March 2, 2026

This month, we'll be discussing Children and Youth with Special Healthcare Needs (CYSHCN). Although 13 – 18% of children are considered to have special needs, there is a consistent discrepancy in terms of medical complexity, functional limitations, and resource needs among CYSHCN. These patients are commonly identified as children who require health services above the average and are expected to be required for more than 12 months, sometimes dependent on assistive devices for daily living. The group of CYSHCN patients is extremely wide and includes several conditions, such as syndromic patients, patients affected by metabolic diseases, patients with neurological problems (i.e., severe seizure or malformations of the central nervous system), patients with congenital skeletal conditions, and users of medical devices. The Centers for Disease Control (CDC) estimates that 11.2 million children (representing roughly 15.1 % of children in the United States) are CYSHCN. Greater than 11% utilize durable medical equipment, and approximately 25 – 30% of children treated in the ED have special needs. Nearly 1 out of every 5 children in the United States has a physical, intellectual, and developmental disability, as well as long-standing medical conditions. This is four times the number of hospitalizations, twice as many physician visits, and 1.5 times as many ED visits. As EMS providers, it is important to know which children in your geographic area have special needs.

Parents of these children are forced to provide managed care. Most are knowledgeable about their child’s medical history and conditions; you should use them as a resource. They live with these patients, work with the portable equipment, know how to troubleshoot, and know the treatments very well. Fortunately, we have seen many medical advancements with portable technology as well as improved and efficacious medications. When evaluating these patients, please remember to assess and manage Airway, Breathing, and Circulation (ABCs) first, as you would with any other child. Treat the child, not the equipment. If the emergency is due to the child’s equipment, use your own equipment. It is important to note that (1) physical handicaps do not necessarily imply mental deficits and (2) assess and communicate with the child on his/her developmental age, not chronological age.

• Challenges to caring for these children include: 

• Language barriers  

• Developmental delay  

• Visual/auditory deficits 

• The scene and the child’s response to that environment can be a great source of tension and anxiety 

• Multiple providers can create fear  

• Multiple voices can cause confusion 

• Anxiety in a child 

• The child may resist being restrained 

Use a soothing voice to provide comfort. Please try to explain each movement to them. Remember to ask the caregiver for a medical summary card. Sometimes, caregivers may be too stressed to remember vital information. During transport, allow the child to lie in a comfortable position and use padding around buckles and contractures. Do not use excessive force to straighten or manipulate contracted extremities. The patient may have osteopenia or osteogenic imperfecta and be prone to fractures. Brittle bones and muscle contractures can easily lead to injuries during transport; do not pull on extremities. In addition, some CYSHCN are unable to straighten extremities beyond a nominal degree. A slow, careful transfer with two or more people is preferable. Ask for the “go bag,” which usually has the child’s spare equipment and supplies. Bring the bag with you during transport. Transfer the patient, if possible, to their medical “home” hospital.  

 Next week, we will discuss specific medical illnesses/ailments that affect CYSHSN. Have a great week.

Stay warm, and thank you so much for all that you do,

Regina Yaskey, MD