• Advocacy efforts by health care professionals have prompted state legislative changes mandating the use of car seats and seat belts by children. These initiatives have greatly improved the level of safety in transportation of nonhandicapped children. Despite these positive changes, the transportation needs of nonambulatory children have not been addressed. In addition, implementation of Public Law 99-457 will result in larger numbers of young children with motor impairments requiring transportation to preschool early intervention programs. This study sought to describe how safely children in wheelchairs are transported. Observations of subjects were made as they were transported by their families or agencies at a residential summer camp, a preschool program for children with developmental disabilities, and a school for children with cerebral palsy. A safety score system was developed based on laboratory studies conducted on wheelchair restraint systems. This observation tool described the position of the wheelchair in the vehicle, the occupant restraint system, and the wheelchair restraint system. These structured observations revealed inadequate safety measures. Comparisons of safety scores of subjects transported by families with those transported by agencies were not found to have statistically significant differences. The findings of this study demonstrate a gap between minimal safety standards in wheelchair transportation and actual observed practices. In an effort to promote safe transportation practices of children regardless of their developmental differences, we present guidelines for health care providers for monitoring safe wheelchair practices in family, school, and community settings.