Q: My baby has achondroplasia, will sitting in a car safety seat hurt my baby’s back?

A: No. sitting straight against the firm surface of the car safety seat is good for your baby’s back. This position will help keep your baby from developing a hump in his lower back.

Q: How long should I keep my baby with achrondroplasia facing the rear of the vehicle?

A: Keep your baby rear facing as long as possible. Riding rear facing longer is important for children with achrondroplasia due to their larger heads, weaker muscles, and shorter height. Riding rear facing helps support your child’s entire body and protects her better from an injury, especially to the spine. Most new convertible child safety seats allow children to ride rear facing up to 30 or 35 pounds. Move your child into a convertible seat when she outgrows her infant-only seat. Because your child is small, she should be able to ride rear facing longer than most children. However, if your child is older and resists riding rear facing, try to keep her entertained with soft books, music, and conversation.

Q: What car safety seat should I use when I turn my child with achrondroplasia around?

A: Use a car safety seat with harness straps until your child outgrows it. A convertible car safety seat can be used forward facing until your child weights about 40 pounds or until your child’s shoulders are above the top harness slots. A combination car safety seat will also allow your child to remain in a harness up to 40 pounds. Some convertible and combination seats have harnesses that fit children over 40 pounds. A combination seat can be changed to a belt-positioning booster seat when your child is too big for the harness. Because your child is small, she should be able to ride in a car safety seat with a harness longer.

Q: When can my child with achondroplasia ride in a booster seat?

A: Use a booster seat after your child outgrows her car safety seat with a harness. This is usually when a child weighs about 40 pounds or her shoulders are above the top harness slots of the car safety seat. A belt-positioning booster seat will lift up your child so the seat belt fits properly and will make your child safer in a crash. Never use a booster seat with a lap only seat belt. Because your child is shorter than her peers, she should be able to use a booster seat longer.

Q: When can a child, teenager, or adult with achondroplasia use a seat belt?

A: • When she can sit all the way back on the vehicle seat without slouching; and • When her knees hang comfortably over the edge of the vehicle seat; and • When the lap/shoulder belt lies flat and snug on the upper thighs and between the neck and shoulder.

Q: When can my child ride in the front seat?

A: The back seat is the safest place for all children 12 years and under, even if your car does not have an airbag.

Q: How should my child ride in a school bus?

A: Pre-school age children who weigh less than 40 pounds should use a car safety seat on a school bus. Talk with the school about your child's transportation needs. Make sure they are included in the IEP (Individualized Education Plan). If your child has trouble walking, she may need to ride in a large medical seat or a wheelchair.

Q: Where can I get vehicle adaptations for teenagers and adults who have achondroplasia and want to drive?

A: Contact the Association for Driver Rehabilitation Specialists at www.driver-ed.org and click on “membership directory” to locate a driver rehabilitation specialist in your area. A driver rehabilitation specialist has the skills to evaluate and determine appropriate vehicle adaptations for each individual. Vehicle adaptations must be done by a vehicle mobility specialist. Vehicle adaptations could include: • Hand controls • Raising the floor of the vehicle • Custom-made seat inserts to accommodate for spinal curvature • Mirrors that accommodate decreased movement in the neck or trunk • Magnetic keyless entry • Smaller diameter steering wheels • Pedal extensions/parking brake extension • Reduced effort needed to operate steering, braking and acceleration

Q: What if my child with autism gets out of her car safety seat, booster or seat belt?

A: • Pull your car off the road where it is safe and re-fasten her car safety seat or seat belt. If possible it may help to have someone sit next to her in the back seat. • Make sure the car safety seat fits your child correctly. Harness straps that are loose or through the wrong set of slots could make it easier to get out of the seat. The harness should fit snuggly and without any slack. Forward facing, the harness should be through the slots at or above your child’s shoulders. Read the car safety seat instructions to make sure you are using the harness the right way for your child. • If your child opens the car safety seat’s chest clip, you may need to try other car safety seats that have different types of clips. • If your child gets out of her booster seat or seat belt, try a car safety seat that can still be used with a harness. A harness will hold your child better than a booster seat or a seat belt. You can buy child restraints with harnesses for children over 40 pounds at local retail stores. • Other types of restraints, such as large medical seats or vests might work better for your child. Some will need to be ordered with the help of a healthcare professional.

