Go directly to: ------------------ Adaptive and Specialized Restraints Adapted Vehicles Miscellaneous

Children with Special Health Care Needs

Conventional Restraints

For purposes of this section, conventional restraints are defined as child safety restraints that meet Federal Motor Vehicle Safety Standard 213, can be purchased at retail stores, and are not designed specifically for children with special health care needs. Infant only seats, convertible seats, forward facing only harness seats, combination car seat/booster seats, and belt-positioning booster seats are included in this category. (Detailed information about conventional child restraints is available on www.nhtsa.dot.gov and www.aap.org.)

Oftentimes, conventional restraints are appropriate for children with medical needs. Not only can they provide suitable positioning and protection, but also they are easier to obtain, less expensive, and more convenient to use than many of the specialized restraints. However, if a conventional restraint does not meet a child's positioning needs and proper use of the restraint is comprised then a specialized restraint should be considered.

Infant Only Seats

In general, infant-only seats are designed for newborns and infants who weigh less than 20-22 pounds and are up to 26 inches in length. Infant only seats are installed rear-facing (link to rear facing section of website) in a vehicle and semi-reclined according to the manufacturer’s instructions.

Infant only seats provide appropriate protection for many infants with medical conditions, provided an infant can tolerate a semi-reclined sitting position.

When selecting an infant only seat, keep the following in mind:

• Seats with smaller harness dimensions should be selected for premature infants so the harness is at or below the baby’s shoulders.
• Many infant only seats come with head support systems that provide adequate lateral support for babies.
• Many infant seats have a 5 pound minimum weight. For baby’s who weigh less, please refer to Table 1 for a list of infant seats that have a minimum weight below 5 pounds.

Convertible Car Seats

In general, convertible seats are designed for rear-facing use for infants and forward facing use for toddlers up to 40 pounds and 40 inches. They are "converted" from an infant seat to a toddler seat by making specific changes, according to manufacturer's instructions.

Keep your child rear facing as long as possible.  Riding rear facing helps support your child’s entire body and protects her better from an injury, especially to the spine.  Most newer convertible seats are approved for rear- facing up to 30 or 35 pounds and should be considered for infants whose height and weight have exceeded the limits of the rear-facing infant-only seat (Check manufacturer’s instructions for weight limits).  Move your child into a rear facing convertible seat when she outgrows her infant-only seat.  Convertible seats that rear-face to higher weights can also be beneficial to many children with medical conditions. For example, children of smaller stature, developmental delays, brittle bones, down syndrome, hydrocephalus, low tone, and poor upper body control will be better positioned and protected rear-facing in a child restraint.

When selecting a convertible seat, keep the following in mind:

• Consider a seat that can rear face to higher weights of 30-35 pounds.

·          Consider a seat that has a five-point harness. Car seats that have trays or shields should be avoided if a child has a tracheostomy.
In a crash or sudden stop, the tray or shield could hit the child's trach. The five-point harness is also more flexible and easier to buckle over the thickness of a long leg cast.      

·          Consider a seat that can be semi-reclined in a forward facing position for a child who has poor upper body strength and has outgrown a rear-facing seat. The semi-reclined position can help the child ride more comfortably and keep his head from falling forward during normal driving.

Consider a higher weight harness if child has behavior or development problems or is overweight. Please refer to Table 2 for a list of convertible seats that have harnesses to higher weights. See Table 3 for a list of forward facing only seats with harnesses to higher weights.

Convertible Restraints	Weight	Manufacturer/Phone
Britax Boulevard	Rear-facing harness 5-33 pounds/Forward facing harness one year and 20-65 pounds	Britax Child Safety 888-427-4829
Britax Decathlon	Rear-facing harness 5-33 pounds/Forward facing harness one year and 20-65 pounds	Britax Child Safety 888-427-4829
Britax Marathon	Rear-facing harness 5-33 pounds/Forward facing harness one year and 20-65 pounds	Britax Child Safety 888-427-4829
Titan	Rear-facing harness  5-33 pounds/Forward facing harness 20-50 pounds	Evenflo
Radian 65	Rear-facing harness 5-33 pounds/Forward facing harness 20-65 pounds	Sunshine Kids Juvenile Products 443-539-1440
Radian 80	Rear-facing harness 5-33 pounds/Forward facing harness 20-80 pounds	Sunshine Kids Juvenile Products 443-539-1440
This table is not all inclusive and does not imply product endorsement

Forward Facing Only Seats

Forward facing only seats are designed for children who are at least one year of age and at least 20-30 pounds. There are different types of forward facing only seats, including forward facing only seats with harnesses, forward facing only seats with harnesses to higher weights (Table 3), and forward facing only seats that can be changed to belt-positioning boosters by removing the harness (combination child safety seat/boosters).

Forward facing only seats that have harnesses can be useful for some children in casts, who have weak upper body control, who have behavioral challenges or are obese. Some forward facing only seats have harness systems that can be used for children who weigh over 40 pounds. These can be useful for children who would benefit from using a harness but do not need the additional positioning support of a large medical seat.  Refer to table 2 for information.

Table 3

Forward Facing Restraints	Weight	Manufacturer/Phone
Britax Regent	Forward-facing harness from 1 year and 22-80 pounds	Britax Child Safety 888-427-4829
SafeGuard Child Seat	Forward-facing harness from 1 year and 22-65 pounds	Safeguard Child Seat 800-586-7839
Cosco Apex 65	Forward-facing harness 20-65 pounds/belt positioning booster 30-100 pounds	Dorel Juvenile Group 800-544-1108
SafeGuard Go	Forward-facing harness 1 year 30-60 pounds/belt positioning booster 40-100 pounds	Safeguard Child Seat 800-586-7839
Ride Safer Travel Vest (Small)	35-60 pounds	Safe Traffic System 847-329-8111
Ride Safer Travel Vest (Large)	50-80 pounds	Safe Traffic System 847-329-8111
This table is not all inclusive and does not imply product endorsement

BELT POSITIONING BOOSTER SEATS

Belt-positioning booster seats are designed for children who weigh over 40 pounds. They raise a child up so that the adult seat belt system fits the child properly. They must be used with a combination shoulder/lap seat belt.  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. 

Never use a booster seat with a lap belt only.  Booster seats must be used with lap and shoulder belts.  Consult an occupational or physical therapist if your child does not have good control of his muscles and has outgrown his car safety seat.

Adaptive or Specialized Restraints

Specialized child restraints for infants who may need to travel lying down

Car Beds

Car beds are restraints that allow infants to travel lying down. There are three different kinds of car beds, the Dream Ride SE by Dorel Juvenile Group, the Angel Ride car bed by Angel Guard, and the Snug Seat car bed by Snug Seat (no longer being manufactured but available through some hospital car seat programs). Although there are variations in design, all of the beds must be used with the infant's head facing toward the center of the vehicle, away from any side or door. When positioning an infant in a car bed, it is important to ask the medical staff if the baby should lie on his or her stomach, back, or side. Due to concerns about placing babies on their belly increasing the risk of sudden infant death syndrome (SIDS), babies should not be positioned on their stomach unless prescribed by their physician to be medically necessary.

For specific product information, contact:

Dorel Juvenile Group, Inc. 2525 State Street Columbus, IN 47201-7494 800-544-1108 www.djgusa.com		Dream Ride SE Weight: 5-20 pounds Height: 19-26 inches
Mercury Distributing 7001 Wooster Pike Medina, OH  44256 800-815-6330 www.mercurydistributing.com		Angel Ride Car Bed   Weight: less than 9 pounds Height: less than 20 inches
Snug Seat, Inc. 12801 East Independence Blvd. P.O. Box 1739 Matthews, NC 28106 800-336-SNUG (7684) www.snugseat.com		*Snug Seat Car Bed   Weight:  up to 21 pounds Height: up to 29 1/2 inches   *Discontinued

Specialized restraints for children in hip casts.

The Snug Seat Hippo is a convertible safety seat specifically for children in hip casts.   The modified E-Z-ON Vest may be an option for those children who do not fit in the Hippo.

The Hippo convertible car seat by Snug Seat is designed for infants and toddlers in hip casts. Unlike conventional convertible seats, the Hippo has a shallow seating surface and low sides in order to accommodate hip casts. The Hippo convertible seat also has a wedge positioning system for children in casts to assist in achieving a snug fit in the seat.

The Hippo is used rear-facing in the reclined position and with the harness straps at or below the shoulders for infants from 5-33 pounds. The seat is used forward-facing, upright or semi-reclined for toddlers from 20-65 pounds and up to 49 inches. In the forward facing position the seat can be used reclined or upright to 40 pounds and must be upright 40-65 pounds. The weight of the cast is included in the child's weight. Always use the tether for children who weigh more than 40 pounds.  Click here for more information on tethers.  

For specific information about this product, contact:

Snug Seat, Inc. 12801 East Independence Blvd. P.O. Box 1739 Matthews, NC 28106 800-336-SNUG (7684) www.snugseat.com

Snug Seat Hippo Weight: 5-33 pounds rear facing/1 year old and 20-65 pounds forward facing Height: up to 49 inches For infants and toddlers in hip casts.

The Modified E-Z-ON Vest

To date, there is only one vest available for children who are two years or older and must be transported lying down. Manufactured by E-Z-ON Products, the Modified E-Z-ON vest is designed for children 2-12 years old and 20 - 100 pounds. In order to use the vest, a child must be able to fit lengthwise on a vehicle bench seat. Two separate seat belts may be required for installation. Padding is required to fill in the vehicle floor space in front of the child. Additional padding can be placed under the child's head and between the child's head and feet and the side of the vehicle. The child should be positioned with her head away from the side of the vehicle.

E-Z-ON Products, Inc. of Florida 605 Commerce Way West Jupiter, FL 33458 800/323-6598 www.ezonpro.com

Modified E-Z-ON Vest Ages: 2-12 Weight: 20-100 pounds Height: Child must fit lengthwise on vehicle bench seat. For children who must travel lying down.

Forward Facing Medical Seats

Forward facing medical seats are designed for occupants who require more positioning support than that offered by a conventional car seat or restraint. Some medical seats will fit occupants to weights as high as 150 pounds. Large forward facing medical seats are installed with seat belts and tethers. 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.

Forward facing medical seats are available with standard and optional features, including postural pads, recline wedges and bars, seat depth extenders, and stroller bases.
It is important to work with a rehabilitation therapist when selecting a medical seat. The therapist can help determine which seat will provide the features most appropriate for the child's positioning needs.  Please see below for information on forward facing medical child restraints.

 For specific product information , contact:

Snug Seat, Inc. 12801 East Independence Blvd. P.O. Box 1739 Matthews, NC 28106 800-336-SNUG (7684) www.snugseat.com		Britax Traveler Plus Weight: 22-105 pounds Height: up to 56 inches For older children who need more support because of sitting or behavior problems. Tether required.
Columbia Medical P.O. Box 633 Pacific Palisades, CA 90272 800-454-6612 www.columbiamedical.com		Columbia Medical Orthopedic Positioning Seat (2 sizes) Child Weight: 20-102 pounds Height: 36-60 inches Small Adult Weight: 40-130 pounds Height: 54-66 inches For older children who need more support because of sitting or behavior problems. Tether required.
Merritt Manufacturing P.O. Box 17152 Indianapolis, IN  46217-0152 317-409-0148 www.eztether.com	Visit www.eztether.com to view a photo restraint	The Roosevelt Weight: 35-115 pounds Height: 33.5 to 62 inches For older children who need more support because of sitting or behavior problems. Certain installations require tether.

Bergeron Health Care 15 Second St. Dolgeville, NY 800/371-2778 www.adaptivemall.com		Special Tomato (2 sizes) Small Weight: 20-80 pounds Height: 32.5-50 inches Large Weight: 80-150 pounds Height: 50-63 inches For older children who need more support because of sitting or behavior problems.  Optional seat cushion to increase width and depth. Tether required.
Sammons Preston/Tumble Forms 4 Sammons Court Bolingbrook, IL 60440 800/323-5547 www.tumbleforms.com		Carrie Car Seat  (4 different sizes) Weight: 20-130 pounds Height: 30-68 inches For older children who need more support because of sitting or behavior problems. Tether may be required.
Reha Partner, Inc. 530 Means St. Suite 120 Atlanta, GA 30318 866/282/4558 www.reha-partner.com		Peppino Car Seat Weight: 20-55 pounds Height: 33.5-47 inches For older children who need more support because of sitting or behavioral problems.  Comes with internal harness for positioning and uses lap/shoulder belt for occupant protection.
Reha Partner, Inc. 530 Means St. Suite 120 Atlanta, GA 30318 866/282/4558 www.reha-partner.com		Recaro Car Seat Weight: 30-80 pounds Height: 37-59 inches For older children who need more support because of sitting or behavioral problems.  Comes with internal harness for positioning and uses lap/shoulder belt for occupant protection.

 Upright Vests

Typically, vests are intended to be used by children who are over two years of age and have behavioral problems.

There are different types of upright vests. Depending on the manufacturer and model, vests can have front closures or back closures and features such as adjustable shoulder straps and crotch straps. Installation usually requires a vehicle seat belt as well as a tethering system.

Some upright vests are designed only for use on school buses.
Vest manufacturers should be contacted as to the most current
recommendations for installation of their products on school buses.

For product information, contact:

E-Z-ON Products, Inc. of Florida 605 Commerce Way West Jupiter, FL 33458 800/323-6598 www.ezonpro.com

E-Z-ON Vest Ages: 2 and older Weight: 20-168 pounds