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Traveling safely: Guidance for transportation of children with special needs :

April 22, 2019

Courtesy Rebecca Wegener

Many pediatric primary care providers care for children who have physical, behavioral or developmental conditions that present specific challenges. A topic not always thought of is safe transportation.

An updated AAP policy statement reviews important considerations for transporting children with special health care needs, including those with airway obstruction, orthopedic conditions or procedures, developmental delays, muscle tone abnormalities, challenging behaviors and gastrointestinal disorders.

The policy provides current guidance to protect these children and emphasizes communication among the patient and caregivers, medical team and child passenger safety technicians who have enhanced skills to help transport every child safely and comfortably in a motor vehicle. Resources help providers and the community identify capable assistance for transporting children with special health care needs.

Pediatricians can serve as a resource for legislators, policymakers, law enforcement and school officials, who may be less familiar with the importance and availability of occupant protection systems for these children.

The policy Transporting Children With Special Health Care Needs, from the AAP Council on Injury, Violence and Poison Prevention, is available at and will be published in the May issue of Pediatrics.

General guidance

Highlights of the policy include the following:

  • Always follow the recommendations and guidelines provided by the manufacturers of the vehicle and the car safety seat.
  • After a child outgrows the length or weight limits of a conventional car safety seat with an internal five-point harness, utilize other resources for proper and secure occupant restraint.
  • Don’t transport passengers in a reclined vehicle seat because the lap-shoulder belt system will not be positioned properly during a crash.
  • Children should ride in the rear seat — the safest place for all children — at least until age 13 years. Seating in the front seat may be considered for a child with special needs who requires frequent observation and when no adult is available to accompany the child in the back seat. An air bag on/off switch should be considered for the vehicle if the National Highway Traffic Safety Administration approves a petition to disable the airbag.
  • Children’s special transportation needs should be incorporated into their Individualized Education Program developed with the school.
  • Children with special health care needs may travel on commercial airlines. Each airline has its own policies in accordance with Federal Aviation Administration regulations on the use of assistive devices.

Transporting equipment

  • Secure ancillary equipment on the floor of the vehicle or, if allowed by the manufacturer, under a vehicle seat or wheelchair or below the window line. Refer to the vehicle owner’s manual or consult the vehicle manufacturer for proper locations and methods of safe equipment storage.
  • Children who require electrical-powered medical equipment for use during transit should have portable self-contained power for double the expected duration of the trip, along with a fully charged backup system.

All children should be transported in the safest possible way. Those with special health care needs need access to the expertise and means to travel safely to help them achieve their greatest potential.

Dr. O’Neil is a lead author of the policy and a former member of the AAP Council on Injury, Violence and Poison Prevention Executive Committee.

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