail before you present it, to anticipate and pre-empt likely objections, and get it as right as possible at the beginning.

When communicating the proposals be confident about it and absolutely be clear about your intentions, the benefits and disadvantages. Proposals must be clear and unambiguous, as detailed as possible, including good maps and drawings, and frank about the disadvantages, to build trust and discourage misrepresentation.

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