Child Passenger Safety for Infants and Young Children With Special Health Care Needs

All children deserve to be safe when riding in motor vehicles. Children with certain medical conditions can often use traditional child safety seats. However, some children need to use a specially designed type of child restraint seat to keep them safe.

What types of conditions may require a special child restraint?

Infants with breathing, muscular and orthopedic conditions

A car bed may be used for infants who should ride flat on their stomachs or backs because they have trouble breathing, poor muscle control, bones that break easily, have had recent surgery on the spine or are wearing a cast.

Orthopedic conditions

A special child restraint may be necessary for children in hip spica casts because the cast holds their legs out at a wide angle and they cannot bend at the hips. Children in full body casts or larger children in partial body casts may need to use an E-Z-On vest and leg strap so they can lie down in the back seat of the vehicle.

Neuromuscular conditions

Some children with conditions such as cerebral palsy, poor head/neck control and various neuromuscular disorders may still need to use a special child restraint after they have outgrown a traditional child safety seat. There are restraints available that fit children who weigh up to 105 pounds that have extra pads and accessories to help position the child in the seat.

Behavioral conditions

Some children may need to use child restraints that cannot be unbuckled by the child. For toddlers or young children whose behavior will not yet allow the safe use of a booster seat and who are too large for a forward-facing child safety seat with a harness, a travel vest may be an option. Most travel vests have upper weight limits of 60 to 168 pounds.

How do you know if your child needs a special child restraint?

Talk with a doctor, physical therapist or occupational therapist about your child's medical condition and transportation needs.

What should be considered when buying a child restraint?

A child restraint should:

  • fit your child, fit properly in your car and be used correctly every time.
  • meet your child's age, height, weight, physical development and behavioral needs.

Read the instructions for both the child restraint and your vehicle. Both sets of instructions should be used, to ensure you are using the child seat and vehicle restraints correctly.

How do you obtain a special child restraint?

Generally, special child restraints cost more than traditional seats and are not available in stores. For help in finding this type of seat, speak with your doctor, local hospital, pediatrician, physical therapist, or occupational therapist. Your health insurance, including Medicaid, may help cover the cost of this type of seat.

Helpful Hints

  • Be aware that some child restraints for children with special needs may take up more room in a vehicle than traditional restraints.
  • Premature and small infants should not be placed in a child safety seat with a harness-tray/shield combination or an armrest. In a crash or sudden stop, the baby's head could hit the tray or shield, causing face, head and brain injuries.
  • Most infant seats have a five-pound minimum weight limit.
  • Child restraints with a five-point harness may provide good upper body support for children with special needs.
  • Families with children with conditions such as autism, attention-deficit-hyperactivity disorder (ADHD) or cognitive impairment may have to try a variety of child restraints to find the best one to meet their needs.

Other Safety Considerations

Never try to modify a traditional child safety seat or use one that has been altered to fit your child.

Safely transport medical equipment

Safely store and secure medical devices such as apnea monitors, oxygen tanks, ventilators, walkers and crutches during travel so they do not become flying objects in the event of a crash or sudden stop. Try wedging the equipment under the vehicle seat with pillows or with seat belts not being used by other passengers to strap it down. Devices using batteries should have enough power for a least double the length of your trip.

Make sure your child is transported safely by others

Make sure that the child restraint can be properly installed in any other vehicles used to transport your child. Baby sitters, grandparents, school bus drivers, or other caregivers transporting your child should know how to properly secure your child in the seat and install the seat in their vehicles.

Think about traveling distance and time

Depending upon your child's condition, you may want to limit the amount of car travel and/or make frequent stops on long trips.

Address transportation service needs

If your child has special needs and receives services through the local Early Intervention Program or Committee on Pre- School Special Education, transportation issues can be addressed through the Individual Family Service Plan (IFSP) for children under 3 years old, or the Individual Education Plan (IEP) for children 3 to 5 years old

Provide supervision

Whenever possible, have an adult ride in the back seat to monitor your child. Take your child with you whenever leaving the vehicle, unless another adult is present to supervise.

Be prepared to handle emergencies

Develop a medical care plan with your doctor in case your child has a medical emergency while riding in the car. Attach a copy of the plan to the outside of the car seat or other readily accessible location. Have an emergency kit in your vehicle that includes special medications or supplies for your child and include a checklist to make sure that all of the items are present and identifiable. Keep a cellular phone in your vehicle in case you need to call for help.

For more information

American Academy of Pediatrics

This web site includes the on-line booklet "Car Child Safety Seats: A Guide for Families – 2006", with a listing of child safety seats and restraints for children with special needs. Automotive Safety for Children Program

Riley's Hospital for Children

(Click on "special needs technician database") This website offers information on correctly installing a child restraint in your car, and contact information for certified child passenger safety technicians trained in special needs transportation. Information is also available at (317) 274-2977.