How children with special needs travel with their parents: Observed versus reported use of vehicle restraints

OBJECTIVES. The difficulties entailed in transporting children with special physical and behavioral needs could influence child restraint misuse and nonuse within this population. Although parental interview is often used to assess child vehicle restraint use, little research had been performed to validate this approach, and none has been done in the special-needs population. The objectives of this study were to assess the prevalence of nonuse and misuse of child restraints in the special-needs population and to assess the validity of using parental report as a measure of child restraint use. METHODS. Restraint use in 115 children with special needs, aged 0 to 18 years, was observed on their arrival at the parking lot of the Alyn Hospital Pediatric Rehabilitation Center in Jerusalem. The observation noted type of restraint used or absence thereof. If a restraint was used, correct use/misuse was recorded. In 94 cases, the parents were interviewed later that day in the clinic. RESULTS. Seventy percent of the children were observed as traveling unrestrained or with a restraint that was grossly misused to the extent that it provided no meaningful protection. The remaining children were observed displaying a variety of errors in the selection or use of the restraint that compromised their safety to varying degrees. Analysis of the observation results versus parental reporting revealed a 44% overreporting of child restraint use. Sensitivity was 71%, and specificity was 86%. CONCLUSIONS. The high prevalence of restraint nonuse and misuse within the specialneeds population defines this as a population at risk and emphasizes the need for intervention. Cautious interpretation is required of information acquired from parental reporting of child restraint use. The results of this study should raise awareness among professionals working with children with special needs as to the need for tailored assessment and intervention in the area of child-passenger safety.