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Recommendations by the AAP for babies and children with special needs

Recommendations by the AAP for babies and children with special needs


If there is any country that has paid special attention to traveling with special needs children, it is the United States. In that country, it is considered essential for parents and caregivers to have access to all the information and advice about how to choose a child car seat, how to install it in a car or school vehicle, how to seat the child properly, etc.

All of this information and advice was found at the American Academy of Pediatrics (AAP), considered the main opinion leader and source of advice on childrens' health in the United States. In this article, we will focus on babies and very young children with special needs. How should they ride in a car?

What does the AAP advise for babies and very young children with special needs?

  • The first and foremost point is that the child car seat must be in compliance with the corresponding standard. There are many children with special needs who can use conventional seats. If this is the case, the best choice is to delay the use of special restraint systems as long as possible.
  • Child restraint systems should never be modified or used in any way other than that specified by the manufacturer. The only exception would be modified seats that have been re-submitted for testing and found to meet the standardized requirements for child seats.
  • Which conventional child car seats are the most useful for these children with special needs? A good example would be backward-facing baby seats, since their tilt can be regulated, which helps children with medical problems, especially those with respiratory problems.
  • Another type would be convertible seats, meaning those that can be used facing forward or facing backward. These seats are useful for children weighing up to 13 kilos (29 pounds) with poor control of their head or neck.
  • In general, child car seats with a restraining five-point harness –with straps for both shoulders, both hips and between the legs- provide good upper-torso support for many children with special needs.
  • If the seat back is too vertical and prevents the child from holding his or her head still, the use of a rolled-up towel or piece of cloth under the base of the seat is recommended, in order to tilt the seat farther back, but never more than 45 degrees and always in accordance with the specifications of manufacturer of the child car seat.
  • The AAP advises that infants born pre-term should not use baby car seats that have trays or other rigid components to avoid them striking such components in case of an accident.
  • It should be kept in mind that seats measuring less than 14 centimeters (5.5 inches) from the slot where the strap passing between the babies legs comes out, and the seat back, can help to prevent the child from slipping or sliding downward, while seats that measure less than 25 centimeters (10 inches) from the lower adjustment slot of the upper harness straps to the seat tray will help to keep the upper straps away from the baby's ears.

Before premature or low-birth-weight babies leave the hospital,  it is advisable for them to be observed in their child car seats and monitored by medical personnel, especially if they have a low blood oxygen level, a slow heart rate or apnea. If the baby has any of these symptoms, he or she should be carried in a bassinet or carrycot where he or she can lie completely flat.

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