Case Studies Discussion Updated 10/12/2017

Developmental Dysplasia of the Hip (DDH) Hip bone slipping in and out of the hip socket Overall treatment goals are to place the head of the femur back into the socket Treatment can include splinting, bracing, casting, and/or surgery Emphasize that a child with developmental dysplasia of the hip can go through a series of procedures and treatments and can have special transportation needs for an extended period of time. Developmental dysplasia of the hip was previously known as CDH, congenital dislocated hip. The National Center has developed a fact sheet brochure that addresses commonly asked questions and provides recommendations for the safe travel of children in casts. 4/8/2019

Case Study: DDH In most instances, the child being treated for DDH will be unable to bend at the hip and maintain a sitting position required for use of a standard child safety seat Alternative restraints such as a car bed, Hippo, or modified E-Z- ON may need to be considered In some cases, a child safety seat with low sides will accommodate a cast 4/8/2019

Case Study: DDH Some surgeons may appreciate input from CPST and other health professionals on hip angles necessary for child restraint use. By increasing their awareness of issues related to transporting children in hip abduction devices, they may be receptive to casting at an angle conducive to restraint use, as there may be leeway in hip angle. 4/8/2019

Case Study: Omphalocele An omphalocele is a congenital abnormality in which the abdominal contents are outside the abdomen in a sac, due to a defect in the development of the muscles of the abdominal wall. 4/8/2019

Case Study: Omphalocele Consult with the child’s surgeon and trial seats with the surgeon to determine the best options Pressure from the chest clip and buckle prongs could be of concern and placement should be considered 4/8/2019

Case Study: Omphalocele Initially, infants may require a car bed with restraint bag instead of a car seat with a harness Before the child outgrows the car bed, consider feasible options with the surgeon If the child can ride in a rear- facing seat, position rear- facing as long as possible Baby with omphalocele (circled) in restraint bag of Hope car bed 4/8/2019

Case Study: Omphalocele Consider rear-facing seat designed for children with omphaloceles Secure prescribed medical equipment 9 months, 18 pounds Source: Children’s Hospital of the King’s Daughters, Norfolk, VA 4/8/2019

Halo Traction Metal frame attached to the skull for treatment of neck fractures, degenerative diseases of the cervical spine, and stabilizing the cervical spine postoperatively Halo traction is generally applied by screwing the head piece into the skull. Length of application time varies with treatment type. Research on the effect halo traction has on safe transportation practices is limited to crash tests conducted by the Automotive Safety Program, Riley Hospital for Children, at the University of Michigan Transportation Research Institute. The crash testing results were not definitive enough to allow development of strong, specific recommendations. Child with halo 4/8/2019

Case Study: Halo Traction Consider an adjustable upright vest or harness for older children, with shoulder straps that can be unthreaded, routed through the frame and over the child’s shoulders for ease of use The child in the Y-Harness is 3 ½ years old, 45 pounds, with a Dx of congenital unstable cervical spine. The Y-Harness was used because it could be easily routed over the Halo. 4/8/2019

Case Study: Halo Traction Select a seat that provides adequate room for the halo Select a seat with a harness that is easy to route over the shoulders and secure Rear-facing, select a seat with a harness that can be easily removed from a splitter plate and rerouted over the shoulders once the child is in the seat Forward facing seats with harnesses may need to be reinstalled every time the child is restrained unless the harness can be removed and rerouted from the front of the seat Make sure that the child can be evacuated in an emergency Consider a seat that can be tethered. Halo traction is generally applied by screwing the head piece into the skull. The length of application time varies with treatment type. 4/8/2019

Case Study: Halo Traction Consider a modified E-Z-ON vest for older children who must lie down 18 month old in modified E-Z-ON The child in the picture on the left was 18 months old and had a degenerative condition of his spine. His doctor wanted him to lie down during travel. There were no car beds available large enough to accommodate the halo. A strip of Velcro was used to keep the vest closed and a liability waiver was signed with the familiy. Same child with halo in back seat and vehicle floor space padded 4/8/2019

Case Study: Fragile X Most common inherited cause of intellectual disabilities Developmental delays Mild to profound intellectual disabilities Associated with behavioral challenges May display violent outbursts, short attention spans, hyperactivity Parents (usually mothers) may be affected Fragile X is included for discussion as it is the most common form of inherited cognitive disability (prevalence: 1/3717 to 1/8918 white males (from “Smith’s Recognizable Patterns of Human Malformation”, Kenneth Lyons Jones, MD, Sixth edition, page 160, 2006). Discuss implications for educating the mother of the child as the disorder is most commonly passed down maternally. 4/8/2019

Case Study: Fragile X A car seat with a higher weight harness or large medical seat may provide securement for older children. Some large medical seats can be ordered with seat-specific accessories that deter escaping behaviors. During school bus transportation, an upright travel vest or other school bus restraint system may be advised. 4/8/2019

Case Study: Fragile X Children with behavioral challenges may also benefit from behavior plans. Parent, usually mother, may need repetition of structured, clear, and simplified instructions. 4/8/2019

Case Study: Spinal Muscular Atrophy (SMA) Spinal Muscular Atrophy is a motor neuron disease characterized by muscle wasting and motor impairment There are varying degrees of severity of SMA Children diagnosed with SMA may have severe hypotonia, respiratory problems, and feeding issues Intellect and sensation are not affected 4/8/2019

Case Study: SMA A car bed may be indicated in some cases If an older child must lie down, a modified E-Z-ON vest may be necessary Rear-facing as long as possible If an older child can tolerate forward-facing, consider a forward-facing seat that can semi- recline and has a higher weight harness Some children may require an adaptive restraint with positioning accessories 4/8/2019

Case Study: SMA If a child has a feeding tube, select a restraint that does not rub against the tube Secure prescribed medical equipment If possible, have an adult sit in the back seat and observe the child Some children may require a wheelchair Work with rehabilitation therapist 4/8/2019