Children as young as five end up in hospital with e-scooter and e-bike injuries as officials warn growing use could further clog emergency rooms.
As NSW contemplates how best to legalise the electric transport devices, doctors urge MPs to impose strict regulation including bans on riders aged under 16.
More and more children arrive in emergency after crashes including a "very sharp increase" in 2024, Westmead Children's Hospital trauma specialist SV Soundappan told a parliamentary inquiry on Wednesday.
"What concerns us most is two-thirds of these children are not wearing helmets when they're on these bikes," he said.
"We have seen this happen in a variety of environments and it's very concerning some of them are happening on streets with children colliding against stationary vehicles or even moving vehicles."
Common injuries to the youngsters include soft-tissue complaints and fractures, along with significant head injuries, complex fractures, brain bleeds and internal organ injuries.
The inquiry continues on Wednesday, two days after the state government revealed its draft plan to overhaul rules for e-scooters.
Along with legalising the scooters, which are officially barred from use in public areas of the state, the proposed changes include a ban for under-16s along with mandatory helmets and a 0.05 blood alcohol limit.
The e-scooters would be allowed on bike paths and shared pathways, as long as riders gave way to pedestrians and stuck to 20km/h speed limits.
It is estimated almost 460,000 e-scooters are already in homes across NSW, despite them being illegal to ride on the state's roads and streets.
Dr Soundappan said the speed limits on shared paths should be 10km/h to lower the risk of collisions with pedestrians, if e-scooters were allowed to be used there at all.
Royal Australasian College of Surgeons trauma chair Vikram Puttaswamy foresaw an increase in major injuries without stricter rules governing the use of e-mobility devices.
"They would then come to our emergency departments and also increase the amount of morbidity and mortality we are already seeing ... in a significantly stretched hospital system," he said.
"We're aware obviously there's a benefit in these mobility devices, but we would like to make sure there are strict guidelines put in place to reduce their trauma-related impact."
Trauma surgeon John Crozier urged parliamentarians to prioritise the needs of pedestrians when reforming laws.
"This is about people and place, it is about movement and amenity," he said.
"But that has to be tempered with a consideration of the fact ... the devices are powered with electric motors and should be regarded as motor vehicles."
E-scooters, with some restrictions, are legal to ride publicly in Queensland, Victoria, Tasmania, WA and the ACT.
