Children with special needs

Children with special medical needs also require effective occupant protection. The same general occupant protection principles apply, such as rear-facing as long as possible, tight installation of the child restraint, and snug harness adjustment.

Given the needs of these children, however, sometimes their occupant protection system must be different or include additional postural support elements. Car beds are one example, but there are other systems to address most of the commonly encountered healthcare issues, including children in hip and body casts, those with tracheotomies or muscle tone abnormalities, and those who use wheelchairs for ambulation. The Indiana School of Medicine provides a more comprehensive website on Special Needs Transportation. They also offer a training course titled “Safe Travel for All Children: Transporting Children with Special Health Care Needs,” at The American Academy of Pediatrics (2019) offer additional recommendation in their policy statement.

For children who use wheelchairs and cannot transfer to a child restraint, the best practice is to use a wheelchair that meets a voluntary crashworthiness standard (RESNA WC19), which means it is designed to perform as a motor vehicle seat. The wheelchair is attached to the vehicle with a crash tested securement system, most often a four-point tiedown that complies with RESNA WC18. The child in the wheelchair must be provided with a crashworthy belt system that is properly fitted to their body. Most belts attached to the wheelchair are meant for postural positioning and may not protect a child during a crash. For more information about wheelchair transportation safety, see