This study was designed to evaluate bicycle-related injuries among children requiring emergency treatment, assess the use of safety measures before and after injuries, and determine parental attitudes regarding bicycle safety. Six hundred fifty-eight children were treated for bicycle-related injuries during the study period. Follow-up contact with patients' families was made by telephone or mail within 2 months. Use of safety equipment other than brakes and reflectors occurred in less than 7% of cases. Less than 25% of children used hand signals. Sixty-eight percent of children reportedly owned a bicycle helmet before the injury, but only 26.1% "always" and 29.7% "never" wore a helmet. Given the high parental understanding of the importance of bicycle helmet use, more education and warnings alone are unlikely to increase helmet usage. Parents support a mandatory helmet use law, and therefore, local and state bicycle helmet ordinances and laws should be combined with education.