Special Medical Conditions
Transporting children with special medical conditions requires an understanding
of the condition as it relates to car safety seats and safety restraints.
Below is a list of some of the more common medical conditions. Each provides
a link to information and special car safety seats that may be considered.
If a condition is not listed or if you wish to be contacted by a Certified
Child Passenger Safety Technician (CPST), complete
this form.
You may also be interested in our Child Passenger
Safety Handbook for Children with Special Needs (PDF format; please
allow a few minutes to load).
- Low birth weight and premature infants
- Casts and/or braces
- Tracheotomies
- Developmentally dislocated hip (DDH)
- Cerebral Palsy (CP) and other neuromuscular conditions
- Developmental delays
- Spina Bifida (Myelomeningocele)
- Hydrocephalus
- Feeding tubes/gastrointestinal tubes
- Reflux
- Brittle bone disease (Osteogenesis Imperfecta)
- Behavioral challenges, attention deficit-hyperactivity
disorder (ADHD), autism, or cognitive disorders
- Scoliosis
- Achonroplasia (Dwarfism)
- Pierre Robin Sequence
- Halo Traction
- Neck Collars
- Low birth weight and premature infants:
- Monitor the child in the car safety seat before discharge from
the hospital 30-60 minutes after feeding (AAP recommends this for
any infant under 37 weeks gestation)
- Maintain the appropriate recline angle both during the monitoring
and while traveling in the vehicle (refer to car safety seat instructions)
- Select a car safety seat with a smaller harness dimension -- not
all harnesses are the same
- Check the minimum weight guidelines for the car safety seat - Avoid
car safety seats with shields or trays
- Do not add padding under or behind the infant to
make the "seat fit the infant"
- Shoulder harnesses should not cross the ears - use the set of harness
slots that are either level to or below the infant's shoulders
- Center the infant by placing rolled receiving blankets on each side
of the baby. A "crotch roll" (a rolled wash cloth) around
the crotch buckle may be needed to prevent submarining
- Seats to consider for infants under five pounds: Century Assura
(five-point harness), Britax Companion , Chicco Roma, Combi Tyro,
Peg Perego, Primo Viagio
- Casts and/or braces:
If a child cannot sit up:
- Consider a Hippo car seat
if the child is between 10 and 65 pounds
- Consider an E-Z-On
Modified Vest if the child is over two years old and 20 pounds
- Consider a Dream
Ride car bed or Snug
Seat car bed if the infant is under 20 pounds
- Never transport an individual on a reclined vehicle seat;
this could result in the lap belt riding up onto the stomach and cause
"seat belt syndrome" or the child may submarine
under the lap belt
- In some instances, an ambulance may be required for transporting
If a child can sit up:
- A conventional car safety seat will probably work, however it must
be used correctly. The cast or braces cannot interfere with the harness
or buckle
- The Cosco Alpha Omega or Enspira; Britax Marathon, Boulevard or
Decathalon; or the Nania Airway often accommodate some casts and braces
- A Hippo car safety seat may
be needed for some casts/braces for children less than 65 pounds.
