Test Your Knowledge

Behavioral Child Passenger Safety Concerns

Scenario 1: My child is still riding in a 5-point harness. They are unbuckling the chest clip and/or crotch buckle.

Some common considerations:

1)   Is your child well under 65 lbs. and unbuckling their chest clip to get out?

  • It may seem silly, but schedule an appointment with a certified child passenger safety technician just to be sure the seat is being used correctly, EVEN if you think you are. You’d be amazed how sometimes small suggestions or corrections from a CPST can make a huge difference.
  • How old is the seat you are using? If it’s more than a few years old or so, it has likely become worn with use and that makes it a lot easier for little hands to undo the chest clip and/or crotch buckle. Consider purchasing a NEW harnessed car seat that will have firmer buttons that are harder to kiddos to push.

2)   Two words: Positive. Reinforcement.

  • It may seem like a small thing, but a little encouragement and reward can go a long way for keeping children buckled in their seat.
  • One common issue we see with parents who have obtained a new seat (see point 1B), is that as soon as their child is fitted in their new seat, the parent actively encourages the child to try to unbuckle the seat as a test to see if it ‘works’. This only makes the problem worse and the child takes it as permission from a parent and a welcome challenge to try to get out of their new seat!

Scenario 2: My child is in a booster seat but they always unbuckle the seatbelt or put the shoulder portion behind their back.

Is your child still small enough that they could still be riding in a harness? The answer may surprise you.

  • Sometimes parents transition their child to a booster seat as soon as they reach the minimum requirement per their state’s laws, which is often before they outgrow their harness forward-facing. If your child still fits in their harness weight and height wise (check your car seat manual for the ranges), you may want to consider putting them back into a harness. Sometimes young children lack the maturity or understanding for why seatbelts are so important and need a little more time in a more restricted (and safer) transportation option. It is possible and permissible for small children to still ride in a harness regardless of age, as long as they fit within the size guidelines for their seat.
  • Many times children may unbuckle the seatbelt or put it behind their back because the shoulder portion is digging into their neck –ouch! You can fix this by putting them in their harnessed seat as long as they still fit according to the size guidelines for that seat. This is also an issue many times with backless boosters because parents are not using a belt positioning clip when it is available for the booster seat, this will help position the seatbelt to the mid collarbone area to keep it from digging into the child’s neck.
  • Once again, it’s worth finding a child passenger safety technician in your area to have an assessment done for your transportation situation. They will also be able to help you figure out if your child can still fit appropriately in their harness, or of any adjustments can be made for comfort and correct use since discomfort is sometimes why children want to get out of their seats also.
  • As always, positive reinforcement can go a long way for encouraging little ones to stay buckled in the way they should be.

Scenario 3: I have tried all of the possibilities above, but it isn’t enough, or my child is too big for a car seat or booster seat. My child has severe and/or diagnosed behavioral concerns that make them a danger to themselves, me, other passengers, or even other cars on the road during transportation.

It is typically encouraged to try to keep a child in their regular car seat if at all possible, but for some severe behaviors that is not going to be an option that works. This is a very stressful situation for parents most of all, and unfortunately there is no one-size fits all answer. There are many third-party and after-market products designed to keep children in their car seats, including locking chest clips and seatbelt buckle shields, but these are not recommended due to safety concerns. However, many parents elect to purchase and use these items at their own discretion in an effort to keep their child secured during transport.

There are a many other approved and special transportation seats or vests for children or adults with severe behavioral concerns. It is VERY important to note that it is always best to consult a special needs child passenger safety technician and/or physical or occupational therapists who should not only be able to help you find the right option, but also work with insurance to try to get these seats covered as it’s an expense many families cannot afford out-of-pocket. Below are a few that we find most frequently meet the needs of most cases:

