transporting children with special needs - Kids Health @ CHW

TRANSPORTING CHILDREN WITH SPECIAL NEEDS 

This document reflects that which is currently regarded as safe practice, however, as in any clinical 

situation there may be factors, which cannot be covered by a single set of guidelines. This 

document does not replace the need for the application of clinical judgement to each individual 

presentation. 

© The Children’s Hospital at Westmead - Valid only on the day of printing – discard immediately after use. 

Transporting Children With Special Needs 

Page 1 of 27

CONTENTS 

1. TRANSPORTING CHILDREN WHEN THE REGULAR CAPSULE, CHILD RESTRAINT OR SEAT 

BELT IS NOT SUITABLE 

1.1 Recommended process for transporting children with special 

needs 

2. GENERAL INFORMATION FOR TRANSPORTING CHILDREN WITH SPECIAL NEEDS 

2.1 Australian Standards 

2.2 Standard child restraints 

2.3 Guidelines for the prescriber 

2.4 Modifications 

2.5 Use of additional padding (soft modifications) 

2.6 Explanations to parents 

2.7 Fitting stations 

3. CONDITIONS AND DISABILITIES THAT MAY REQUIRE MODIFICATION TO 

CHILD RESTRAINTS OR TRANSPORT OPTIONS 

3.1 Head and trunk control problems, including weakness 

3.2 Behavioural problems 

3.3 Airway problems 

3.4 Children with connective tissue disorders, awkward shapes 

3.5 Plasters, orthopaedic patients 

3.6 Children in wheelchairs/specialised buggies 

4. CONTACT INFORMATION 

5. APPENDICES 

1a Use of a modified restraint – parent letter 

1b Use of an E-Z-ON-Vest – parent letter 

2a Travelling in a wheelchair - SPOT 

2b Travelling in a vehicle in a wheelchair - TranSPOT 

3a General guidelines for transporting children with disabilities - 

TranSPOT 

3b General guidelines for transporting students with disabilities 

- TranSPOT 

4a Transporting children with special needs, a guide to using 

child restraints in vehicles - TranSPOT 

4b Transporting children with special needs - TranSPOT 



Page 2 of 27

1. TRANSPORTING CHILDREN WHEN THE REGULAR CAPSULE, CHILD RESTRAINT OR SEAT BELT 

IS NOT SUITABLE 

Hospital staff and parents expect children to be sent home from hospital in 

the safest possible way. Problems arise when the challenge of a child in bulky 

plasters, with respiratory compromise, poor head control, generalised rigidity 

or a behavioural disorder makes it impossible to use the regular capsule, 

infant/child restraint or seat belt. The following aims to act as a guide to staff 

in outlining how best to address these difficult problems. 

Conditions and disabilities have been allocated to one of five categories. It is 

hoped that these are sufficiently encompassing to allow staff to use the 

recommended options so that children with differing conditions may be 

transported safely. 

These guidelines can also be used in outpatient settings by clinicians to 

provide advice and information for parents, if their child has a medical 

condition or disability which makes it difficult to use the common transport 

options. 

1.1 Recommended process for transporting children with special needs 

Critical Pathway 

Discussion of potential transport problems should commence when 

planning for admission. 

The parent/carer should be encouraged to bring the child’s own 

restraint in to assess its suitability early in the treatment phase. 

Assess child’s transport needs 

The Occupational Therapist will assess the child with complicated postural 

difficulties or poor head control, or the child in need of customised adaptations. 

The therapist will: 

Try the child in an Australian Standards approved capsule, infant/child 

restraint or seat belt (this can be done on the ward/in the department or in 

the vehicle that the child will be transported in.) 

Ask the parent/carer to have the restraint fitted by an authorised fitter or 

at an authorised fitting station. 

Demonstrate to the parent/carer the placing of the child in the child 

restraint device. 

Refer to the appropriate section of this document, if modifications are 

needed. 

Document all modifications, recommendations and advice given to 

parent/carer in the child’s medical record. 

Complete the letter in appendix 1a and/or 1b and provide copies to the 

parent/carer. 

2. GENERAL INFORMATION FOR TRANSPORTING CHILDREN WITH SPECIAL NEEDS 

Listed below are the recommendations of Australian Standards for child 

restraints. However, an exemption may be required and granted on the grounds of 

the child having a medical condition that makes it impossible to use an Australian 

Standards approved restraint. In these instances, modified child restraints are 

available for use in Australia. Although these may have been tested overseas, 

usually they have not been tested to current Australian Standards. If a non- 

Standards approved child restraint is recommended for a child, the 

documentation contained in appendix 1a and/or 1b must be completed for the 

child and copies provided to the parent/carer. 



Page 3 of 27

2.1 Australian Standards 

This document should be used in conjunction with the relevant Australian 

Standards documents outlined in the ‘Special Note’ section at the end of the 

document. 

2.2 Standard Australian child restraints 

Recommendations of Australian Standards for child restraints include: 

A child restraint should not weigh more than 9kg. 

Any child restraint should be used by one occupant only. 

A chest cross-strap shall allow release of the occupant by a tear-away 

action. 

Any removable cover must be able to be detached independent of the 

harness. 

Any removable cover must be well secured to prevent the occupant 

gaining access to foam or polystyrene. 

When a buckle is used, a single pressing operation should activate a 

quick-release device. The buckle should be red or orange. 

Infant Restraints: 

Any restraining harness shall have no less than 5 points of attachment. 

Most infant restraints face the rear of the vehicle and are suitable for 

infants of a weight no greater than 9kg and a supine length up to 

700mm. 

Child Restraints: 

Any restraining harness shall have at least 5 points of attachment. 

The average recline angle for child car seats shall be no greater than 

45 degrees. 

The back of the restraint must be higher than the level of the child's 

eyes. 

Forward facing seats are suitable for children weighing between 8- 

18kg. 

Adequate head and trunk control are recommended before the child 

can be placed in a forward facing seat. 