It can be used both rear and forward-facing depending on the weight
of the child
- A "combination car safety seat," which is a forward-facing
only car safety seat with an internal harness for up to 65 pounds,
may accommodate some casts and braces. Look for one with low sides
and a wide seated width (various manufacturers and models)
- Support may be needed under some casted legs. Use pillows, foam
or blankets
- Tracheotomies:
- Conventional car safety seats can be considered, however avoid car
safety seats with trays or shields that could come in contact with
the trach tube. A five-point harness system is recommended
- A car safety seat that can be semi-reclined forward- facing can
help position the child's head back and thus prevent the chin from
covering the trach (such as Dorel Scenera or Touriva or Graco Safe
Seat Step 2)
- Secure all medical equipment - do not use the same seat belt that
secures the car safety seat. Place the equipment on the floor under
padding (blankets, pillows, etc) or wedge it under a vehicle seat
- Medical equipment that requires batteries should have enough power
for at least double the length of the trip
- Have an emergency plan in case the tracheotomy comes out during
travel
- Choose a car safety seat with a higher rear-facing weight limit,
which will allow the child to remain in a reclined position, such
as Dorel Scenera or Touriva convertibles. Check individual car safety
seat instructions for the availability of using the semi-reclined
position while forward-facing such as Dorel Scenera or Touriva convertibles
or Graco Safe Seat Step 2
- Developmentally dislocated hip (DDH):
- Refer to "Casts and/or braces"
- Cerebral Palsy (CP) and other neuromuscular
conditions:
- If the child has poor head and neck control, select a rear-facing
car safety seat with a higher weight limit A few models have a 35
pound rear-facing weight limit, such as Dorel Scenera or Touriva convertibles
(check manufacturer's instructions)
- Once the child is forward-facing, select a car safety seat that
can semi-recline in the forward-facing position such as Dorel Scenera
or Touriva convertibles or Graco Safe Seat Step 2 (check the manufacturer's
instructions)
- Rolled blankets may help to center the child's torso
- A special positioning car safety seat or large medical seat may
be needed once the child outgrows a conventional car safety seat
- Work with a physical therapist for specific positioning requirements
- Seats to consider: Columbia 2000 , Columbia 2500 , Traveler Plus
, Special Tomato, Peppino, Recaro, The Roosevelt or Carrie Seat .
There are also several newer conventional car safety seats on the
market that have an internal, five-point harness to accommodate a
higher weight such as the Britax Husky, Regent, Wizard , Marathon
, Decathlon, or Boulevard; Nania Airway; Dorel Apex 65 ; Radian; Evenflo
Triumph Advance or Titan; or Safegaurd Car Seat. Also consider the
E-Z-On Modified Vest and regular E-Z-On Vest with the Ride Ryte booster
or RideSafer Travel Vest for positioning needs
- Wheelchair transport in a vehicle may be required if the weight
and size of a larger child prohibits transferring of the child from
the wheelchair to the vehicle seat or car safety seat (Note: not all
wheelchairs can safely transport children in vehicles. Check
for a transit option)
- Developmental Delays:
- The car safety seat or safety restraint chosen will depend on the
specific problem associated with the developmental delay
- Older children who have outgrown conventional car safety seats may
need an E-Z-On Vest
or a large medical seat or special positioning
seat that will give needed support
- Seats to consider:Columbia 2000, Columbia 2500, Traveler Plus,
Special Tomato, Peppino, Recaro, The Roosevelt, or Carrie Seat. There
are also several newer conventional car safety seats on the market
that have an internal, five-point harness to accommodate a higher
weight such as the Britax Husky, Regent,Wizard, Marathon, Decathlon,
or Boulevard; Nania Airway; Dorel Apex 65; Radian; Evenflo Titan or
Triumph Advance; or Safegaurd Car Seat. Also consider the E-Z-On Modified
Vest and regular E-Z-On Vest with the Ride Ryte booster or RideSafer
Travel Vest for positioning needs
- Transportation via wheelchair may be required (Note: not all wheelchairs
can be safely transported in vehicles. Check
for a transit option)
- Spina Bifida (Myelomeningocele):
- A car bed may be needed during
the postoperative period if the child is less than 20 pounds. The
child's health care practitioner should determine this
- Consider a car safety seat that can recline (such as Dorel Scenera
or Touriva convertibles or Graco Safe Seat Step 2) for children with
hypoventilation. Not all car safety seats can be reclined forward-facing.
Follow the manufacturer's instructions
- Position children rear-facing in a car safety seat that accommodates
higher weights (such as Dorel Scenera or Touriva convertibles) if
the child is smaller in size, has low muscle tone and/or a large head
(i.e. if hydrocephalus is a problem)
- Older children may need a special positioning car safety seat or
large medical seat such as: Columbia 2000, Columbia 2500, Traveler
Plus, Special Tomato, Peppino, Recaro, The Roosevelt or Carrie Seat.
