Published online July 13, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 596-603 (doi:10.1542/peds.2008-1124)
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ARTICLE

Transporting Children With Special Health Care Needs: Comparing Recommendations and Practice

Joseph O'Neil, MD, MPH, FAAPa,b, Janell Yonkman, MS, OTRb, Judith Talty, BAb and Marilyn J. Bull, MD, FAAPa,b

a Section of Developmental Pediatrics, Department of Pediatrics
b Automotive Safety Program, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana

OBJECTIVE: We compare the use of the American Academy of Pediatrics (AAP) guidelines for the safe transportation of children with special health care needs (CSHCN) with reported and observed practices.

METHODS: This observational study was based on a convenience sample of vehicles exiting the garage of a tertiary children's hospital. Certified child passenger safety technicians with a health care background and specialized training in the transportation of CSHCN gathered the driver's demographic information and the child's reported medical condition, weight, age, clinic visited, and relation to the driver. The safety technicians observed the car safety seat (CSS) type, vehicle seating position, and if the child required postural support.

RESULTS: During the study, 275 drivers transporting 294 CSHCN were observed. Overall, most drivers complied with AAP recommendations by using a standard CSS seat (75.4%). Among the seats evaluated, 241 (82.0%) were the appropriate choice, but only 75 (26.8%) of 280 assessed had no misuses. Approximately 24% of the drivers modified the CSS, and 19.4% of the children would have benefited from additional body-positioning support. Only 8% of medical equipment was properly secured.

CONCLUSIONS: Although most drivers seemed to choose the appropriate seat, many had at least 1 misuse. Drivers complied with most AAP recommendations; however, some deviated to facilitate care of the child during transport. Discussions with parents or caregivers about the proper transportation of CSHCN and referrals to child passenger safety technicians with special training may improve safety, care, and comfort in the vehicle.

Key Words: child passenger safety • children with special health care needs • safe transportation • car safety seats

Abbreviations: AAP—American Academy of Pediatrics • CSHCN—children with special health care needs • CSS—car safety seat • CPST—child passenger safety technician • FMVSS—Federal Motor Vehicle Safety Standards • NHTSA—National Highway Traffic Safety Administration

Accepted Dec 12, 2008.


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