The CPST course includes a lengthy introduction to car seats and booster seats and an introduction to the idea that conventional car seats can often be a safe, secure option for children who have special needs. But what happens when the car seat that’s easily available on your local store shelf isn’t an option for a child with special needs?
For some kids, their differences make it more difficult for their parents to restrain them in the car. All kids deserve to be safe while being transported and it’s our goal to help as many children as possible travel safely. Luckily in the United States, we have a lot of car seat options for kids who have special considerations. We always recommend that families add an additional member to the child’s care team: a CPST trained in special needs.
The Safe Travel for All Children: Transporting Children with Special Health Care Needs child passenger safety training is a two day class for CPSTs that focuses specifically on children with special health care needs. Just like the CPST training, Safe Travel for All Children course includes hands-on work with seats in the classroom and in the vehicle, tests on the material covered, and ideally, ends with a car seat check with families.
There are many physical and occupational therapists who have taken the time to become a CPST and then additional training in transporting children with special needs.
Important note: therapists may or may not be trained in child passenger safety or be well versed in the special needs car seats that are currently available. Many therapists can recognize when there is a need for additional information or change to the current set up in a parent’s car, but they may or may not know the best car seat for a particular child.
If your family needs to meet with a CPST who is trained in special needs, visit the Safe Kids’ website and select “Special Needs” under “Extra Training.”
Option: Conventional Car Seats
In many cases, kiddos who have special needs can ride safely in a conventional car seat. Here are a few reasons why a conventional seat is our first choice:
- First, conventional car seats are easy to get. They’re sold in stores that sell car seats or can be purchased online with a very small wait time until the seat arrives.
- Second, they’re relatively inexpensive. Even the most expensive car seats are cheaper than most special needs car seats (which can range from $500 to $2500).
- Third, for a child who is old enough to be aware of their surroundings and their differences, riding in a conventional car seat can be a way to help them feel more like their peers since they are all riding in the same type of car seat.
- Fourth, conventional car seats tend to fit better and more easily in vehicles without requiring any adaptation for a secure installation.
Option: Special Needs Car Seats
However, for some children, a conventional seat simply cannot work. The following are some examples of special needs car seats for these situations, and the times when they might be needed.
Preemies, Newborns, and Kiddos who need to Lay Flat
Cosco Dream Ride Car Bed
Car Bed
For a preemie or newborn who is ready to go home but isn’t quite heavy enough for a traditional car seat (some conventional car seats can accommodate newborns as light as 3 pounds), who does not pass their car seat challenge (also called the angle tolerance test, or the car seat test), or who must lie on their back, side, or belly, due to some other limitations, a car bed is the primary option. These are installed so the child is sideways, with their head toward the center of the car, rather than rear facing.
Car beds can accommodate children from birth up to 35 pounds, depending on the specific product. These do not really look like a traditional car seat. For a child using a car bed, trips in the car should be limited to and from medical appointments and other essential rides.
We strongly recommend that families who need this type of car seat meet with a CPST trained in special needs before proceeding.
Car Seats in this Category: Cosco Dream Ride Car Bed
Special Mention: Conventional Car Seat, Evenflo LiteMax
Evenflo LiteMax preemie doll
As of August 2019, the Evenflo LiteMax rear facing only car seat is approved for use with infants who weigh as little as 3 pounds. This is a huge change for the tiniest of passengers. As always, we recommend working with a CPST to ensure that the fit is correct for your child.
Car Seats in this Category: Evenflo LiteMax
Harnessed Car Seat
When a child or young adult with special needs who has a tendency to unbuckle themselves at unsafe times has outgrown a conventional car seat, a special needs harnessed car seat may be a suitable option for their next seat.
We strongly recommend that families who need this type of car seat meet with a CPST trained in special needs before proceeding.
Car Seats in this Category: IPS 2000
Belt Positioning Booster
RECARO Monza
Here we see a belt-positioning booster seat that has a harness as well. In many cases, this type of seat is an option for neurotypical children who have low tone or older children who can sit properly (for the most part) in a booster seat but need just a little extra support from their car seat. In addition to the positioning harness, this belt positioning booster seat has approved bolsters for that additional support.
We strongly recommend that families who need this type of car seat meet with a CPST trained in special needs before proceeding.
Car Seats in this Category: RECARO Monza, Defender Reha, Roosevelt
Vest
An additional option is the safety vest. This type of restraint is useful for situations where a child escapes from the vehicle seat belt or for passengers with low tone who need assistance remain upright and in a proper seating position. Some models of these vests can be used for adults with special needs in addition to children.
Car Seats in this Category: EZ-On Vest
Older Children, Teens, and Adults
Merritt Churchill
Modified booster seats can help older children, teens, and adults who have low tone and/or cognitive delays but have outgrown their conventional car seat or booster seat sit properly in the vehicle. One example is the Merritt Churchill booster seat. This seat has a small, lightweight base and a vest that can be specially altered for the child by the manufacturer for an improved fit. In addition to the customized design, additional parts such as a pommel for leg positioning are available. Supports, such as lateral head supports, can help make the child more comfortable and better positioned in the vehicle.
We strongly recommend that families who need this type of car seat meet with a CPST trained in special needs before proceeding.
Car Seats in this Category: Merritt Churchill
Spica Casts/Upper Leg Casts
Merritt Wallenberg Spica Car Seat
Casts are a common challenge for hospital-based CPSTs. Some types of casts can fit in conventional car seats — casts that end as high as the thigh, or lower leg casts only. Even casts on both legs–as with club feet–may work in some conventional car seats.
A more consistently-fitting option is a dedicated spica seat, like the Merritt Wallenberg. This type of car seat will restrain the child, but still keep their leg in proper position and accommodate the width of a broomstick or casting angle. While this is by no means an easy car seat to use, it’s available for children who need to be transported while their bodies heal from injury or surgery.
If a child is casted, be mindful that the weight limits of the seat do include the casted weight (with only one exception, read the car seat’s manual to check). This may mean a child must be turned forward facing if the seat in which they ride cannot accommodate the weight of child plus cast rear facing.
We strongly recommend that families who need this type of car seat meet with a CPST trained in special needs before proceeding.
Car Seats in this Category: Merritt Wallenberg Spica Car Seat
In Summary
Great strides have been made in recent years for children with special health care considerations. Traditional car seats now have higher height and weight limits in both rear and forward facing modes. Many of these conventional car seats can accommodate many children, and allow them to feel more like their peers. But for some kids, these special car seats are the best and safest way for them to travel. Working with a Special Needs trained technician, physical and occupational therapists, as well as the child’s doctors is the best way to ensure even children with special health care considerations remain as safe as possible while they’re on the go.