There are also several newer conventional car safety seats on the
market that have an internal, five-point harness to accommodate a
higher weight such as the Britax Husky, Regent,Wizard, Marathon, Decathlon,
or Boulevard; Nania Airway; Dorel Apex 65; Radian; Evenflo Triumph
Advance or Titan, or Safegaurd Car Seat. Not all large medical seats
have a reclined angle
- Transportation via wheelchair may be required (Note:
not all wheelchairs can safely transport children in vehicles. Check
for a transit option)
- Hydrocephalus:
- Consider a conventional car safety seat appropriate for the age
of the child and select it based on the proper
guidelines
- Select a car safety seat that will allow for rear-facing to higher
weights (some go to 30 to 35 pounds such as Dorel Scenera or Touriva
convertibles- refer to specific car safety seat instructions)
- Look for roomier space in the head area of a car safety seat
- For older children, select a forward-facing car safety seat that
can be used in the recline position according to the manufacturer's
instructions such as Dorel Scenera or Touriva convertibles ot Graco
Safe Seat Step 2
- For infants who need to lie down, consider the use of the Snug
Seat car bed. Additional considerations may be necessary because
of related medical conditions
- Other car safety seats to consider: Cosco Alpha Omega , Husky ,
or Marathon or any of the special positioning car safety seats or
large medical seats that have a slightly reclined position and plenty
of head room
- Feeding Tubes/Gastrointestinal Tubes:
- Consider a conventional car safety seat appropriate for the age
of the child and select it based on the proper
guidelines
- Select a car safety seat in which the harness does not rub against
the feeding tube (work with the health care practitioner for appropriate
location of the harness)
- The harness must be snug and secure on the child according to the
car safety seat manufacturer's instructions - cover the opening with
gauze if the tube comes out during travel
- Have an emergency plan to replace the tube as soon as possible
- Car safety seats chosen depend on individual situations
- Reflux:
- A physician should determine which position is best for travel i.e.
upright, semi-upright or lying down
- Consider using a car bed if an infant needs to lie down or recline
beyond the car safety seat's recommended guidelines or consider the
E-Z-On Modified Vest
if the child is older than 2 years and
over 20 pounds
- Wait an hour after feeding before traveling
- Car safety seats chosen depend on individual situations
- Brittle Bone Disease (Osteogenesis Imperfecta):
- Infants with respiratory problems may need a car
bed
- Select car safety seats that allow for rear-facing to higher weights
(30 to 35 pounds)– refer to car seat instructions or consider
seats such as Dorel Scenera or Touriva convertibles - Use conventional
car safety seats with harnesses for infants and younger children and
booster seats for older children to minimize risk of injuries
- Do not loosen the harnesses or put padding under the child - special
restraints (i.e. Hippo car
safety seat) may be needed to accommodate casts
- Older children may need to work with an occupational therapist to
use an adaptive wheelchair with customized inserts
- The Snug Seat
car bed utilizes a bunting or "sleeping bag" instead
of a harness system for restraining the infant which may be more accommodating
in positioning
- Car safety seats chosen depend on individual situations
- Behavioral Challenges, Attention deficit/hyperactivity
disorder (ADHD), autism or cognitive impairment
- The child may resist the use of a car safety seat or safety restraint
and can be a distraction to the driver
- Parents and caregivers must be firm and consistent and require
that the child always remain buckled in appropriately while riding
in the car
- Seek assistance with behavior management if needed
- A variety of conventional car safety seats may have to be tried
to find one that is the most difficult for the child to "escape"
from
- Keep harnesses snug and make sure that the harness retainer clip
(chest clip) is positioned at arm pit level
- An E-Z-On Vest
with a back closure may need to be considered or a large medical car
safety seat or special positioning seat with an internal harness to
a higher weight may be required for older children. (If possible "try
it out" before purchasing because of their higher costs)
- Q'Vest
and BESI Harness
may be considered for school bus travel only
- Scoliosis:
- Children with scoliosis may not be able to sit properly with their
backs and bottoms flat against the seat
- The Snug Seat
car bed with its bunting instead of a harness restraint system
may be necessary for infants
- A Modified E-Z-On
Vest may be necessary for children over 2 years and 20 pounds
to lie down on the rear vehicle seat
- Older children may need to use a large medical or special positioning
car safety seat such as: Columbia 2000, Columbia 2500, Traveler Plus,
Special Tomato, Peppino, The Roosevelt, Recaro or Carrie Seat. There
are also several newer conventional car safety seats on the market
that have an internal, five-point harness to accommodate a higher
weight such as the Britax Husky, Regent,Wizard, Marathon, Decathlon,
or Boulevard; Nania Airway; Dorel Apex 65; Radian; Evenflo Triumph
Advance or Titan; or Safegaurd Car Seat.
