TRANSPORTING A CHILD WITH CEREBRAL PALSY

Grace's Note:  Useful safety recommendations for medically fragile children has been one of the most difficult items to find on the web.  The American Academy of Pediatrics offers these suggestions.  Another good web site is the Indiana School of Medicine Automotive Safety Program.  Their PDFs on safely transporting children with CP and Transporting Children with Wheel Chairs are excellent.

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A page created from: Transporting a Child With Special Needs from the American Academy of Pediatrics by kids health.

Question and Answer from the American Academy of Pediatrics

Q: How long should I keep my child with cerebral palsy rear facing?

Because your child may have poor muscle control she should ride rear facing longer than most children. Rear facing helps support your child’s entire body and protects her better from an injury, especially to the spine. Most new convertible car safety seats allow children to ride rear facing up to 30-35 pounds. Move your child into a convertible seat when she outgrows her infant-only seat.

Q: What car safety seat should I use when I turn my child with cerebral palsy around?

Use a car safety seat that has harness straps until your child outgrows it. A convertible car safety seat can be used forward facing until your child weighs about 40 pounds and is about 4 years old, or until your child’s shoulders are above the top harness slots. A convertible seat that can be tilted back in the forward-facing position will help keep your child’s head and back against the seat. You must check the manufacturer’s instructions to determine if your convertible seat can be tilted back in the forward-facing position. A combination car safety seat will also allow your child to remain in a harness up to 40 pounds. Some convertible and combination seats have harnesses that fit children over 40 pounds. A combination seat can be changed to a belt-positioning booster seat when your child is too big for the harness.

Q: What if my child with cerebral palsy has trouble sitting up or cannot hold up her head?

If possible, keep your child rear facing. Riding rear facing helps keep your child’s head and back against the car safety seat. Your older child may need a convertible car safety seat that can be tilted back in the forward-facing position or a large medical car safety seat. Large medical seats have special padding for the head and trunk and may tilt back in the forward-facing position. You can place rolled blankets or towels along the side of your child’s head or trunk to prevent your child from falling side to side. Never put anything behind your child. If your child needs more support for her neck, a soft cervical neck collar can be used to help prevent her head from falling forward. A hard collar should be removed during travel. Never recline the vehicle seat more than allowed by the manufacturer.

Q: Will a large medical car safety seat fit in my car?

Large medical car safety seats will fit in most passenger cars. Most large medical car safety seats require use of a top tether (a strap with a hook that connects to a tether anchor in your car). You may need to get special heavy duty tether anchors installed in your car to use a large medical seat. You should be able to get the special tether anchor hardware for your car from the car safety seat manufacturer.

Q: What if my child has a tracheostomy?

Use a car safety seat with a five-point harness. A five-point harness has harness straps that come over your child's shoulders and hips and buckle into a crotch strap. Do not use a car safety seat that has a tray or a shield. In a crash or sudden stop, the tray or shield could hit the tracheostomy and hurt your child's neck or throat.

Q: What if my child with cerebral palsy has casts because of surgery or botox?

Your child will need a car safety seat that has enough room to fit the cast. Your child might be able to use his own car seat but make sure to try it before you leave the hospital. If the cast prevents your child from sitting, your child may need a special car bed or child restraint. Ask your child's nurse if there is a special needs car seat program in your area that can help find the right child restraint or car bed for your child.

Q: What if my child with cerebral palsy has pain or pressure areas on her skin when she rides in a car safety seat?

Contact your doctor or rehabilitation therapist to help you determine what is causing the pressure or pain. Your child may need a different car safety seat that fits better, need to be repositioned in her car safety seat, or need a seat that offers more padding. Only use padding that comes with your car safety seat. Do not add extra padding behind your child's back and bottom. Your child's car safety seat might not work as well in a crash.

Q: What if my child with cerebral palsy has seizures?

Use a car safety seat that has harness straps until your child outgrows it. The harness straps will provide support to your child during and after a seizure. Your child may benefit from a large medical seat when she outgrows her convertible or combination seat. A large medical seat has a harness for children over 40 pounds.

Q: When can my child with cerebral palsy ride in a booster seat?

Your child may be able to use a booster seat if he can hold up his head and sit without any help. Use a booster seat after your child has outgrown a car safety seat with a harness. This is usually when a child weighs about 40 pounds and is about 4 years old. The booster seat helps lift a child up so the adult seat belt fits properly. Never use a booster seat with a lap belt only. Booster seats need both lap and shoulder belts. Consult an occupational or physical therapist if your child does not have good control of her muscles and has outgrown her car safety seat.

Q: When can my child with cerebral palsy use a seat belt?

Your child must be able to hold her head up and sit without any help in order to use a seat belt. She must also be able to sit all the way back against the vehicle seat without slouching, bend her knees easily over the edge of the seat, and wear the lap/shoulder seat belt flat and snug on her upper thighs and between her neck and shoulder. This is usually when a child is 8-12 years old is about 4'9" tall.

Q: What if my child uses a wheelchair?

If possible, your child should ride in a car safety seat in your vehicle instead of the wheelchair. If your child must ride in a wheelchair, make sure to ask your child’s occupational or physical therapist about a transit option model. A transit option wheelchair has been crash tested so it is safer to use in a vehicle. It also has many features that make it easier to use and tie down in a vehicle. Fasten the wheelchair to your vehicle with a tie-down system that meets safety standards. The tie-down location on a transit wheelchair is marked with a hook symbol and is easy to find. The wheelchair should face the front of your vehicle. Make sure your child uses a separate shoulder/lap belt.

Q: Where should I put medical equipment in the car?

Place medical equipment such as apnea monitors and oxygen tanks on the floor of the vehicle wedged with pillows, foam or blankets. Equipment can also be tied down with unused seat belts. There are no straps or belts specifically made for securing equipment in a vehicle.

Apply for a handicap-parking permit on behalf of your child if it is hard to get her in and out of the car safety restraint. Handicap parking often allows more space to maneuver.

Never leave your child alone in a vehicle, even to do an errand that should only take a minute. Your child's safety is worth the effort to remove her from the car safety seat/restraint, take her with you, and then

secure her again when you return.