Child Safety Harness: 

If a child safety harness or H-Harness is used in conjunction with a 

booster seat the weight of the occupant must be between 14-26kg. 

The maximum allowable weight of a booster seat plus an occupant 

using the child safety harness is 27kg. 

If a harness is used without a booster seat, the weight of the occupant 

must be between 14-32kg. 

The harness can be used with a standard lap belt or lap-sash belt with 

a seat belt converter. 

Booster Seats: 

Ideally, the use of booster seats (with back attached) is recommended 

in preference to the use of booster cushions. 

Use of a “safefit” as a seat belt converter is recommended 

(http://www.safefit.com/2005/ontheroad.html; 



Page 4 of 27

http://www.matson.com.au/safefit.html). NB: airway safety must be 

considered. 

Booster seats are for children weighing 14-26kg. They can be used in 

conjunction with a child harness or with an adult lap-sash seat belt. 

No anchorage point is required if the maximum weight of the seat is no 

greater than 2kg. 

If the seat is fitted with an upper anchorage strap, the maximum weight 

of the seat must be no greater than 4kg and the weight of the back of 

the seat no greater than 2kg. 

When seated in the booster seat, the back of the vehicle seat must be 

above the level of the child's eyes. 

Booster seats can provide limited postural support and the child can be 

positioned so that the lap-sash belt fits properly. Motion sickness may 

also be prevented with the child being able to see out the window. 

Booster Cushions: 

Booster cushions are for children weighing 14-26kg. 

The maximum weight of a booster cushion must be no greater than 

3kg. 

Booster cushions may be used in conjunction with a child harness or 

with an adult lap-sash seat belt. 

When seated on the booster cushion, the back of the vehicle seat must 

be above the level of the child's eyes. 

Child's 

Weight 

Birth 

8kgs 

9kgs 

11kgs 

12kgs 

14kgs 

18kgs 

26kg 

CHOOSING THE RIGHT CHILD RESTRAINT FOR A CHILD 

Approx 

Age of 

Child 

Birth 

5-6 

months 

6 

months 

12 

months 

2 years 

3 years 

4years 

7years 

Birth to 

9kgs 

Infant 

Restraint 

Birth to 

18kgs 

Convertible 

Restraint 

8 to 

18kgs 

Child 

Restraint 

8 to 

26kgs 

Child 

Restraint 

& Booster 

seat 

Adapted from Britax Child-care Products Pty Ltd. Safety and your family (July 

2000) 



Page 5 of 27 

14 to 

26kgs 

Booster 

seat

2.3 Guidelines for the prescriber 

Refer to the Australian Standard AS/NZS 4370:1996, which provides general 

guidelines for the prescriber. 

General guidelines for the use of all child restraints should be followed, including: 

Checking that the weight limit of the restraint is suitable for the child. 

Checking that the back of the restraint is higher than the level of the 

child’s eyes. 

Regularly checking the webbing and anchorage points for signs of wear 

and tear. 

It is illegal to position child restraints or booster seats in a rear or side 

facing position (except for those restraints suitable for babies weighing 

less than 9kg, which can be rear-facing). 

2.4 When modifications are required: 

Under no circumstances should one attempt to alter the hard shell or anchorage 

system. Only soft modifications to the restraint should be attempted by anyone 

other than the restraint manufacturer. Examples of soft modifications include 

foam padding (refer to section 2.5) and soft sleeves that may cover part of the 

webbing or buckle. Webbing should only be altered in consultation with the 

manufacturer. 

When modifying any restraint, the parent/carer must be informed of the 

modifications being performed. This is of particular importance when using 

restraints that have had major modification, such as extended crotch straps, even 

if the restraint was modified by the manufacturer. The parent/carer must be 

provided with instructions on installation and use of the modified child restraint. 

The parent/carer must also be notified in writing that “the restraint is to be used 

only by the child for whom it was modified,” and that they are “not to carry out 

further modifications to the child restraint without reference to the person who 

prescribed the modification.” 

Some restraints may require modifications to be made to the vehicle (eg seat 

belt/anchor point strengthened). Any modification to a vehicle must be carried out 

by a RTA-approved supplier and checked by a RTA-approved engineering 

signatory. 

2.5 Use of additional padding (soft modifications) 

The general principle to be adhered to, when using padding, is that the firmer the 

padding, the greater the support during a crash. The following important points 

should be considered: 

The harness should be fitted first and then the padding should fill all gaps 

and spaces. 

The padding beneath and behind the child should be firm, as soft padding 

will crush on impact. 

Total padding should not exceed 2kg in weight. 

Fire resistant materials should be used. 

Padding should be secured under the seat cover. 

Folded cloth nappies or towels are suitable for use as support. 

Avoid placing padding/foam between the child and the harness. 



Page 6 of 27

Foam used should be of a minimum density of mauve H42-500, core 

density 42kg-44kg/m3. 

Solid polystyrene foam cut to the appropriate shape may be considered. 

2.6 Explanations to parents 

The health professional, if necessary, should remind parents/carers that it 

is an RTA recommendation that children under 12 years sit in the back 

seat of a car/vehicle. 

The health professional should explain to the parents/carers that if the car 

in which the restraint is installed is in an accident, the restraint has to be 

thrown out. Parents should also be asked to contact the relevant health 

professional, in the event that a modified restraint is still required. 

A record should be kept of all recommendations and actions in the child’s 

medical record. This includes changes made to restraints and 

recommendations/demonstrations to parents/carers. 

The health professional should discuss the restraint option with the child’s 

doctor to ensure that he/she is aware of the recommendation. 

Parents should also be notified of whether the equipment has or has not 

been tested to current Australian Standards. 

Letter in appendix 1a and/1b should be completed and copies provided to 

the parent/carer. 

2.7 Fitting stations 

The RTA has a current listing of Authorised Restraint Fitting Stations in NSW and 

they may be contacted on 1800 042 865. 

