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updated 9/14/2015 2:15:27 AM ET 2015-09-14T06:15:27

Tricycle accidents requiring a visit to the emergency room peak when children reach age 2, a new study finds.

The most common ER-worthy injuries from tricycles in the study were injuries to the head, according to the research published today (Sept. 14) in the journal Pediatrics. Most kids showed up at the ER with cuts, although some had internal damage.

Most deaths involving tricycles occurred when children fell into swimming pools while riding unsupervised, the researchers also found, leading to an important take-home message for parents.

"The environment in which children ride their tricycles should be free of pathways leading to sources of water," said study researcher Sean Bandzar, a medical student at the Medical College of Georgia. "In addition, parents should supervise all children riding tricycles." [ 9 Weird Ways Kids Can Get Hurt ]

Tricycle accidents

Bandzar was inspired to study tricycle injuries after a stint in the pediatric emergency department, he told Live Science. He used data from the National Electronic Injury Surveillance System for 2012 and 2013, which records demographic information and data on injuries from emergency-room visits from a sample of hospitals across the U.S. The researchers used the data to estimate the number of injuries nationally.

On the whole, serious tricycle injuries are rare. Over the two years studied, there were an estimated 224 injuries serious enough to require hospitalization out of the estimated 9,340 injuries nationwide that brought children to the ER, the researchers reported. The rest of the children were treated and sent home.

However, in most years, tricycles are the second-most common cause of toy-related deaths in the United States, and they rose to the most common cause in 2012. Still, the chances of a child dying on a trike remain extremely small. In 2012, when tricycles reached the No. 1 spot, five children died while riding tricycles. Four of those children drowned after their tricycles tipped into swimming pools, and one, a 12-month-old boy, fell over along with the tricycle on a concrete driveway and sustained a fatal head injury.

In the new study, Bandzar and his colleagues found that 2-year-olds were the most likely victims of tricycle injuries, accounting for an estimated 3,000 injuries over the study period. Three-year-olds and 1-year-olds followed, with 2,023 injuries and 1,990 injures, respectively.

Common injuries

The most common injury type seen in the ER was lacerations (such as cuts, gashes and scrapes), which made up 2,637 of all injuries seen. The most frequently injured body part was the head, accounting for nearly 30 percent of the injuries in the database. In cases of broken bones, children's arms were more often fractured than their legs, Bandzar said.

The database didn't include crucial information like whether children were supervised at the time of injury, or if they were wearing protective equipment, Bandzar said. However, he said, helmets and elbow pads could prevent many of the injuries seen in the study.

Modifications to tricycles could help, too, Bandzar and his colleagues wrote in Pediatrics. For example, because many injuries occur when kids turn the front wheel too sharply and tip over, tricycles could be changed so that the wheels didn't turn as far.

Toy-related injuries are relatively frequent, with the Consumer Product Safety Commission reporting that there were 256,700 emergency room visits related to toy injuries in 2013. However, 96 percent of children injured are treated and released. Toy-related fatalities are rare, with 18 reported in 2011, 16 in 2012 and nine in 2013.

© 2012 LiveScience.com. All rights reserved.

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