488 - Child Passenger Restraint System Use Patterns and Adaptive Transportation Needs in a National Cohort of Children with Complex Chronic Conditions

Publication Number: 1468.488

MIchelle Macy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Arthi Kozhumam, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Yeeun Tak, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Jennifer B. Peralta, UCLA, Los Angeles, CA, United States; Amanda Gatewood, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Carolyn Foster, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: The American Academy of Pediatrics (AAP) published its first policy statement on Transporting Children with Special Healthcare Needs (CSHCN) in 1999. Since then, this population has grown, their care has shifted from the hospital to home, and many depend on medical devices. The AAP recommends CSHCN use standard child restraint systems (CRS) when possible. In the general population, age-appropriate CRS use declines from 90% for infants to < 70% for older children. Current CRS use patterns and adaptive transportation needs for CSHCN, especially those with medical device dependence and equipment, are poorly understood.

Objective: Describe the types of CRS and vehicles, standard and adaptive, used by children with complex chronic conditions (CCC) and compare CRS use by medical device and equipment dependence across age groups.

Design/Methods: Cross-sectional survey of parents in the Family CIRCLE cohort whose children had ≥1 CCC and ≥2 healthcare visits at study sites in the past year. Baseline data were collected 9/24. Transportation data, collected in summer 2025, included CRS and vehicle types and child passenger safety experiences, knowledge, and confidence. Age-appropriateness was based on the 2018 AAP Child Passenger Safety Policy Statement and typical size limits of standard CRS. Special needs CRS (e.g., car beds, adaptive CRS, travel vests, and wheelchairs) were considered appropriate regardless of child age. Descriptive statistics were calculated, and responses were compared using χ² tests for children with and without medical device dependence by age group.

Results: Transportation responses were received by 552 (82%) of 673 parents in the initial cohort who provided their child's age. Most were mothers (93%), median age 38 years (IQR 34, 44); children were 57% male, median age 7 years (IQR 3, 11) (Table 1), 89% traveled in standard vehicles, 25% in adapted vehicles, and 10% in ambulances at least once in the past 3 months. Just 29% of parents recalled talking with a healthcare provider about how their child's medical condition would affect transportation. Overall, 59% used an age-appropriate CRS (Table 2). Considering special needs CRS as age-appropriate, children with medical device dependence were most commonly using an age-appropriate CRS (Figure).

Conclusion(s): Pediatric healthcare providers often overlook child passenger safety for children with CCC. Although children with medical dependence had greater age-appropriate CRS use, efforts are needed to support knowledge, boost confidence, and increase access to financial resources and insurance benefits for families of all children with CCC.

Family CIRCLE Cohort Sample Demographics


Transportation Experiences


Child Passenger Restraint System Use Patterns