Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 518-523 (doi:10.1542/peds.2008-0092)
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ARTICLE

Children With Special Health Care Needs: Patterns of Safety Restraint Use, Seating Position, and Risk of Injury in Motor Vehicle Crashes

Patty Huang, MDa, Michael J. Kallan, MSb,c, Joseph O'Neil, MD, MPHd, Marilyn J. Bull, MDd, Nathan J. Blum, MDa,e and Dennis R. Durbin, MD, MSCEb,c,e

a Division of Developmental and Behavioral Pediatrics
c Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
b Center for Clinical Epidemiology and Biostatistics
e Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
d Section of Developmental Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana

OBJECTIVES. Special health care needs associated with behavioral conditions may influence a child's safety in motor vehicle crashes. The aim of this study was to describe and compare variation in restraint use, seating position, and injury risk in motor vehicle crashes among children with and without special health care needs likely to affect behavior.

PATIENTS AND METHODS. This study uses data collected between December 1, 1998, and November 30, 2002, in a cross-sectional study of children <16 years of age who were involved in crashes of State Farm–insured vehicles in 15 states. Parent reports via a validated telephone survey were used to define precrash special health care needs, restraint status, seating position, and the occurrence of clinically significant injuries by using a previously validated survey instrument.

RESULTS. Complete data were collected for 14654 children aged 4 to 15 years, representing 171633 children in crashes. Of these, 152 children were reported to have a special need likely to affect behavior, representing 1883 children. A greater proportion of children with special needs likely to affect behavior were appropriately restrained, particularly among children aged 4 to 8 years. Drivers of children with special needs likely to affect behavior were more often restrained and more often were the child passenger's parent. There were no differences in the rates of front-row seating. There was no significant association between the presence of a special need likely to affect behavior and risk of injury, after adjustment for child/driver characteristics and crash severity.

CONCLUSIONS. Despite a greater proportion of children with special needs likely to affect behavior using proper vehicle restraint, their injury risk was similar to that of children without these special needs. Primary care pediatricians providing best practices for vehicle safety should consider the unique riding experience and risk of injury among children with special health care needs likely to affect behavior.

Key Words: motor vehicle accidents • child passenger safety • injury • behavior disorders/problems

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • ODD—oppositional defiant disorder • ASD—autism spectrum disorder • SNLAB—special need(s) likely to affect behavior • MVC—motor vehicle crash • PCPS—Partners for Child Passenger Safety • APD—auditory processing disorder • AIS—Abbreviated Injury Scale • OR—odds ratio • CI—confidence interval

Accepted May 19, 2008.


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