Transporting Children with Special Needs

Finding the right car seat for your child and using it correctly can be challenging. However, if your child also has a special medical need, it may seem overwhelming. Below are some tips and resources to help properly and safely transport children with special needs.


Primary Children's Medical Center

National Center for the Safe Transportation of Children with Special Healthcare Needs

American Academy of Pediatrics

Car Beds

Car beds are used when transporting an infant who must lie down. Car beds are for medical conditions only or when prescribed by a doctor.

There are two types of car beds: Angel Ride and Dream Ride.

Angel Ride

Dream Ride

Angel Ride

  • Infants under nine pounds and under 21.5" in length.
  • Infant can be placed on his back or when medically necessary, his right side or stomach.
  • Premature or low birth weight infants.

Dream Ride

  • Infants between five to 20 pounds and 26" long.
  • Infant can be placed on his back, but if medically necessary can be positioned on his stomach.
  • Talk to your pediatrician and rehab therapy team. He or she can give you guidelines about your child's positioning issues. A Child Passenger Safety (CPS) Technician who is certified in Transporting Children with Special Health Care Needs will know how to best protect your child when traveling.

Special Needs Information

  • Many traditional car seats work well with children with special needs. Choose one that has features such as a higher harness weight, higher rear-facing weight, forward facing recline and accessories that allow for positioning. Do not alter a traditional car seat or use positioning products that did not come with the seat.
  • There are many medical seats and vests made for children who have outgrown traditional seats. Most have accessories that allow for growth and changing positioning needs. This will permit you to use the seat longer and the seat will continue to be safe for your child.
  • For information on higher weight traditional car seats and medical car seats visit the Automotive Safety Program website.
  • Buy a car seat with thick, firm padding for more body support. Never add padding behind or underneath your child's body. Rolled towels along the child's sides, outside the harness straps, may be used for body or head support.
  • Choose a car seat with a cover that can be removed and cleaned easily. Follow the manufacturer's guidelines for cleaning your seat.
  • Most medical seats come with an adjustable headrest or special cap for positioning. Children who have difficulty in holding their head up will benefit from this. Other children will benefit from this feature if they fall asleep while riding in the seat.
  • Primary Children's Medical Center is a resource for special needs transportation questions and concerns. Call 801-662-6583 and a special needs CPS Technician can give you recommendations on restraints that will work best for your child, your family and your vehicle.

Tips & Warnings

  • All car seats should meet Federal Motor Vehicle Safety Standards 213. Check for this on the label before you buy.
  • Special needs seats are expensive. Check with your insurance for coverage. Medicaid provides coverage for these restraints in some cases, usually requiring a letter of medical necessity.
  • If your child gets a hip spica cast, brace or other treatment that prevents sitting properly, you will need to get a special needs seat. Even though the condition may be temporary, the specially designed seat, vest or bed is the only way to comply with the law and to keep your child safe. The car seat technicians at Primary Children's Medical Center can be a resource for finding a restraint for short-term use.
  • Don't use a car seat that has a tray or a shield if your baby is premature, has low birth weight or has a tracheostomy. The tray or shield does not protect a small infant and can injure the child's neck.
  • Don't make changes to your child's car seat to make it fit better. The changes will not have been crash tested and they may not protect your child in a crash.
  • Always follow the manufacturer's recommendations for weight and height. When your child is too tall or too heavy for the seat, get a new seat. Pay attention to the direction the seat is facing. Remember it is safer to keep a child rear-facing until two years and 30 pounds.

When Your Child Won't Stay Buckled (Adapted from

Get a Car Seat That Fits
Placing a large child into a too small car seat may be uncomfortable and add to the urge to escape. Sometimes trying a seat with a different type of chest clip may do the trick. Because children with special needs may need to ride in a car seat longer than the usual age and size, a roomier car seat with a higher harness weight may help.

Use a Seat That Can Adapt to Your Child's Needs
Children with physical limitations may need a car seat that comes with accessories that lets them sit safely and securely. The American Academy of Pediatrics has issued some guidelines on seating kids with tracheostomies, muscle tone abnormalities, spica casts and behavioral issues, as well as children who must be restrained while lying down.

When You Can't Pull Off, Turn Off
Pulling over and stopping the car when a child unbuckles is fine in theory, but many times you are going somewhere important and your child doesn't care so much whether you get there or not. In that case, help your child understand the consequences of good behavior. For example, tell your child because he is wearing his seat belt correctly, he can listen to his favorite music or watch his favorite DVD.

Make Your Child the Seat Belt Police
Always wear a seat belt yourself and make sure everyone in the car is buckled. Put your car seat Houdini in charge of checking that everyone stays buckled. The right to boss others about their seat belt use may make your child more careful about keeping his own seat belt buckled.

Provide Distractions
Make sure the belt buckle isn't the most interesting thing your child has to play with in the car. Toys that need a lot of hand involvement such as activity kits or handheld games may help distract your child from the fun buckle "toy."

Give a Reward
If you use a behavior charts or a reward point system with your child, give points for staying safely seated. Or let your child earn points that can be used immediately on arrival for a treat or privilege - ice cream at the mall, maybe, or an item of choice at the supermarket. Be sure to keep the reward small and sacrifice-able - something that highly motivates your child but makes no difference to you one way or the other is ideal.

Furnish a Seatmate (Fake)
Do you have extra backseat space and an old car seat? Try putting the extra seat beside your child's, buckling in a favorite doll or stuffed animal and putting your child in charge of making sure that playmate does not escape from the seat. Whether your child is occupied with patrolling and role-modeling, or with helping her friend stay buckled, she may keep her hands off her own buckle.

Furnish a Seatmate (Adult)
Mom and Dad usually sit in the front seat and the kiddos take up the back, but if policing your child's car seat safety is too hard to do with your back to the culprit, placing one parent in the back to police, re-latch and distract may work better. If you are the only adult, try giving a sibling rewards or behavior-chart points for peacefully keeping the escaping child seated.

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