Fitting stations close to Hospitals include: 

Blacktown: Little’s Child Restraints Tel:(02) 9622 6598 or 1 300 728 363 

Seven Hills: Snug as a Bug in a Rug Tel:(02) 9674 4982 or (02) 9674 6654 

Randwick: Royal Hospital for Women Tel: (02) 9382 6033 

Restraint Fitting Station 

Randwick: Baby Things Tel: (02) 9663 2320 



Page 7 of 27

3. CONDITIONS AND DISABILITIES THAT MAY REQUIRE MODIFICATION TO CHILD 

RESTRAINTS OR TRANSPORT OPTIONS 

3.1 Head and trunk control problems 

Examples: 

Children with increased tone who are hard to seat in a flexed position (Cerebral 

Palsy, Brain Injury) 

Muscular Dystrophy 

Other neurological impairments 

Spinal Injury (prone lying post-surgery) 

Hydrocephalus 

Developmental Disability 

Demyelinating diseases 

Low tone syndrome 

Option Product Available from Comments 

Seats 

found to be 

useful for 

children 

with special 

needs 

Traveller Plus Britax and most large 

retail outlets 

Tel: 1300 303 330 

Tel: (03) 9288 7288 

Columbia 

Orthopaedic 

Car Seat 

Lars 

Rehabilitation 

Car Seat 

FAS Equipment 

Tel: 1300 303 536 

Tel: (03) 9587 6766 

Fax: (03) 9587 6899 

OR 

Paediatric Mobility 

Equipment 

Tel: (02) 9674 5400 

Fax: (02) 9836 1793 

Liberty Rehabilitation 

Tel: 1300 882 471 

Tel: (03) 5941 8282 

Suitable for children 9 – 48 kg 

5-point harness 

Optional abductor 

Requires reinforced anchor 

point or second anchor point 

(with engineer’s certificate) 

Suitable for children 9 – 45 kg 

(up to 1.52 m tall) 

Includes 4 full positioning 

pads and adjustable harness 

Weight 5 kg 

Seat depth extender, extra 

tether strap and car seat 

stroller base also available 

NOT TESTED TO AUSTRALIAN 

STANDARD 

Suitable for children up to 35 

kg 

Undercarriage, swivel base 

and other accessories also 

available 

Could be expensive for 

families 


STANDARD 



Page 8 of 27


Booster 

Seat and 

Harness 

Gorilla Car 

seat 

Dejay Medial 

Tel: (02) 9838 8869 

Fax: (02) 9838 7869 

Turn-A-Tot Renolux 

Tel: (02) 4577 4588 

Standards 

approved 

booster seats 

Harness Hemco Child 

Harness 

Seat Belt 

Sash 

Guides and 

other 

Options 

Most major retail 

outlets and baby 

stores 

Hemco Industries 

Tel: (03) 5334 1213 

Fax: (03) 5334 1011 

Safefit All Big W Stores 

OR 

Matson 

100 Links Rd, 

St Marys 

Child Seat 

Belt 

Comforters 

Tel: (02) 9833 3444 

Most major retail 

outlets 

Suitable for individuals weight 

9-47 kg 

Adjustable 5-point harness 

and positioning pads 

Weight 10 kg 

Accessories also available 


STANDARD 

Suitable for newborns to 18kg 

Car seat revolves to face the 

door for ease of placing and 

buckling up the baby. May be 

useful for parents with a 

disability or back injury. It 

revolves around from rearward 

facing to forward facing mode 


STANDARD 

Harness and booster 

combination is suitable for 

children from 14-21 kg 

Available in small (14-32 kg) 

and large (>32 kg) 

A reinforcing plate and safety 

bolt are supplied for fitting by 

an authorised fitter 

Requires a letter from a doctor 

for approval 

Crotch strap option available 

Seat belt sash guide for 

children. Used to adjust sash 

belt to fit the child safely and 

comfortably 

Sheepskin sleeves to fit over 

shoulder straps of child’s 

restraint 



Page 9 of 27


Positioning 

Assistance 

The TREC 

Supporter 

Malu Travel 

Seat Triangle 

3.2 Behavioural problems: 

Examples: 

Autism 

ADHD 

General behavioural problems 

Mobility Plus 

Tel: (03) 9495 1955 

Fax: (03) 9480 3177 

Malu Terren-Hall 

16 Farnells Rd, 

Katoomba 

Tel: (02) 4782 3391 


Seat Belt 

Cover 

Columbia 

Orthopaedic 

Car Seat 

FAS Equipment 

Tel: 1300 303 536 

Tel: (03) 9587 6766 

Fax: (03) 9587 6899 

OR 


Equipment 

Tel: (02) 9674 5400 

Fax: (02) 9836 1793 

Use the reclined position that is 

available on various child 

restrains to obtain improved 

support 

Postural support device to be 

used in conjunction with an 

adult seat belt 

Attached by 2 webbing straps 

which pass around the back of 

the vehicle seat 

Adjustable height for thoracic 

support 

3 models available depending 

on vehicle in use 

Adult and junior size differ only 

by size of lateral supports 

Helps to maintain a 90 degree 

seated position. 

Available in a range of sizes or 

can be custom made 

Suitable for younger children 9 

– 45 kg (up to 1.52 m tall) 

Includes 4 full positioning 

pads and adjustable harness 

Weight 5 kg 

Seat depth extender, extra 

tether strap and car seat 

stroller base also available 


STANDARD 



Page 10 of 27


Child 

Restraint 

Locks 

The TREC 

Supporter 

Hemco Child 

Harness 

Seat Belt 

buckle 

protector 

Sedo-Ed seat 

belt cover 

Mobility Plus 

Tel: (03) 9495 1955 

Fax: (03) 9480 3177 


Tel: (03) 5334 1213 

Fax: (03) 5334 1011 

FAS Equipment 

Tel: 1300 303 536 

Tel: (03) 9587 6766 

Fax: (03) 9587 6899 

OR 


Equipment 

Tel: (02) 9674 5400 

Fax: (02) 9836 1793 

Kidsafe ACT 

Tel: (02) 6290 2244 

Buckle Cover Mark Shaw 

PO Box 8150, 

Tumbi Umbi NSW 

2261 

Tel: (02) 4389 1677 

Postural support device to be 

used in conjunction with an 

adult seat belt 

Attached by 2 webbing straps 

which pass around the back of 

the vehicle seat 

Adjustable height for thoracic 

support 

3 models available depending 

on vehicle in use 

Adult and junior size differ only 

by size of lateral supports 







for approval 

Crotch strap option is available 

Small clear plastic box that fits 

over the seat belt buckle. A 

key is inserted in the slot to 

push a button down and 

release the buckle. 

