Objectives Children with special health care needs (SHCN) have or are at elevated risk for chronic physical, developmental, behavioral or emotional conditions and therefore require specialized health care services. This study examines the relationship between residential neighborhood amenities and physical activity among U.S. children with SHCN. Methods A nationally representative sample of 113,767 children aged 6-17 years was taken from National Survey of Children's Health (NSCH) 2007-2008 and 2011-2012. Residential neighborhood amenities were defined by parent-reported presence or absence of sidewalks, parks/playgrounds, and recreation center. Physical activity was measured by parent-reported number of physically active days (0-7), defined as 20 min or longer during the past week. Negative binomial regressions were performed to estimate the associations between residential neighborhood amenities and physical activity among U.S. children with and without SHCN, adjusting for various neighborhood (detracting condition and safety) and individual characteristics and NSCH sampling design. Results Approximately 23% of young children aged 6-11 years and adolescents aged 12-17 years had SHCN. Number of weekly physically active days was both 4.8 among young children with and without SHCN, and 3.7 and 4.1 among adolescents with and without SHCN, respectively. Among young children with SHCN, neighborhood availability of a recreation center was associated with increased weekly physically active days by 0.23; whereas among young children without SHCN, number of weekly physically active days was not associated with the availability of any amenity. Among adolescents with SHCN, neighborhood availability of parks/playgrounds was associated with increased weekly physically active days by 0.33, whereas neighborhood availability of sidewalks was associated with reduced weekly physically active days by 0.21. Conversely, among adolescents without SHCN, neighborhood availability of a recreation center was associated with increased weekly physically active days by 0.22. Conclusions for Practice Vulnerable health status and high dependence on health care may prevent children with SHCN from being physically active. Provision of adequate amenities in residential neighborhoods could be essential in promoting physical activity and preventing obesity among children/adolescents with SHCN.