Q: My child with autism unbuckles the seat belt. Is there anything that I can put over the buckle?

A: No. Although, there are buckle covers made to keep children from unbuckling their seat belt, they are not recommended because it is unknown how the device would interact with the seat belt buckle in the event of a crash. Using an E-Z-On Vest with a vehicle floor mount tether may help keep your child restrained in the car. This restraint can be used with a vehicle bucket or bench seat. You have to get special hardware placed in your vehicle but you don't have to use the seat belt. Contact E-Z-ON at www.ezonpro.com to see if the floor mount tether will work in your vehicle.

Q: My child with autism doesn't like change and needs a new car safety seat. What should I do?

A: It is important to plan ahead. Let your child get used to her new car seat before she has to use it. It may help to have your child sit in the new car safety seat for short periods of time, buckle a favorite stuffed animal in the seat or place stickers on the seat. This change may take a few days to several weeks.

Q: My child with autism likes stories. Do you have a story about car safety seats?

A: Ask your child's speech therapist to write a special story for your child. The following story is an example: RIDING IN THE CAR When we go places, we ride in the car. When we get in the car, we always have to keep our car seat buckled. Keeping the car seat buckeled makes us safe. When I keep my car seat buckled, I will get to play with my favorite toy(s)that I want! Making good choices makes my mom and dad happy. When my mom and dad are happy, this makes me happy. Unbuckling my car seat or trying to get out of my car seat is not good. When I do something that is not good, my mom and dad are sad, this makes me sad. It is better to be good in the car so that I get to do fun things. I need to remember to keep my car seat buckled every time I ride in the car.

Q: Would a behavior plan keep my child from getting out of her car safety seat or seat belt?

A: Yes. Consistent use of a behavior plan may help prevent your child from escaping her car seat. Ask your behavioral psychologist, therapist, or pediatrician to help you make a behavior plan you can follow every ride.

Q: What should be in a behavior plan?

A: Teach your child what you expect when riding in the car: Tell your child what the rules are when in the car. If your child has communication delays you may need to use picture cues to explain the desired behavior and reward system. Praise and Reward your child: Praise your child for good behaviors and offer rewards your child likes. Give your child a reward such as a sticker for staying buckled up. At first, you may need to give your child more rewards, more often. For example, give her a sticker every time you come to a stoplight or every minute she follows the plan. Gradually increase the amount of time between rewards until she receives one reward for the full trip. Let her choose the reward she will earn by following the plan. You may need to use a choice board with things that your child likes. Consider a special toy that she can only have in the car, such as a soft book, soft toy, or music tapes. (Hard toys could hurt your child in a crash). As your child becomes too used to the toys, replace them with different ones. Be consistent: Make sure everyone who travels with your child uses the same behavior plan every time the child rides in the car. Follow the plan every trip. Set boundries/Discipline Set limits for behaviors that are okay and not okay when riding in the car and stick to them. Praise and reward good behaviors immediately. Ignore behaviors that are not dangerous.

Q: My child with autism is bothered by light touch and complains when in her child restraint. What should I do?

A: Make sure the harness, vest or seat belt is snug, flat and not twisted against the child's body. Also, make sure the harness is touching your child's clothes and not her skin. Tight fitting underclothes may help prevent irritating light touch.

Q: What if my child with autism moves a lot in the car during travel?

A: Make sure your child has a chance to move around throughout the day or before getting into the car. Running, jumping, and hopping are movements your child could do before riding in the car. If possible, stop during your trip and let your child move. Some children like to wear a compression vest which may help them and decrease movement during travel.

Q: What if my child with autism screams when she hears loud noises such as sirens?

A: Teach your child to cover her ears or wear headphones to block out loud sounds. Explain to your child the reason for loud sounds to help her understand.

Q: What if my child with autism chews on the harness?

A: A chewy tube or lightweight chew toys may help stop chewing on clothes, harnesses, or car safety seat covers. You can purchase a chewy tube or chew toys at www.abilitations.com.

Q: If my child has a cast, will she fit in her car seat?

A: • If your child has a cast and CAN sit up: Your child’s own car safety seat will probably work unless the cast is too wide to fit inside the car seat. In that case a car safety seat with low sides may work. • If your car seat has a tray or shield, it may be hard to buckle if the cast is thick. Use a car seat with a five-point harness instead. Make sure to support your child’s legs with pillows, foam or blankets if needed. • If your child has a cast and CANNOT sit up: Your child may need a special restraint such as a car bed, Snug Seat Hippo, or modified E-Z-On Vest www.ezonpro.com. Approved car beds are for infants who must lie down in the car. The Snug Seat Hippo is a car seat made specifically for kids in casts. The modified vest is for children over two years old and over 20 pounds who need to travel lying down. • In some cases, a child safety seat with low sides and shallow seat depth may fit your child. NEVER transport your child with a cast on a vehicle seat reclined more than allowed by the vehicle manufacturer. The seat belts will not hold your child’s body properly, and he could slide out from under the seat belt system. Your child may need to be transported by an ambulance if she doesn’t fit in an approved car bed, car safety seat, or modified vest.

Q: How long should I keep my child with cerebral palsy rear facing?

A: Because your child may have poor muscle control she should ride rear facing longer than most children. Rear facing helps support your child’s entire body and protects her better from an injury, especially to the spine. Most new convertible car safety seats allow children to ride rear facing up to 30-35 pounds. Move your child into a convertible seat when she outgrows her infant-only seat.

Q: What car safety seat should I use when I turn my child with cerebral palsy around?

A: Use a car safety seat that has harness straps until your child outgrows it. A convertible car safety seat can be used forward facing until your child weighs about 40 pounds and is about 4 years old, or until your child’s shoulders are above the top harness slots. A convertible seat that can be tilted back in the forward-facing position will help keep your child’s head and back against the seat. You must check the manufacturer’s instructions to determine if your convertible seat can be tilted back in the forward-facing position. A combination car safety seat will also allow your child to remain in a harness up to 40 pounds. Some convertible and combination seats have harnesses that fit children over 40 pounds. A combination seat can be changed to a belt-positioning booster seat when your child is too big for the harness.

Q: What if my child with cerebral palsy has trouble sitting up or cannot hold up her head?

A: If possible, keep your child rear facing. Riding rear facing helps keep your child’s head and back against the car safety seat. Your older child may need a convertible car safety seat that can be tilted back in the forward-facing position or a large medical car safety seat. Large medical seats have special padding for the head and trunk and may tilt back in the forward-facing position. You can place rolled blankets or towels along the side of your child’s head or trunk to prevent your child from falling side to side. Never put anything behind your child. If your child needs more support for her neck, a soft cervical neck collar can be used to help prevent her head from falling forward. A hard collar should be removed during travel. Never recline the vehicle seat more than allowed by the manufacturer.

Q: Will a large medical car safety seat fit in my car?

A: Large medical car safety seats will fit in most passenger cars. Most large medical car safety seats require use of a top tether (a strap with a hook that connects to a tether anchor in your car). You may need to get special heavy duty tether anchors installed in your car to use a large medical seat. You should be able to get the special tether anchor hardware for your car from the car safety seat manufacturer.

Q: What if my child has a tracheostomy?

A: Use a car safety seat with a five-point harness. A five-point harness has harness straps that come over your child's shoulders and hips and buckle into a crotch strap. Do not use a car safety seat that has a tray or a shield. In a crash or sudden stop, the tray or shield could hit the tracheostomy and hurt your child's neck or throat.

Q: What if my child with cerebral palsy has casts because of surgery or botox?

A: Your child will need a car safety seat that has enough room to fit the cast. Your child might be able to use his own car seat but make sure to try it before you leave the hospital. If the cast prevents your child from sitting, your child may need a special car bed or child restraint. Ask your child's nurse if there is a special needs car seat program in your area that can help find the right child restraint or car bed for your child.

Q: What if my child with cerebral palsy has pain or pressure areas on her skin when she rides in a car safety seat?

A: Contact your doctor or rehabilitation therapist to help you determine what is causing the pressure or pain. Your child may need a different car safety seat that fits better, need to be repositioned in her car safety seat, or need a seat that offers more padding. Only use padding that comes with your car safety seat. Do not add extra padding behind your child's back and bottom. Your child's car safety seat might not work as well in a crash.

Q: What if my child with cerebral palsy has seizures?

A: Use a car safety seat that has harness straps until your child outgrows it. The harness straps will provide support to your child during and after a seizure. Your child may benefit from a large medical seat when she outgrows her convertible or combination seat. A large medical seat has a harness for children over 40 pounds.

Q: When can my child with cerebral palsy ride in a booster seat?

A: Your child may be able to use a booster seat if he can hold up his head and sit without any help. Use a booster seat after your child has outgrown a car safety seat with a harness. This is usually when a child weighs about 40 pounds and is about 4 years old. The booster seat helps lift a child up so the adult seat belt fits properly. Never use a booster seat with a lap belt only. Booster seats need both lap and shoulder belts. Consult an occupational or physical therapist if your child does not have good control of her muscles and has outgrown her car safety seat.

Q: When can my child with cerebral palsy use a seat belt?

A: Your child must be able to hold her head up and sit without any help in order to use a seat belt. She must also be able to sit all the way back against the vehicle seat without slouching, bend her knees easily over the edge of the seat, and wear the lap/shoulder seat belt flat and snug on her upper thighs and between her neck and shoulder. This is usually when a child is 8-12 years old is about 4'9" tall.

Q: What if my child uses a wheelchair?

A: If possible, your child should ride in a car safety seat in your vehicle instead of the wheelchair. If your child must ride in a wheelchair, make sure to ask your child’s occupational or physical therapist about a transit option model. A transit option wheelchair has been crash tested so it is safer to use in a vehicle. It also has many features that make it easier to use and tie down in a vehicle. Fasten the wheelchair to your vehicle with a tie-down system that meets safety standards. The tie-down location on a transit wheelchair is marked with a hook symbol and is easy to find. The wheelchair should face the front of your vehicle. Make sure your child uses a separate shoulder/lap belt.

Q: Where should I put medical equipment in the car?

A: Place medical equipment such as apnea monitors and oxygen tanks on the floor of the vehicle wedged with pillows, foam or blankets. Equipment can also be tied down with unused seat belts. There are no straps or belts specifically made for securing equipment in a vehicle.

Q: How can I be sure my child is buckled up correctly?

A: Always read and follow the directions that come with your car safety seat and your vehicle owner's manual. If you need help, you can find a certified child passenger safety technician who is trained in special needs transportation at www.preventinjury.org in the special needs technician database section. If there is not someone trained in special needs transportation in your area, please call 1-800-755-0912 for further assistance.

Q: What if my baby with osteogenesis imperfecta has breathing problems?

A: If your baby has breathing problems, she may need to ride in a car bed instead of a car safety seat. A car bed that meets federal safety standards allows your baby to lie down when she travels. Check with your baby’s doctor or nurse about which car bed is best for your infant and where you can get one.

Q: How long should I keep my child with osteogenesis imperfecta rear facing?

A: Because your child’s bones break easily, he should ride rear facing as long as possible. Rear facing helps support your child’s entire body and protects him better from an injury, especially to the spine. Most new convertible car safety seats allow children to ride rear facing up to 30-35 pounds. Move your baby into a rear facing convertible seat when he outgrows his infant-only seat.

Q: What car safety seat should I use when I turn my child with osteogenesis imperfecta around?

A: Use a car safety seat that has a harness until your child outgrows it. Your convertible car safety seat can be used forward facing until your child weighs about 40 pounds and is about 4 years old or until your child’s shoulders are above the top harness slots. A combination car safety seat also will allow your child to remain in a harness up to 40 pounds. Some combination and convertible seats have harnesses that fit children over 40 pounds. A combination seat can be changed to a belt-positioning booster seat when your child is too big for the harness.

Q: My child has osteogenesis imperfecta, can I add extra padding to my child’s car safety seat because her bones are brittle?

A: Don’t add extra padding behind your child's back and bottom. Your child’s car safety seat might not work as well in a crash with extra padding. Look for a car safety seat that already has enough padding to help your child ride comfortably. Some large medical seats have more padding.

Q: What if my child with osteogenesis imperfecta has a cast?

A: If your child has a cast because the bones in her legs or spine are broken, she will need a car seat that has enough room to fit the cast. Your child might be able to use her own car seat but make sure to try it before you leave the hospital. If the cast prevents your child from sitting, you may need a special car bed or child restraint. Ask your child’s nurse if there is a special needs car seat program in your area that can help find the right car seat or car bed for your child.

Q: When can my child with osteogenesis imperfecta ride in a booster seat?

A: Use a booster seat after your child outgrows his car safety seat with a harness. This is usually when a child weighs about 40 pounds and is about 4 years old. A belt-positioning booster seat will lift up your child so the seat belt fits properly and will make your child safer in a crash. Never use a booster seat with a lap only seat belt.

Q: How long should I keep my child with Down syndrome rear facing?

A: Keep your child rear facing as long as possible. Children with Down syndrome may have decreased muscle tone or unstable neck bones. Riding rear facing helps support your child’s entire body and protects her better from an injury, especially to the spine. Most new convertible car safety seats allow children to ride rear facing up to 30 or 35 pounds. Move your child into a convertible seat when she outgrows her infant only seat.

Q: My child has Down Syndrome, will the car seat harness straps hurt my child after heart surgery?

A: • Ask your surgeon if you are worried that your car seat’s harness straps will put too much pressure on your child’s stitches. If this is a problem, you may need to use a different car seat. • Pressure from harness straps in a crash is less in a rear-facing position.

Q: What car safety seat should I use when I turn my child with Down syndrome around?

A: Use a car safety seat with harness straps until your child outgrows it. A convertible car safety seat can be used forward facing until your child weighs about 40 pounds and is about 4 years old, or until your child’s shoulders are above the top harness slots. A combination car safety seat also will allow your child to remain in a harness up to 40 pounds. Some convertible and combination seats have harnesses that fit children over 40 pounds. A combination seat can be changed to a belt-positioning booster seat when your child is too big for the harness.

Q: What if my child with Down syndrome has trouble sitting up?

A: • If possible, keep your child rear facing. Riding rear facing keeps your child’s head and back against the car safety seat and is safer than forward facing. • If your child rides forward facing, she may need a convertible car safety seat that can be tilted back in the forward-facing position or a large medical car safety seat. Large medical seats have special padding for the body and may tilt back in g forward-facing position. • You can place rolled blankets or towels along the side of your child’s body to prevent your child from falling side to side. Never put anything under or behind your child.

Q: What if my child with Down Syndrome is too big for a regular car seat?

A: Children with Down Syndrome may weigh too much for their car seat before they are ready to use a booster seat or seat belt. There are car seats with harnesses to higher weights, travel vests and large medical car safety seats available.

Q: What if my child with Down syndrome won’t stay in her car safety seat, booster seat, or seat belt?

A: Children with Down syndrome often have decreased muscle tone and loose ligaments which can make their joints very flexible. You may have heard this called “double-jointed.” This may make it easier for them to wiggle out of her car seat. If your child does this, make sure the harness straps are tight with the chest clip in the middle of the chest. If you child still gets out, you may need a different seat. If your child is big enough to use a booster seat or safety belt but doesn’t keep it on, you may need to use a travel vest or a large medical car safety seat.