Parent/carer must have a 

doctor’s letter to use this 

device 

Fits over the buckle and 

requires adult strength to 

release the buckle. Can be 

used with the lap-sash seat 

belt. 



device 

Bright orange sleeve that fits 

over the seat belt buckle 



device 

Use the locks, if available, to 

ensure that the child cannot 

get out of the car 



Page 11 of 27

3.3 Airway problems 

Examples: 

Pierre Robin syndrome 

Ventilator/Oxygen dependent 

Tracheotomy 

NOTE: Prior to trialling the options below, all other restraint options should be 

explored and documented in the child’s medical records as to why these options 

were not appropriate. If there is a particular requirement for these 

babies/children with special needs, perhaps liaison should be made with 

manufacturers to investigate equipment possibilities. 

Option Comments 

Child to be seated in an 

Australian approved child 

restraint. 

Carer in the rear with the 

child 

Secure oxygen cylinder 

with Oxygen Cylinder Cage 

When oxygen/ventilation is required, appropriate 

modifications to the vehicle needs to be made (in 

consultation with biomedical engineering) in order to 

safely restrain medical equipment. 

Children with these medical conditions will require a 

competent carer seated in the rear with them in order 

to tend to the medical needs of the child. 

The child will sit in the car seat/booster in the rear of 

the vehicle (not in the front seat). 

Available from Technical Aid to the Disabled (TAD) 

Tel: (02) 9808 2022 

Made to fit the oxygen cylinder 

TAD will also make and fit devices that secure other 

potential missiles in the vehicle such as crutches and 

wheelchair trays 



Page 12 of 27

3.4 Children with connective tissue disorders, awkward shapes 

Examples 

Osteogenesis Imperfecta 

Arthrogyposis and other musculoskeletal disabilities 

Kyphoscoliosis 

Encephalocoele 

Spina Bifida 

Option Comments 

“Memory” eggshell foam Foam for infant capsule can be cut to suit the child. 

The supports are used under the cover of the restraint. 

Sheepskin lining on infant 

and child restraints 

Sheepskin lining/cover is usually available on most 

models, it is preferable to a fabric lining 

Planning of travel routes Bus and car travel routes should be planned in 

advance to avoid unnecessary bumps 

3.5 Plasters, orthopaedic patients 

Examples: 

Congenital Dysplasia of the Hip (CDH) 

Broomstick plasters 

Plaster body casts 


Convertible 

Child 

Restraint 

Convertible 

Child 

Restraint 

Safe N 

Sound 

Safeguard 

(with 

extended 

crotch strap) 

Safe N 

Sound 

Guardian 


extended 

crotch strap) 

Britax and most large 


Tel: 1300 303 330 

Tel: (03) 9288 7288 

The Children’s 

Hospital at 

Westmead 

OT Department 



Tel: 1300 303 330 

Tel: (03) 9288 7288 

John Hunter 

Children’s Hospital 

OT Department 

Suitable for children from 0-18 

kg. Can be rear-facing (0-9kg) 

or forward facing (9-18kg). 

Britax will supply extended 

crotch straps on request. 

A hiring fee and deposit are 

payable. 


STANDARD (WITH CROTCH STRAP) 

Suitable for children from 0-18 

kg. Can be rear-facing (0-9kg) 

or forward facing (9-18kg). 

Britax will supply extended 

crotch straps on request. 


payable. 





Page 13 of 27


Child 

Restraint 

Child 

Restraint 

Booster 

Seat 

Maxi Rider 


extended 

crotch 

straps) 

Snug Seat 

Spelcast car 

seat for child 

in hip spicas 

Safe N 

Sound 

Advantage 


extended 

crotch strap) 



Tel: 1300 303 330 

Tel: (03) 9288 7288 


Hospital at 

Westmead 

OT Department 

OR 

John Hunter 


OT Department 

Dejay Medical and 

Scientific P/L 

Tel: (02) 9838 8869 

Fax:(02) 9838 7869 



Tel: 1300 303 330 

Tel: (03) 9288 7288 


Hospital at 

Westmead 

OT Department 

OR 

John Hunter 


OT Department 

The Maxi Rider is suitable for 

children weighing 8-26 kg. It 

has two seating positions – 

recline and upright – and can 

be used as a child restraint or 

booster seat. It has a wide 

seat without high sides and 

may be suitable for some 

children in plaster. On request 

Britax may be able to provide 

extended crotch straps. 


payable. 

The maxi rider (harness/seat) 

has been tested with a dummy 

for up to 22 kg. However, for a 

child between 22 and 26kg, 

the maxi rider harness can be 

used as a postural support in 

conjunction with a standard 

la/sash belt. 


STANDARD (WITH EXTENDED 

CROTCH STRAP) 

Forward and rear facing seat 

for children with spica or hip 

casts. Has a five-point harness 

and an optional tether strap. 

Suitable for children up to 18 

kg. 


STANDARD 

Suitable for children from 14 

to 26kg. For use with safe n 

sound harness. Britax is able 

to provide extended crotch 

strap on request. 


payable. 





Page 14 of 27


Modified 

Child 

Restraint 

Adjustable 

Vest 

Modified 

Aprica 

Convertible 

Harness Hemco Child 

Harness 

Ambulance 

Transport 


Hospital at 

Westmead 

OT Department 

OR 

John Hunter 


OT Department 

E-Z-On Vest FAS Equipment 

Tel: 1300 303 536 

Tel: (03) 9587 6766 

Fax: (03) 9587 6899 


Tel: (03) 5334 1213 

Fax: (03) 5334 1011 

Transport 

Department 

Has passed crash testing by 

the RTA Crash lab. Suitable for 

children with CDH only up to 

18 kg. It has an extended 

crotch strap to fit the child in 

plaster. A hiring fee and 

deposit are payable 


STANDARD 

Adjustable Vest may be used 

for children from 2 years 

3 zipper positions ensure 

proper fit. 

Modified Vest allows child to 

travel in a prone or supine 

position securely. Child will 

also require padding next to 

the head and shoulders to limit 

lateral neck extension. For 

occupants weighing more than 

32 kg, an authorised fitter and 

RTA approval are required 


STANDARD 







for approval 

May be an option. The cost 

may be covered by a health 

fund or by the parents. Road 

ambulance transport may be 

recommended when the child 

cannot be safely restrained 

Rear Seat The RTA recommends that 

children under 12 years of age 

should not travel in the front 

seat of a car, especially 

vehicles fitted with airbags. If 

the child has to be in the front 

seat, the child should be as 

upright as possible. 



Page 15 of 27

3.6 Children in wheelchairs/specialised buggies 

Many children with physical disabilities are not able to travel on a passenger 

vehicle seat because they are unable to sit in a seat without special support. They 

may have grown out of a child restraint and/or be difficult to lift in and out of the 

vehicle because of their size. These children may need to travel seated in their 

wheelchair. At times, a child will be required to travel in a specialised buggy, for 

example, when they are unable to be seated in an Australian approved child 

restraint or in a wheelchair. This decision needs to be made in consultation with 

the child’s occupational therapist. At present, there are no standards relating to 

transportation in buggies, however the ‘Risk Assessment and Management Plan – 

Transport of ventilated children in modified buggies’ may provide some relevant 

information (link to be provided when finalised). 

Wheelchairs and their occupants need to be properly restrained within the 

vehicle. Note the following points for safe wheelchair travel: 

Approved restraints should be used to anchor the wheelchair to the floor of 

the vehicle 

There should be a minimum of four anchor points 

The wheelchair restraints must attach to the base frame of the wheelchair 

(not the wheels or the foot plates) 

The wheelchair must face the front of the vehicle 

Wheelchairs must have enough space around them to allow access, and to 

prevent the occupant from contacting another person in an accident 

The occupant must have a separate occupant restraint system which is 

anchored to the vehicle as part of the approved wheelchair restraint 

system 

The lap belt must be anchored behind and below the seat of the 

wheelchair. It must pass inside (not through) the wheels of the wheelchair 

and under the armrest 

Lap-sash belts are also available, however, they are generally not 

recommended as correct positioning is difficult. 

The occupant restraint system and attachment points need to be installed 

or approved by an authorised fitting station 

Head support on the wheelchair is strongly recommended 

Wheelchair should be in an upright position. Tilt can be used if necessary 

to maintain the child’s head in an upright position. 

The headrest should be above the child’s eye level 

The wheelchair must have a metal frame to which the wheels and 

upholstery are securely attached. 

A fixed frame wheelchair is preferable to a folding wheelchair 

It is recommended that children who use low back wheelchairs be 

transferred from their wheelchair onto a passenger seat and transported 

with the wheelchair stowed in the rear compartment/boot of the vehicle 

It is advisable to stow easily removable items such as trays in a safe 

manner to avoid them becoming projectile in the event that the vehicle 

suddenly stops. A foam tray can be used if the child requires postural 

support, but it must weigh less than 2 kg. 



Page 16 of 27

4. CONTACT INFORMATION 

TRANSPOT 

TranSPOT acts as a resource in liaising with organisations, providing information 

and assisting in developing training for transport safety needs for people with 

disabilities. TranSPOT has published the documents “Transport Safety Guidelines 

for People with Disabilities – Checklist”, June 2002 and the following pamphlets: 

General Guidelines for Transporting Children with Disabilities 

Transporting Children with Special Needs and Travelling in a Wheelchair 

Contacts: Occupational Therapy Department 

Sydney Children’s Hospital 

Ph (02) 9382 1073 

Dick Jones 

Accessible Transit Specialists 

Ph (02) 9773 8755 

dick@accessibletransit.com 

Technical Aid to the Disabled (TAD) 

TAD uses volunteers dedicated to the design, construction and provisions of aids 

for people with disabilities. 

Contact: Winsome Baker: (02) 9808 2366 

(wbaker@technicalaidnsw.org.au) 

Travel Safe 

Travel Safe provides disabled conversions to vehicles, cargo barriers and many 

disabled restraints 

Contact: Wayne Sibley: 7 Rosulyn Street, Dubbo NSW 2830 

(02) 6884 5764 

BRITAX 

Britax is the manufacturer of Safe-n-Sound Child Restraints and other products, 

including the Modified Aprica Convertible. 

Contact: Barbara Carpenter Key Account Manager (NSW) 

(barbara_carpenter@britax.com.au) 

or 

Britax Child-Care Products Pty Ltd: (03) 9288 7288 or 1300 303 330 

RTA Fitting Stations 

Provides information on your closest fitting station 

1800 042 865 or visit the website: www.rta.nsw.gov.au 

RTA 

Vehicle Standards: 131 782 

Child Restraint Enquires: (02) 9482 4572 

Technical Enquiries: 1 300 137 302 

NRMA Technical Advice 

The Hotline provides road safety advice 

1 300 655 443 or visit their website: www.nrma.com.au 



Page 17 of 27

Department of Education and Training, Special Transport Branch, Wollongong 

The Department offers information and advice regarding school transport 

13 10 71 

Standards Australia 

Standards Australia gives advice regarding Australian Standards 

1300 654 646 or visit their Website: www.standards.com.au 

Mobility Engineering 

Mobility Engineering provides specialised engineering advice on child restraints 

for children with disabilities, seatbelts for minibuses and the installation of child 

restraints in vehicles requiring suitable anchorage points or other fittings. 

(02) 9482 4572 

Kids Health,The Children’s Hospital at Westmead 

Kids Health is able to provide advice and referral on issues relating to 

transporting children 

(02) 9845 3585 or kidsh@chw.edu.au 

Tramanco 

Tramanco provide equipment and services for disabled children and adults. 

1800 123 266 

Accessible Transit Specialists 

Accessible Transit Specialists are manufacturers of a belt cutter which may be 

used in an emergency. They provide equipment and other services to the 

disabled. 

Contact Dick Jones: (02) 9773 8755 or 0425 289 568 

(dick@accessibletransit.com) 

SPECIAL NOTE: 

This document should be used in conjunction with the relevant Australian 

Standards documents: 

AS 1754:2000 Child restraint systems for use in motor vehicles (and 

Amendment 1-2001) 

AS/NZS 4370:1996 Restraint of children with disabilities in motor vehicles (and 

Amendment 1-1999) 

AS 3856:1998 Hoists and Ramps for people with disabilities – Vehicle 

Mounted (Part 1 – Product requirements, 

Part 2 – Installation requirements) 

AS 2942:1994 Wheelchair Occupant Restraint Assemblies for Motor 

Vehicles (and Amendment 1-1998) 

AS/NZS 4535:1999 Ambulance Restraint Systems 

ACKNOWLEDGMENTS 

This document was initiated by Kids Health at The Children’s Hospital at 

Westmead and was initially developed by a committee established to determine 

solutions to the issues of transporting children with medical conditions and 

disabilities in 1998. Participants included staff from Rehabilitation, Kids Health, 



Page 18 of 27

Occupational Therapy, Appliance Centre, Speech Therapy, William Stuart Ward, 

Commercial Travellers Ward and the Neonatal Service. 

Michelle Maxwell, Nina Hodge and Fiona Sampson reviewed the document in 

2000. 

The document was reviewed during November 2004 by staff from Sydney 

Children’s Hospital at Randwick, The Children’s Hospital at Westmead and John 

Hunter Children’s Hospital at Newcastle. Thanks to the following staff who made 

this possible: Alison Jones, Katy Rowe, Brooke Drelincourt and Anna Prior. 

Thanks also to Michael Foley, Dushyanthi Vimalachandra and Ian Palmer for 

participating in the review process of the document in its entirety. 

The most recent review conducted, during April 2006, by staff from Sydney 

Children’s Hospital at Randwick, The Children’s Hospital at Westmead and John 

Hunter Children’s Hospital at Newcastle followed feedback from members of 

TranSPOT. Our thanks to TranSPOT for their input. 

5. APPENDICES 

There are six pamphlets from TranSPOT which are provided at attachments: 

“Travelling in a Wheelchair” (Appendices 2a and 2b) 

“General Guidelines for Transporting Children/Students with Disabilities” 

(Appendices 3a and 3b) 

“Transporting Children with Special Needs” (Appendices 4a and 4b), June 

2001. 

“Wheels within wheels: a guide to safe vehicle travel for wheelchair users” by 

A Gagalowitz, 1995 is also a useful document. (not attached) 



Page 19 of 27

Appendix 1a 

To whom it may concern 

My child …………………………….. has ……………………………….. which means that 

he/she is unable to be transported in a regular manner. A restraint is 

required that does not comply with Australian Standards. The 

modifications made to the restraint are:- 

……………………………………………………………………………………………………………………………………… 

……………………………………………………………………………………………………………………………………… 

(When applicable, instructions/photos has been included.) 

The Occupational Therapist has discussed this with me. (Please tick) 

□ I will not change the recommended method of transport or 

carry out modifications 

□ ………………… is the only child who will use this modified restraint. 

□ I will maintain the restraint in good order 

□ I will check that the restraint is correctly fastened and 

adjusted before each journey 

□ I will return to a complying restraint as soon as possible 

□ I will as far as possible follow the manufacturers instructions 

for installation and use 

□ I will not use the modified restraint following the removal of 

the orthopaedic plaster/brace OR 

□ Not applicable 

I understand that it is important that the restraint be fitted to the 

vehicle in the correct manner. 

_______________ _________________ _________ 

Parent/Caregiver Signature Date 

_______________ _________________ _________ 

Medical Officer Signature Date 

_______________ _________________ _________ 

Occupational Therapist Signature Date 

_______________ _________________ _________ 

Interpreter Signature Date 



Page 20 of 27

Appendix 1b 

To whom it may concern 

The Occupational Therapy Department have informed the 

parent/caregiver of:- 

………………………………………………………. …………………… 

that the Modified E-Z-ON-Vest has no Australian Standards approval. As 

such, The Occupational Therapy Department of:- 

……………………………………………………………………………. 

cannot be held accountable in the event of an adverse incidence occurring 

while this transportation device is in use. 

_______________ _________________ _________ 

Parent/Caregiver Signature Date 

_______________ _________________ _________ 

Medical Officer Signature Date 

_______________ _________________ _________ 

Occupational Therapist Signature Date 

_______________ _________________ _________ 

Interpreter Signature Date 



Page 21 of 27

Appendix 2a 

Relevant Australian Standards 

AS 2942 –2000 Wheelchair occupant restraint 

assemblies for motor vehicles 

AS/NZS 1754 – 1995 Child restraint systems for 

use in motor vehicles 

AS/NZS 4370 – 1996 Restraint of children with 

disabilities in motor vehicles 

AS/NZ 3856 – 1998 Hoists and ramps for people 

with disabilities- Vehicle mounted 

Others may be relevant in certain circumstances 

The Standards listed above are published by: 

STANDARDS AUSTRALIA 

286 Sussex Street 

Sydney 2000 Australia 

The authors of these Guidelines do not assume responsibility or 

liability for any loss or damage that may result from any error, 

discrepancy, inaccuracy, inadequacy or unsuitability in the 

information contained herein or from the interpretation of such 

information. 

Developed by the Nepean School Age 

Therapy Team, Department of Ageing, 

Disability & Home Care, with the 

assistance of TranSPOT (Transport 

Seating Group affiliated with SPOT on 

DD) 

For further information contact the 

occupational therapist from your local area: 

Occupational Therapist 

Department of Ageing, Disability and Home Care 

16 Gladstone Ave, Wollongong 2500 

Ph: 4254 0382, Fax: 4225 9549 

Kathy Shelley, O.T. TranSPOT 

Department of Ageing, Disability & Home Care 

Richmond Community Services Centre 

PO Box 388, Richmond NSW 2753 

Phone: 4578 4744 Fax: 4578 3201 

June,2001 

© The Children’s 

Hospital at Westmead 

- Valid only on the day of printing – discard immediately after use. 

Transporting Children 

With Special Needs 

Page 22 of 27 

or 

Travelling in a 

Wheelchair 

A Guide to Transporting People who 

use Wheelchairs in Vehicles

Appendix 2b 

Travelling in a Vehicle in a 

Wheelchair 

The safest way to travel in a vehicle is to sit in 

the standard passenger vehicle seat and use the 

standard vehicle restraints. Many children with 

physical disabilities are not able to travel this 

way because they are unable to sit in a seat 

without a great deal of special support. They 

have grown out of the baby safety seats (eg. the 

Safe'n'Sound car seat) or the Safe'n'Sound 

Special Purpose Booster seat. Lifting them in 

and out of the vehicles is becoming difficult and 

dangerous because the children have grown too 

large and /or because of the nature of their 

physical disability. 

This means these 

children travel to 

and from school 

seated in their 

wheelchairs. 

Wheelchairs were 

not designed for 

travel in vehicles 

and can be 

dangerous to the 

occupants in the 

vehicle. 

Therefore wheelchairs and their occupants need 

to be properly restrained within the vehicle. 

♦ Approved restraints should be used to 

firmly anchor wheelchairs to the floor of 

t 

h 

e 


Hospital at Westmead - Valid only on the day of printing – discard immediately after use. 


Page 23 of 27 

♦ 

♦ 

♦ 

♦ 

♦ 

v 

eLap 

hBelt 

i 

c 

l 

e 

. 

Wheelchair Restraints 

There should be a minimum of 4 anchor 

points. 

The wheelchair restraints must attach 

to the base frame of the wheelchair, not 

the wheels or the foot plates. 

The wheelchairs must face the front of 

the vehicle. 

Wheelchairs must have enough space 

around them to allow access for an 

escort and to provide space to prevent 

the wheelchair occupant from hitting the 

person next to them in an accident. 

The wheelchair occupant must also have 

a separate occupant restraint system 

♦ 

which is anchored to the 

vehicle as part of the approved 

wheelchair restraint system. 

The lap belt must be anchored behind 

and below the seat of the wheelchair and 

pass inside, not through, the wheels of 

the wheelchair and under the armrest. 

Lap Belt 

anchored 

behind and 

below seat 

Belt 

correctly 

placed on 

lap and 

adjusted 

firmly 

Separate Lap Belt- Correctly Placed 

Many children have lap belts and other straps 

and devices to assist them with postural support 

in the wheelchair. 

These posture support straps are not strong 

enough to withstand the forces that occur in a 

crash or even a sudden stop. Strollers and some 

wheelchairs are not suitable for transport. This 

includes Buggy Majors and wheelchairs with low 

backs. Head support on the wheelchair is 

recommended to provide some head protection.

Appendix 3a 

Relevant Australian Standards: 

AS/NZS 1754 – 2000 Child restraint systems 

for use in motor vehicles 



AS 2942 – 1994 Wheelchair occupant restraint 


AS/NZ 3856 – 1998 Hoists and ramps for 

people with disabilities – Vehicle mounted 

Others may be relevant in certain 

circumstances. 

The Standards listed above are published by: 




The authors of these guidelines do not assume any 

responsibility or liability for any loss or damage that may 

result from any error, discrepancy, inaccuracy, inadequacy or 

unsuitability in the information contained herein or from the 

interpretation of such information 




assistance of TranSPOT 

(Transport Seating Group affiliated 

with SPOT on DD) 



Occupational Therapist 

Department of Ageing, Disability and Home Care 

16 Gladstone Ave, Wollongong 2500 

Ph: 4254 0382, Fax: 4225 9549 

or 

Kathy Shelley, O.T. TranSPOT 

Department of Ageing, Disability & Home Care 

Richmond Community Services Centre 

PO Box 388, Richmond NSW 2753 

Phone: 4578 4744 Fax: 4578 3201 

June, 2001 




Page 24 of 27 

General Guidelines 

for Transporting 

Children with 

Disabilities

Appendix 3b 

General Guidelines for Transporting 

Students with Disabilities 

When transporting students and young people 

with disabilities there are some extra 

considerations that drivers need to be aware of 

to ensure that everyone has a safe and happy 

journey to and from school. 

In the Beginning 

Check that all seat belts are in good order with 

no rips, tears or fraying. If a seatbelt is 

damaged it must be replaced NOT repaired. 

Seatbelt buckles should have the bright orange 

sticker clearly visible. 

Any modifications to the vehicle are required by 

law to be carried out by an approved fitting 

station. Vehicle modifications require an 

engineering certificate. Contact the RTA for a 

list of authorised engineers in your area. 

Car seats, booster seats and postural supports 

must not be modified in any way as this can 

compromise their performance in the event of an 

accident. 

Know the weight limits of any restraint that is 

being used in your vehicle. Check with the 

manufacturer if you are unsure. 

Know the medical conditions of the students 

travelling in your vehicle. Students with 

epilepsy could have a seizure and you need 

to know what to do if this happens. 

Some students are not allowed to eat 

anything by mouth or may have allergies, so 

check with their parents before giving 

anyone on your bus any treats. 

Before the journey begins 

Check that students restraints are 

correctly fitted and that the student is 

sitting up straight, with their hands and 

arms safely positioned away from windows 

or doors. 

For students in wheelchairs 

* Make sure the wheelchair is tied down 

correctly, and the occupant restraint belt 

is on. 

* The brakes on the wheelchair should be 

on. Electric wheelchairs should have their 

power turned off. 

* All trays should be removed from 

wheelchairs and safely stowed away. 

Where possible, bags and equipment should 

be tied down with approved tie downs. 

Getting on and off the bus 

Students who can walk or transfer by 

themselves should be encouraged to do this. 




Page 25 of 27 

Allow more time for this and only assist 

the student as much as they require. 

Sometimes a small step at the door of the 

bus can mean independence for the 

student and less lifting for you. 

During the journey 

Students with disabilities often find it 

harder to stay upright: 

* Accelerate and decelerate smoothly and 

slowly. 

* Be aware of bumps, holes and speed 

humps, these can make sitting up 

straight harder. Plus, wheelchairs don’t 

have suspension so all shocks are 

transferred to the persons back, neck 

and spine. 

Escorts should be seated next to the 

student being escorted so that they can 

be reached immediately if there is a 

problem. 

Some students have difficulty controlling 

their body temperature. If your bus does 

not have air conditioning consider installing 

small fans or carrying a damp cloth to cool 

the students down. 

Check regularly to make sure students are 

sitting up straight and look comfortable. 

If they aren’t contact your therapist.

Appendix 4a 

Relevant Australian Standards: 

AS/NZS 1754 – 2000 Child restraint systems for 

use in motor vehicles 



AS 2942 – 1994 Wheelchair occupant restraint 


AS/NZ 3856 – 1998 Hoists and ramps for people 

with disabilities – Vehicle mounted 

Others may be relevant in certain circumstances. 

The Standards listed above are 

published by: 




The authors of these Guidelines do not assume any responsibility or 

liability for any loss or damage that may result from any error, 

discrepancy, inaccuracy, inadequacy or unsuitability in the information 

contained herein or from interpretation of such information. 




assistance of TranSPOT 

(Transport Seating Group 

affiliated with SPOT on DD) 






Page 26 of 27 

OR 

TranSPOT 

The Transport Seating Group affiliated with 

SPOT on DD 

(Speech Pathologists, Physiotherapists and 

Occupational Therapists on Developmental 

Disability) 

PO Box 1222, Penrith, NSW, 2751 

Email spotonddsec@bigpond.com 

June,2002 

Transporting 

Children with 

Special Needs 

A Guide to Using Child Restraints in 

Vehicles

Appendix 4b 

Transporting Children with Special Needs 

The safest way to travel in a vehicle is to sit in 

the standard passenger vehicle seat and use the 

standard vehicle restraints. Many children with 

physical and intellectual disabilities are not able 

to travel this way because they are unable to sit 

in a seat without some support. This may include 

using a booster seat, a child restraint (baby car 

seat), a special purpose car seat for larger 

children, a positioning device, or a device to 

restrict the undoing of the seat belt buckle. 

These supports and their occupants need to be 

properly restrained within the vehicle. 

♦ ONLY approved child restraints, booster 

seats, positioning devices and harnesses 

should be used. 

♦ Approved anchor points MUST be used and 

devices correctly installed. 

♦ Booster seats, harnesses, child restraints, or 

seat belts must NOT be modified. This may 

compromise their safety. 

♦ An approved fitting station must carry out 

any modifications to the vehicle. An 

engineering certificate must be obtained 

from a RTA authorised engineer. Contact the 

nearest RTA for more information. 

Booster Seat 

The main purpose of a booster seat is to 

1. Provide limited postural support. 

2. To position the child so that the lap/ sash 

belt fits correctly. 

Booster seats are light (usually under 2kg) 

and therefore do not need to be restrained 

themselves. Booster seats need to have the 

full support of the car seat behind them. 

If the booster seat is fitted with an 

anchorage strap it MUST be anchored to an 

APPROVED mounting point. When the child 

is sitting in the booster seat the back of 

the VEHICLE seat must be higher than the 

level of the child's eye. 

H Harness 

An H Harness is often used in conjunction 

with a booster seat. It MUST be anchored 

to an APPROVED mounting point. Knowing 

the child's weight is very important because 

weight limits apply to the use of H 

Harnesses. 

Child Restraints/Car Seats 

Child restraints provide a great deal of 

support for children who have difficulty 

with sitting. A weight and size limit applies 

to the use of child restraints. 

Car seats such as Safe ‘N’ Sound Special 

Purpose or Columbia are larger versions of 



Transporting 

Children With Special Needs 

Page 27 

of 27 

the child restraint and suit larger children 

with special needs. 

♦ The child restraint must be an 

APPROVED child restraint. 

♦ It MUST be installed correctly 

according to the manufacturer's 

instructions. 

♦ It MUST be anchored to an 

APPROVED mounting point. 

♦ The child must weigh less than the 

maximum weight allowed for the use of 

the child restraint. 

♦ The back of the child restraint MUST 

be higher than the level of the child's 

eye. 

♦ Check that the bolt is the correct size 

for the child's weight. Sometimes a 

substitute bolt must be purchase 

(check with O.T. or an approved fitting 

station). 

Buckle Cover 

Buckle covers prevent children undoing the 

car seat while the vehicle is travelling. An 

unrestrained child is a great danger to 

themselves and all other occupants in the 

vehicle. 

When using a buckle cover, special 

approval is required from the RTA. A 

letter from the doctor must be presented 

to the RTA. The RTA approval letter must 

be kept in the vehicle where it is being 

used at all times.

transporting children with special needs - Kids Health @ CHW

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