Transporting children with orthopaedic conditions and surgeries.

While motor vehicle crashes remain one of the leading causes of death and injury to children, proper and consistent use of child safety seats and safety belts can greatly improve children's chances of survival in motor vehicle crashes. Children with orthopaedic conditions and children after orthopaedic surgery, however, may be restricted to specialized child restraint options that are capable of providing proper fit and safe travel for a period of time after the procedure. To assure proper selection and avoid secondary injury, parents and health care professionals need to be aware of best practices for transporting children postoperatively and of restraint options that exist for children with orthopaedic conditions.

Child safety seat use for infants with Pierre Robin sequence.

OBJECTIVE: To determine what child restraints would accommodate infants with Pierre Robin sequence who often require special attention in motor vehicle travel since microagnathia usually requires a prone position to keep the infant's airway open. RESEARCH DESIGN: Dynamic testing and clinical trial. SETTING: An Indiana children's hospital providing primary and tertiary care. PATIENTS: Four patients with Pierre Robin sequence are described to illustrate use of the modified infant car seat and the appropriateness of the car bed restraints for meeting requirements for prone positioning during travel. SELECTION PROCEDURES: Convenience sample. INTERVENTION: Selected restraints were loaned to families through a clinical setting until the patient was able to use a conventional child restraint. MEASUREMENTS AND RESULTS: Three child restraint systems were determined to accommodate the prone position necessary to keep the airway open for children with Pierre Robin sequence. Dynamic crash testing demonstrated the crashworthiness of an infant car seat modified to allow for prone positioning. Through a clinical trial, two car bed restraints were also found to provide safe prone positioning of infants. CONCLUSIONS: To enable safe transportation for infants with Pierre Robin sequence, health care providers can direct parents to appropriate resources for travel and can monitor the airway and oxygenation of the infant with Pierre Robin sequence before hospital discharge.

A survey of transportation services for children with disabilities.

Although many students with disabilities are transported daily in school vehicles, few state guidelines address special transportation needs. This study collected information from two states on the types of vehicles and safety restraints used, and the problems encountered by public schools, community agencies, and rehabilitation centers that transport people with disabilities from birth to 21 years of age. The information collected, together with a review of research on special needs transportation, contributed toward development of state regulations for school buses used to transport special education students. Vehicular transportation safety is an important part of individualized education planning for the 18.6% of occupational therapists working in schools. Using this study's questionnaires, occupational therapists who are primary resources for selection of seating and transportation equipment may become informed advocates for implementing safer transportation on an individual and state level for clients with disabilities.

Transportation resources for pediatric orthopaedic clients.

Pediatric orthopaedic surgery clients may be unable to safely, comfortably, and affordably use child safety seats (car seats) for a variety of reasons. This article describes commercially available child safety seats suitable for transporting pediatric orthopaedic surgery clients. Discussed are those children with cerebral palsy, spina bifida, hip dislocations, arthrogryposis, scoliosis, and osteogenesis imperfecta.

Safe transportation for infants with severe hydrocephalus.

Attention must be devoted to proper positioning and selection of an appropriate child restraint system for infants with severe hydrocephalus to reduce the risk of potential injury during motor vehicle travel. Due to the infant's head size, parents may fear the head and neck will fall forward, or they may encounter difficulty positioning the head forward-facing in a child safety seat. Two case studies illustrate how a commercially available infant-only care seat can be modified to accommodate the infant with severe hydrocephalus and how use of a car bed restraint can meet positioning needs of these infants.

Establishing special needs car seat loan program.

Car seat loan and rental programs have provided many families with low-cost access to child restraints. When an infant or child is unable to be accommodated in a standard car seat or seat belt owing to physical or medical problems, parents of these children have few, if any available resources. The establishment and operation of a loan program at the Indiana University School of Medicine for children who are medically fragile is reviewed in this article. This program was developed by the Automotive Safety for Children Program at the James Whitcomb Riley Hospital for Children, Indiana University Medical Center, to meet the special transportation needs of children with respiratory, orthopaedic, and other medical and physical difficulties. A summary table is included to highlight restraints that have performed satisfactorily during dynamic crash tests and are used to meet patient transportation needs at Riley Hospital. Guidelines for establishing and maintaining a child restraint loan program for children with special needs are outlined to encourage replication of this effort.

Transporting children in body casts.

Automotive restraint systems for children in body or hip spica casts, who cannot be accommodated by conventional child restraints or seat belts, were investigated. A car bed restraint and a harness vest restraint were subjected to simulated 30-miles/h crash tests to assess their effectiveness. The successful systems were then tried by patients and their families and found to be convenient as well. Details of the testing, potential limitations of the systems, and a subsequent actual crash experience are reported.

Safe transportation for children with disabilities.

Few guidelines are available on providing safe transportation for children who cannot use conventional auto restraints. This article discusses the misuse of restraints and reviews several modified car seats and other restraints that have been tested and that meet safety standards.