1. Case Studies Discussion
Updated 10/12/2017

2. 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

3. 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
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4. 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.
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5. 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.
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6. 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
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7. 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
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8. 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
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9. 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
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10. 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.
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11. 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.
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12. 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
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13. 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.
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14. 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.
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15. 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.
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16. 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
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17. 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
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18. 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
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