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
(online April 22), 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.
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
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.”
children with special health needs can ride in standard safety seats, which the
AAP says are preferable whenever possible.
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.”
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.
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.
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.
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.
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds