Children with special needs, such as cerebral palsy, autism, or spinal cord problems may need adaptive car seats or a safety harness for safety in cars, buses, and airplanes. Some children may need a more specialized solution if they are in a hip or body cast. Certain medical conditions call for more support for the body; challenging behavior may require a more secure (childproof) restraint. Finding the right car seat for your child can be a challenge.

Some children with special needs continue to need a 5-point harness or specialized seat as they grow, and they will need a seat made for larger children or adults. You will not find this type of car seat in the department store, but they are available if you need one. Below are recommendations from parents who have been through the process of ordering a special needs car seat.

• Find a car seat safety check site or certified technician near you by calling your local hospital or health department (See Resources at the bottom of the page for further information.)
• Talk to the Child Passenger Safety (CPS) technician about their recommendations for your child's safety.
• If your child has a physical therapist, ask for a seat recommendation.
• Ask other parents what their child is using and how they got it.
• Contact your child's primary care doctor and ask for a letter of medical necessity for the insurance company or Medicaid (see Working with Insurance Companies).
• Submit a written request to insurance. If insurance denies the seat, you can appeal the decision. If still denied, look for alternative resources (see Appealing Funding Denials).
• Are there programs in your area that donate or have low-cost seats? (Try your Children's Hospital or Health Department.)
• Are there any organizations in your area that donate or help with funding or a donation? (Independent Living Centers, Lion's Club, Children’s Hospitals, special needs organizations)

When traveling as a passenger in a car, it is generally safest for the wheelchair user to transfer from the wheelchair to a seat with seatbelts or a child safety seat (car seat) that complies with federal safety standards, and then secure the wheelchair in the vehicle.

If transferring is not feasible, it is very important to secure the wheelchair to the vehicle facing forward, and to use crash-tested seatbelts and a four-point tie down system for the wheelchair-seated rider. It is best if you have a wheelchair that has been designed and crash-tested for use as a seat in motor vehicles, often referred to as a WC19 wheelchair or a transit wheelchair. A WC19-compliant wheelchair provides four easily accessible attachment points that help secure the chair using a four-point tie down system. Even with the tie down system, make sure that the wheelchair user is also using crashworthy and properly positioned pelvic and shoulder belt restraints.

School transportation (bus) will usually recommend that your child have a WC19-compliant wheelchair unless they are transferring to a bus seat. However, your child cannot be denied transportation to school because he does not have a WC19 wheelchair. It is in the child's best interest for the parents and the school transportation team to work together to find the safest option for a child to travel on the school bus. More information is available in the American Academy of Pediatrics School Bus Transportation of CSHCN (AAP) policy statement.

New technology gives many people with disabilities the ability to drive or be transported in their own cars with adaptions to the car. Some examples are:

• wheelchair lifts and ramps
• four-point tie down systems
• hand controls
• modified seating
• steering aids

A driving rehabilitation specialist can tell you if it is possible to adapt your vehicle. See the resources section below to find a specialist in your area.

A qualified vehicle modification dealer should install the devices suggested for your car. This dealer is not the same as the dealership who sold you your vehicle. For a consumer guide to buying wheelchair accessible vehicles and equipment, see the National Mobility Equipment Dealers Association (NMEDA) in the Resources below.

Adaptive Driving

When assistive technology and adaptations are needed for a young adult or adult with disabilities to drive a vehicle. For more information, go to the Adaptive Driving page. For information on Driver's Education and getting a driver's license, and more, go to: Transportation Options for Young Adults.

Public Transportation Services

Public transportation allows people with disabilities to be independent within their communities by providing accessible public options. The Americans with Disabilities Act requires that new public buses and rail vehicles (such as subway cars and light rail trains) be accessible to people in wheelchairs. Many new fixed route buses have wheelchair lifts or ramps. Buses must also have at least two seating spaces inside for securing wheelchairs. People who are able to use the fixed route bus service should try to use this option whenever possible.

For people who cannot use fixed route bus services, many city transit agencies provide what is known as "paratransit" for eligible travelers. Paratransit services typically use vans or mini-buses equipped with wheelchair lifts or ramps. These vehicles usually do not follow fixed schedules or routes, but instead allow you to call and schedule a pick-up wherever you are. Disability alone does not determine paratransit eligibility; the decision is based on the applicant's functional ability to use a fixed route bus. Eligibility requires an application that describes the passenger's disability and explains why they are not able to use regular transit, along with the signature of a health care professional.

In some cases, when funded by Medicaid, the use of the specialized transportation services may limit you from using other public transportation services. Check with your Medicaid eligibility worker to find out if Medicaid will pay for both services. Medicaid may have a contract with a designated service only.

States are required to make NEMT available to Medicaid beneficiaries to assure their access to medically necessary services. Most states cover NEMT to enable Medicaid beneficiaries to obtain covered medical services from hospitals and clinics both in and outside their area. Some states have a prior approval process or may limit the number of trips allowed per month. Many states contract with local agencies to coordinate services. For a summary of your state's Medicaid NEMT eligibility and coverage see the Resources section below.

If you are a parent or caregiver flying with your child, here are some suggestions:

Before You Go

• Be sure to call the airline at least 72 hours ahead of time and let them know about your child’s special needs. Doing so will allow for safe and happy travel onboard the aircraft.
• Give advance notice to your airline or travel agent if you require assistance at the airport. Your airline will assist you through the airport facility and the screening line.
• If you need someone to accompany you through the security checkpoint to the gate, talk with your airline representative about obtaining a gate pass for this person before entering the security checkpoint, and know that it may be a challenge to have someone assist, but they may provide an assistant to get you to/from the gate.
• The limit of one carry-on and one personal item (purse, briefcase or computer case) does not apply to medical supplies, equipment and mobility aids, and/or assistive devices carried by and/or used by a person with a disability.
• Pack your medications in a separate pouch/bag to help with the inspection process. Make sure that containers holding medications are not too densely filled, and that all medication is clearly identified. It is recommended that passengers refrain from packing any medications that they do not want exposed to X-rays in their checked baggage. Instead, send larger quantities of medication to your destination by mail or another preferred way.
• Make sure each of your carry-on items, equipment, mobility aids, and devices, have an identification tag attached.

Security

• Let screening officials know about your child's disability and what she is able or not able to do during screening.
• Carry documentation to support any medical or behavioral conditions, and offer suggestions to security staff on how to minimize issues during the screening process.
• Security officers should never remove your child from his wheelchair. Only parents are allowed to transfer their child, and you can refuse if it is not in your child's best interest. You can ask the security officers to use alternate screening measures while your child remains seated in his wheelchair.
• If your child is able to stand and walk, have her walk through the metal detector, as it can make the process much faster.
• Officers in the United States are not required to pat down minors with disabilities; however, other countries may have different regulations. In both the US and Canada, officers will visually or physically inspect and test any seat cushions, pouches, and packs attached to the chair.
• In regards to taking pictures and filming, the TSA allows you to do so as long as it doesn’t interfere with the screening process. That being said, some laws, state statutes, or local ordinances may prohibit taking pictures or filming.
• Most importantly, know you have the right to be with your child throughout the entire travel process; speak up if anything makes you or your child uncomfortable.

Hidden Disabilities

• People with a hidden disability can, if they choose, let security officers know that they have a disability and may need some assistance, or that they need to move a bit more slowly than others.
• Family members or traveling companions can explain the disability to Security Officers and that person may move slowly, become agitated easily, and/or need additional assistance.
• Family members or traveling companions can offer suggestions to Security Officers on the best way to approach the person with a hidden disability, especially when it is necessary to touch the person during a pat-down inspection.
• Family members or traveling companions can stay with the person during a public or private screening; however, they may be required to be re-screened if they provide assistance to the person.

TSA Cares Helpline

TSA Cares is a helpline that assists travelers with disabilities and medical conditions. TSA recommends that passengers or caregivers call 72 hours ahead of travel for information about what to expect during security screening, and to ensure time to coordinate checkpoint support with the TSA Customer Service Manager at the airport if needed.

When a passenger with a disability or medical condition calls TSA Cares, a representative will provide information about screening that is relevant to the passenger’s specific disability or medical condition, or will refer the passenger to disability experts at TSA.

Travelers may call TSA Cares toll free at 1-855-787-2227 Monday through Friday 8 a.m. – 11 p.m. EST and weekends and Holidays 9 a.m. – 8 p.m. Travelers who are deaf or hard of hearing can use a relay service to contact TSA Cares or can e-mail TSA-ContactCenter@dhs.gov.

Disability Notification Card for Air Travel

A handy tool for travelers with a disability is the TSA Disability Notification Card ( 69 KB). You can print the card and complete the blanks which will inform TSA officers of a disability in a concise and discrete manner.

Seating

Children under 2 are not required to have a paid ticket and can sit in a parent’s lap, but for many children this creates anxiety or behavioral issues on a long flight. For children with mobility or behavioral issues, try to request seating where there are no passengers in front of you. The bulkhead of a cabin has extra leg space and with no seat in front of you, no one can recline into your space, and you will not have to worry about the passenger in front of you. Some airlines reserve this space for people with disabilities, so call ahead to ask if it is available for your flight.

For a child with sensory integration issues, a flight can be overwhelming. A plane filled with people, the loud engine, ear pressure, and turbulence can understandably create anxiety for your child, yourself, and sometimes other passengers. Be sure to bring anything that might calm your child, and consider an airplane safety harness.

Before bringing a child safety seat or specialty harness, contact the manufacturer and the airline to make sure it is FAA approved. See Resources section below for information about child safety on airplanes. The Kids Fly Safe, CARES Airplane Safety Harness for Children is now approved for use by kids, teens and adults with special needs. See the Resources section below.

Wheelchair accessibility

All airports are wheelchair-accessible. Contact the airline to find out what their procedures are for a gate check of the wheelchair. As a precaution against loss or damage, always remove the detachable parts before your wheelchair is stored, and label the chair with your name, address, and destination airport. Generally, your child can use her own chair until the boarding process. If she is able to walk a short distance, you can request a seat near the entrance doors. If she needs assistance boarding the plane, request an “aisle wheelchair” at boarding and de-boarding. Your child's wheelchair will then be stored conveniently for immediate availability on arrival. If there is any damage to the wheelchair, inform the airline and inquire about repair/replacement policies.

Flying in a Stretcher

Many larger, international airlines can accommodate a traveler in a stretcher, although you will have to fly with the necessary medical supervision. Transport of a stretcher often requires the purchase of 6-9 seats to cover the airline's cost of lost seating. Medical clearance is required, and we recommend you contact the relevant airline as early as possible to inform them that you will need to fly in a stretcher.

Medical Certification and Medical Equipment

Medical certification is only required for:

• a passenger requiring medical oxygen during a flight – contact the airline for specifics on oxygen use
• a passenger who will probably require extraordinary medical assistance during the flight
• a passenger traveling on a stretcher or in an incubator
• a passenger with a communicable disease

Contact your airline for specific requirements for oxygen tanks, concentrators, suction machines, pulse oximeters and other medical devices needed during flight.

Flying with a Service Animal

The Americans with Disabilities Act of 1990 (ADA) allows Service dogs and emotional support animals to travel in the cabin of the aircraft as long as the dog does not obstruct an aisle or any other area used for emergency evacuations.

Although general in-flight rules will always be enforced by every airline company, the processes of actually making reservations, passing the ticket counter, check-in, security checkpoint, and gate may vary, depending on the airline and airport. By checking the websites for each airline and airport, you'll learn the specific guidelines.

International Travel

Many people with disabilities travel abroad. Each country has their own standards of accessibility for travelers with disabilities. Research and preparation are important for safe and accessible international travel. See the international travel link in the Resources section below for more information on international travel for individuals with disabilities.