Anybody who has ever met more than one child knows that kids are all different. They’re different sizes, different shapes, and have different personalities. For some kids, their differences make it more difficult for their parents to restrain them in the car. Luckily in the US we have a lot of options for kids who have special considerations.
Some of these considerations are visible to an outside observer. A cast or a wheelchair. Other times, they’re completely invisible. Whether temporary or permanent, all kids deserve to be safe while being transported.
Parents of kids with special needs have been through a gambit of medical doctors, therapies, and tests. They are usually absolute authorities in the speciality of Being Their Child’s Parent. They are advocates, nurses, pharmacists, and therapists in addition to being Mom and Dad. They are surrounded by a team of doctors, physical therapists, occupational therapists, and specialists. But often an additional member of the team can be added. A Special Needs trained CPST.
To become Special Needs trained, a certified technician must attend a two day class that focuses specifically on children with special health care needs. As in the main technician certification, there is hands on work with seats in the classroom and in the car, tests to take, and ideally a car seat check with families. In the future this may become a separate certification rather than an enrichment training.
There are many physical and occupational therapists who have taken the time to become a technician, and then a Special Needs trained technician. But please do not assume therapists are trained in child passenger safety, or know the best seat for a child. Many will recognize when there is a need for additional information or change to the current set up in a parent’s car, but they may not know the best seat for a particular child. A Special Needs trained technician can be found on Safe Kids’ website by selecting “Special Needs” under “Extra Training.”
Ideally, most children will simply use a conventional seat. This is done for many reasons.
- First, they’re easy to get. They’re in stores that sell car seats. They can be bought right away in store or online.
- Second, they’re inexpensive. Even the most expensive car seats are cheaper than most Special Needs 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, it’s a way to help them feel more like their peers. They are all using the same seats.
- Fourth, they tend to fit better and more easily in cars without requiring any adaptation.
However, for some children, a conventional seat simply cannot work. The following are some examples of special needs seats for these situations, and times when they might be needed.
A 6 year old child with average mental capabilities who has low tone. The child is too big to fit rear facing, but cannot sit for long unassisted before tiring. A booster seat with a positional harness, added approved bolsters, and an optional recline would be perfect. The positional harness will hold up the child, the bolsters will support, and the recline will help keep their head back. But because the child can understand they should not unbuckle or move around a booster is a good option. It also keeps them similar to their peers, which is often important to children in grade school.
A 12 year old with cerebral palsy, low tone, and cognitive delays who only needs positioning help in the vehicle. This child does not need a harness, and would not get much use out of a seat with a higher weight harness limit due to height, but has also outgrown several adaptive boosters on the market. A Merritt Churchill booster seat will be easy for the family to transport and use in different vehicles, since the base is small and light weight. The vest can be specially altered for the child by the manufacturer for improved fit. In addition to customized design, additional parts such as a pommel for leg positioning, and lateral head supports, among others, can help make the child more comfortable and better positioned in the vehicle.
A 10 year old child with autism who will unbuckle or get out of a booster seat, but stays put while in a harness. The child is too large for conventional seats, but cannot sit properly in a booster seat. This may also be used for a child with sensory disorder who feels far more comfortable with the snug fit of a harness.
Spica Casts/Upper leg casts
For a child with hip dysplasia or an upper leg cast, there is a seat that can be used to restrain the child, but still keep their leg in proper position and accommodate the width of a broomstick or casting angle. Like several other Special Needs seats, it is a modified version of an existing seat. Since they have lower cut sides and an optional positioning wedge, there are several ways a child with an upper thigh or hip cast can be seated. Keep in mind that these seats have undergone testing with their modifications; these are not changes that can be done to any seat on the market.
Some casts can fit in conventional seats, such as casts that end as high as the thigh, or lower leg casts only. Even casts on both legs–as with club feet–may work well in a conventional seat.
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 is turned forward facing if the seat in which they ride cannot accommodate the weight of child plus cast rear facing.
For a preemie or newborn ready to go home who is not yet heavy enough for a traditional seat (four 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, a car bed would be used. These can accommodate children from birth up to 35 pounds, depending on the car bed. These do not really look like seats at all, and are not an ideal choice. For a child using a car bed, trips in the car should be limited to and from medical appointments and other essential rides. These are installed so the child is sideways, with their head toward the center of the car, rather than rear facing.
Great strides have been made in recent years for children with special health care considerations. Traditional seats have gotten longer and longer lasting both rear and forward facing, and these can accommodate many children, and allow them to feel more like their peers. But for some kids, these special seats are truly 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 a fantastic way to ensure even children with special health care considerations remain as safe as possible while in the car.