title: Children with special health care needs: patterns of safety restraint use, seating position, and risk of injury in motor vehicle crashes.
abstract: OBJECTIVE
  Special health care needs associated with behavioral conditions may influence a child's safety in motor vehicle crashes. The aim of this study was to describe and compare variation in restraint use, seating position, and injury risk in motor vehicle crashes among children with and without special health care needs likely to affect behavior.
  
  
  METHODS
  This study uses data collected between December 1, 1998, and November 30, 2002, in a cross-sectional study of children <16 years of age who were involved in crashes of State Farm-insured vehicles in 15 states. Parent reports via a validated telephone survey were used to define precrash special health care needs, restraint status, seating position, and the occurrence of clinically significant injuries by using a previously validated survey instrument.
  
  
  RESULTS
  Complete data were collected for 14654 children aged 4 to 15 years, representing 171633 children in crashes. Of these, 152 children were reported to have a special need likely to affect behavior, representing 1883 children. A greater proportion of children with special needs likely to affect behavior were appropriately restrained, particularly among children aged 4 to 8 years. Drivers of children with special needs likely to affect behavior were more often restrained and more often were the child passenger's parent. There were no differences in the rates of front-row seating. There was no significant association between the presence of a special need likely to affect behavior and risk of injury, after adjustment for child/driver characteristics and crash severity.
  
  
  CONCLUSIONS
  Despite a greater proportion of children with special needs likely to affect behavior using proper vehicle restraint, their injury risk was similar to that of children without these special needs. Primary care pediatricians providing best practices for vehicle safety should consider the unique riding experience and risk of injury among children with special health care needs likely to affect behavior.
authors.affiliation: Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, 3550 Market St, 3rd floor, Room 3041, Philadelphia, PA 19104, USA. huangp@email.chop.edu
authors.forename: Patty
authors.initials: P
authors.lastname: Huang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kallan
authors.forename: Joseph
authors.initials: J
authors.lastname: O'Neil
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Bull
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Blum
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Durbin
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D001523:Mental Disorders; D011187:Posture; D012149:Restraint, Physical; D012307:Risk Factors; D012449:Safety; D014947:Wounds and Injuries / Q000453:epidemiology*