- Work with the child's occupational or physical therapist for positioning
needs
- A wheelchair with customized insert may be necessary in some cases
(check for transit option)
- Conventional car safety seats may be appropriate in some situations
- Achonroplasia (Dwarfism):
- Selection of a car safety seat should be based on size and positioning
needs and not by age
- Use a rear-facing car safety seat with higher weight limits such
as Dorel Scenera or Touriva convertibles as long as possible to minimize
the risk of cervical spine injury in a crash
- Then, use a forward-facing car safety seat with harnesses as long
as possible such as Dorel Scenera or Touriva convertibles or Graco
Safe Seat Step 2. Older children may need to use a large medical or
special positioning car safety seat such as: Columbia 2000, Columbia
2500, Traveler Plus, Special Tomato, Peppino, The Roosevelt, Recaro
or Carrie Seat. There are also several newer conventional car safety
seats on the market that have an internal, five-point harness to accommodate
a higher weight such as the Britax Husky, Regent,Wizard, Marathon,
Decathlon, or Boulevard; Nania Airway; Dorel Apex 65; Radian; Evenflo
Triumph Advance or Titan; or Safegaurd Car Seat.
- Transition to a belt positioning booster seat until the upper weight
limit (generally 80 to100 pounds) is reached or when the seat belt
fits properly
- Pierre Robin Sequence:
- Infants may need to lie on their stomach in a car
bed
- Follow-up sleep studies are recommended to determine when the infant
can travel semi-reclined
- Avoid car safety seats with trays or shields if the child has a
tracheotomy
- If an infant has button traction after surgery to hold the tongue
forward, consider positioning the child on his/her back in a car
bed
- Consider using a rear-facing car safety seat that can be tethered
(i.e. a Britax
Roundabout, Marathon,
or Wizard)
to prevent contact from the vehicle seatback on rebound
- Halo Traction:
- Recommendations for car safety seat and safety restraint use are
limited due to inconclusive crash testing on restraints with this
medical condition
- Select a car safety seat or safety restraint with adequate space
for the halo
- Select a car safety seat or safety restraint with a harness that
is easy to route over the shoulders and secure
- Make sure the car safety seat or safety restraint allows for easy
evacuation of the child in case of an emergency
- Tethering of a forward-facing car safety seat or restraint is recommended
even if it is not required by the car seat manufacturer
- Consider the use of an E-Z-On
Modified Vest for a child over 2 years of age and 20 pounds, which
allows them to travel lying down on a vehicle seat
- Consider the use of a Spelcast
car safety seat (and some conventional seats) for a child under 40
pounds. The harness system is attached and adjusted from the front
allowing the shoulder harness to be placed over the shoulders and
then secured
- Consider the use of a Columbia
2000 where the shoulder harness straps can be placed through the
harness slots from the front of the car safety seat while the child
sits in the car safety seat
- Neck Collars:
- Neck collars are often used to provide additional support for a
child with poor head and neck control
- Crash tests of neck collars have indicated that many models actually
increase neck tension
- It is recommended that stiff or formed collars should be removed
during transport and be replaced with soft, foam cervical collars,
however final determination of medical necessity lies with your health
care practitioner
- Never secure a child's head separately to a car safety seat or restraint
in order to keep the child's head from falling forward
- Car safety seats chosen depend on individual situations
Adapted from:
Transporting Children With Special Health Care Needs
Developed by: James Whitcomb Riley Hospital for Children
Indiana University School of Medicine
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