Newly updated recommendations from the American Academy of Pediatrics (AAP) aim to help parents and caregivers of children with special health care needs secure them safely while riding in motor vehicles.
“Transporting Children with Special Health Care Needs,” which will be published in the May 2019 Pediatrics, supplements the existing “Child Passenger Safety” and “School Transportation Safety” statements by the AAP. It offers guidance to avoid inappropriate and incorrect use of car safety restraints for children with medical conditions that can cause transportation concerns. These include congenital anomalies, respiratory issues, gastrointestinal problems such as reflux, neuromuscular conditions, developmental delays, challenging behaviors, and casts or other medical devices.
Children with special needs should not be exempt from the requirements of each state’s laws regarding child restraint and seat belt use, according to the AAP. In addition, all child restraint seats and systems, whether or not the child has special health care needs, should meet Federal Motor Vehicle Safety Standards.
“It’s important that all children have the opportunity to be transported in motor vehicles as safely as possible,” said Joseph O’Neil, MD, MPH, FAAP, a lead author of the policy statement and member of the AAP Council on Injury, Violence, and Poison Prevention. “Children who have special health care needs and their families shouldn’t be limited by travel or worry that traveling would put their child at risk.”
Many children with special health needs can ride in standard safety seats, which the AAP says are preferable whenever possible.
"Usually, regular car seats can be used to accommodate the needs of most kids with special health needs,” said Benjamin Hoffman, MD, FAAP, co-author of the policy statement and chair of the AAP Council on Injury, Violence, and Poison Prevention. “However, some children require specially designed or custom seats to meet their needs.”
Similarly, Dr. Hoffman said, many older children and teens with special needs can be safely transported with conventional lap-and-shoulder belt systems.
"The key is positioning them correctly, with lap belts positioned low and flat across the child’s hips, the shoulder belt snug across the chest, and the seat in an upright position,” Dr. Hoffman said.
The AAP advises that children stay in rear-facing in child safety seats until they exceed weight and height limits. The rear-facing position is safer for all young children but can be especially protective for children with neuromuscular conditions such as muscular dystrophy. It provides more support to the head and spine and reduces neck injury risk in crashes with front impact.
For children who outgrow standard child safety seats but still need extra support, the AAP outlines options such as travel vests and larger medical car safety seats with National Highway Traffic Safety Administration-approved positioning accessories such as pads, wedges and seat depth extenders. Some older children with disabilities who have poor trunk control can be transported in a special belt-positioning booster or a conventional belt-positioning booster.
The AAP encourages hospitals and health systems to maintain an inventory of passenger safety restraints and have access to custom medical transportation products. Ideally, training for the proper use and installation of equipment could be incorporated into hospital discharge planning for all children with special needs. It also encourages pediatricians to support community programs that make car safely seat systems and training widely available.
Additional Information from HealthyChildren.org: