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.  Please refer to Table 2 for a list of convertible seats that can rear face to 40-45 pounds.

Table 2 Convertible Seats that Rear Face to 40 Pounds

Convertible Seats that Rear Face To 40 Pounds
Type of Seat	Weight	Contact Information
Safety 1st Complete Air, Complete Air LX, Complete Air SE Convertible Car Seats	Rear facing 5-40 pounds and forward-facing harness from 22-50 pounds	800-544-1108 www.djgusa.com
Graco My Ride 65	Rear facing 5-40 pounds and forward facing harness from 20-65 pounds	800-345-4109 www.gracobaby.com
Sunshine Kids Radian XTSL, Radian 80SL	Rear facing 5-45 pounds and forward facing harness from 20-80 pounds	877-746-7178 www.skjp.com
Sunshine Kids Radian 65SL	Rear facing 5-40 pounds and forward facing harness from 20-65 pounds	877-746-7178 www.skjp.com
This table is not all inclusive and does not imply product endorsement (Updated 7/2010)

·          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.

 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 3 for information.

Table 3

Child Restraints with Harnesses for Children Over 40 Pounds

Child Restraint for children over 40 lbs	Weight	Contact Information
Britax Roundabout 50	Forward-facing harness from 1 year and 20-50 pounds	888-427-4829 www.britaxusa.com
Britax Marathon, Marathon CS, Decathlon, Boulevard, Boulevard CS, Advocate CS	Forward-facing harness from 1 year and 20-65 pounds	888-427-4829 www.britaxusa.com
Britax Frontier	Forward-facing harness from 2 years and 25-80 pounds/belt positioning booster from approximately 40 to over 100 pounds and 42 to 60 inches	888-427-4829 www.britaxusa.com
Safety 1st Apex 65	Forward-facing harness 22-65 pounds/belt positioning booster 40-100 pounds	800-544-1108 www.djgusa.com
Safety 1st All-In-One Convertible Car Seat	Forward-facing harness from 22-50 pounds	800-544-1108 www.djgusa.com
Safety 1st Alpha Luxe Echelon Convertible Car Seat	Forward-facing harness from 22-50 pounds	800-544-1108 www.djgusa.com
Safety 1st Go Hybrid Booster Car Seat	Forward-facing harness from 22-65 pounds	800-544-1108 www.djgusa.com
Evenflo Generation 65	Forward-facing harness from 20-65 pounds/belt positioning booster from 30-100 pounds	800-233-5921 www.evenflo.com
Evenflo Maestro	Forward-facing harness from 20-50 pounds/belt positioning booster from 40-100 pounds	800-233-5921 www.evenflo.com
Evenflo Titan Elite, Titan Sport	Forward-facing harness from 20-50 pounds	800-233-5921 www.evenflo.com
Evenflo Triumph Advance	Forward-facing harness from 20-50 pounds	800-233-5921 www.evenflo.com
Evenflo Symphony 65	Forward-facing harness from 20-65 pounds/belt positioning booster from 30-100 pounds	800-233-5921 www.evenflo.com
Evenflo Triumph 65	Forward-facing harness 20-65 pounds	800-233-5921 www.evenflo.com
Evenflo Titan Elite, Titan Sport	Forward-facing harness from 20-50 pounds	800-233-5921 www.evenflo.com
Graco Nautilus	Forward-facing harness from 20-65 pounds/belt positioning booster from 30-100 pounds	800-345-4109 www.gracobaby.com
Recaro G2 Como	Forward-facing harness from 30-70 pounds	248-364-3818 www.recarousa.com
Recaro G2 Signo	Forward-facing harness from 20-70 pounds	248-364-3818 www.recarousa.com
Recaro ProRIDE	Forward-facing harness from 20-70 pounds	248-364-3818 www.recarousa.com
Recaro ProSPORT	Forward-facing harness from 20-90 pounds/belt positioning booster from 30-120 pounds
Ride Safer Travel Vest (Small)	30-60 pounds and at least 3 years old	824-329-8111
Ride Safer Travel Vest (Large)	50-80 pounds	824-329-8111
*Some models only harness to 40 pounds
This table is not all inclusive and does not imply product endorsement (Updated 7/2010)

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.  There are many booster seats that have a 100 pound weight limit and a few go to 120 pounds. Refer to Table 4 for a list of booster seats over 100 pounds.

Table 4 Booster Seats for Children over 100 Pounds

Booster Seats for Children over 100 Pounds	Weight	Contact Information
Britax Parkway SG	From 40-100 pounds and standing height 38-63 inches.  Hip width 13 inches.	888-427-4829 www.britaxusa.com
Cleck Olli	From 40-100 pounds and 40-57 inches. Hipe width 13 3/4 inches.	1-866 65MAGNA www.magnacleck.com
Cleck Ozzi	From 40-120 pounds and 40-57 inches.	1-866 65MAGNA www.magnacleck.com
Combi Kobuk Air-Thru	From 33-125 pounds and 33-57 incehs	800-992-6624 www.combi.intl.com
Kiddy World Plus	From 40-110 pounds and up to 60 inches	678-377-3307 www.kiddy.usa.com
Monterey by Sunshine Kids	From 3-110 pounds and standing height 38-63 inches. Interior seat width 14-20 inches.	877-746-7178 www.skjp.com
Recaro ProBOOSTER	From 30-120 pounds and 37-67 inches	248-364-3818 www.recarousa.com
Recar ProSPORT	From 30-120 pounds and 37-59 inches	248-364-3818 www.recarousa.com
This table is not all inclusive and does not imply product endorsement (Updated 7/2010)

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 Hope car bed by Merritt Manufacturing (Available September 2010). 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
Merritt Manufacturing P.O. Box 17152 Indianapolis, IN 46217-0152 317-409-0148 www.eztether.com	Photo from: www.eztether.com	*Hope Car Bed   Weight:  4.5  to 35 pounds Height: up to 29 inches  (longer if legs are permitted to bend)   *Available September 2010

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 For children who have behavioral problems. Tether required.

Adapted Vehicles

Some families may require use of adapted vehicles in order to meet the transportation needs of their children. The National Highway Traffic Safety Administration (NHTSA) publishes a brochure, "Adapting Motor Vehicles for People with Disabilities," to assist families navigate the process of securing adapted vehicles. In general, NHTSA recommends that families work with a driver rehabilitation specialist who is qualified to assess the family's specific transportation needs and provide them with a list of appropriate vehicle modifications. Although driver rehabilitation specialists typically work with drivers with disabilities, they can also evaluate the vehicle needs of passengers with disabilities. Names of qualified evaluators can be obtained by contacting a local rehabilitation center or the Association for Driver Rehabilitation Specialists at www.driver-ed.org.

Once the vehicle modifications have been evaluated and discussed with the family, appropriate vehicle options can be explored. When choosing a vehicle, it is important for families to work with a reputable dealer of adaptive vehicles. The vehicle should be equipped with seat belts, vehicle seats, and tether anchorage locations that meet all applicable federal safety standards. The seat belts should be capable of remaining locked during normal driving conditions if child safety seats are installed. If the vehicle is adapted to accommodate use of a wheelchair, it should provide adequate space for the wheelchair to face forward, a four-point tie down system, and a separate three-point seat belt for the wheelchair occupant. In addition, the vehicle should be equipped with appropriate restraint systems for all occupants.

New adapted vehicles can be expensive, ranging in price from $20,000-$80,000. NHTSA suggests that families pursue both public and private avenues for funding the vehicles. For example, insurance companies may cover costs associated with evaluations and vehicle modifications. Adaptive vehicle manufacturers may offer rebates or reimbursement plans. Social service agencies may be able to help families explore applicable grants.

Wheelchairs

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.  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 (see figure—need to add) and is easy to find.)  The wheelchair should face the front of your vehicle. Make sure your child uses a separate shoulder/lap belt. For more information contact the University of Michigan Transportation Research Institute (UMTRI) at www.umtri.umich.edu.

Miscellaneous

Head Support Collars

In some instances, head support collars are used to help a child who
has poor head and neck control keep his or her head from falling forward during travel. Research has shown that stiff collars used for this purpose can increase neck tension and increase the risk of serious neck injury in a crash. Based on this research, it is recommended that use of neck collars during transport be limited to the lightest and most compressible head support collar.

Note: A child's head should never be secured separately to a restraint in an attempt to prevent the head from falling forward.

Medical Equipment

To date, there is no product available designed specifically to secure medical equipment, such as apnea monitors or oxygen, in a vehicle. Current recommendations for securing equipment include placing it on the floor of the vehicle wedged with pillows, foam, or blankets or securing the equipment with unoccupied seat belts.

Modifying Restraints

Child safety seats or restraints that have been structurally modified should not be used unless they have been crash tested with the modification to conform to federal motor vehicle safety standards. What might seem like a minor structural modification can greatly compromise the performance of the restraint in a crash and place the occupant in jeopardy.