  • Roosevelt with escape proof package:
    1. Weight range: Min 35lbs – Max 115lbs
    2. Height range: Min 33.5 in – Max 62 in
    3. How does it keep my child restrained? The Roosevelt works similarly to a regular car seat, but has been crash tested with the escape-proof kit add-on and therefore it is approved for use. There are two components to the kit. One is the locking chest clip which works by looping behind the child’s neck so they cannot push the chest clip down, and it has a turnkey hole in the center that locks the clip into place so it cannot be undone without being turned to the release position. The crotch buckle cover creates a shield over the buckle making it nearly impossible or impossible to release the crotch buckle from the upright sitting position the occupant would sit in.
    4. What are the limitations? This seat is very large and doesn’t always work well in very small or compact vehicles. Occasionally, there are some very creative “escape artists” who will hide tools that they can turn and undo the locking chest clip with, but this is not a very common concern and is one that caretakers can be on the lookout for. If the child is able to reach down and unbuckle the seatbelt that actually holds the Roosevelt in place, this seat will not be secured and the restraint will not hold the child in place in the event of a crash.
  • Spirit with escape proof kit:
    1. Weight range: Min 25lbs – Max 130 lbs.
    2. Height range: Less than 66 inches
    3. How does it keep my child restrained? This seat, alike to the Roosevelt, works similarly to a typical car seat. However, it can also come with approved add-ons to keep the chest clip and crotch buckle buckled. For both areas, an attachment can be ordered that works very much like a child-proof medicine bottle cap.
    4. What are the limitations? This is another large seat. Parents may find adjusting the harness height as the child grows to be a little confusing or difficult. If the child is able to reach down and unbuckle the seatbelt that actually holds the Spirit in place, this seat will not be secured and the restraint will not hold the child in place in the event of a crash.
  • EZ-On Upright Escape Proof Vest
    1. Weight range: 31lbs to 168lbs
    2. Height range: None
    3. How does it keep my child restrained? This vest zips up in the back and can come with a zipper cover to make it even harder to get undone. It is then secured to the floor of the vehicle with a floor mounting system that, when used correctly, bypasses the need for using a seatbelt and keeps the child secured with a mounted harness system.
    4. What are the limitations? This option has a very high misuse rate from our observations and will require having permanent alterations done to the vehicle by having a floor mount installed professionally by a mechanic who understands how to do the work properly. This may tie families down to one vehicle if they can only afford to have one floor mount installed. It is also critical families receive training or read the entire manual for the vest to make sure it is being used properly, otherwise it will not keep the child restrained in a crash.
  • The Churchill
    1. Weight Range: 65 lbs. to 175 lbs.
    2. Height Range: Min 48in – Max 72in
    3. How does it keep my child restrained? The Churchill comes in two varieties. The first type is a vest that uses Velcro to close in the front, and the second is a locking chest clip mechanism. Depending on how severe the escaping behaviors are, either may option could offer a potential solution.
    4. What are the limitations? Both varieties require the use of a seatbelt over the top of the Churchill. The Churchill only serves as a positioner and makes it a little harder for kiddos to get out of their restraint, but the seatbelt is what will actually hold the occupant in place in the event of a crash.
  • The Chamberlin
    1. Weight range: Min 81lbs – Max 225 lbs.
    2. Height range: Min 48 inches – Max top of ears cannot exceed top of vehicle seat back or headrest.
    3. How does it keep my child restrained? This seat works very similarly to the Churchill Velcro variety as a positioning device, and makes escaping the restraint a little more difficult.
    4. What are the limitations? This seat, like the Churchill, requires the use of the seatbelt over the top of the restraint. The seatbelt is what will hold the occupant in place in the event of a crash, so if the child will unbuckle the seatbelt, this may not be an ideal option. It also has an even higher minimum weight limit, but does have a higher maximum weight limit that works for larger kids.
  • The Ride Safer Travel Vest
    1. Weight Range: Min 30 lbs. – Max 110 lbs.
    2. Height Range: Min 35 inches – Max 64 inches
    3. Minimum age: Varies by size.
    4. How does it keep my child restrained? This device, like the Churchill and the Chamberlin, works by keeping the seatbelt positioned with the child strapped into the vest. The device makes it harder to get out of the seatbelt.
    5. What are the limitations? Again, like the Churchill and the Chamberlin, this vest must be used with the seatbelt which actually does the restraining in a crash. If the child will not keep the seatbelt buckled, this may not be an ideal option.

This is by no means a comprehensive list, and the needs of every child and family is different, so consulting with a special needs child passenger safety technician and/or physical or occupational therapist in your area is strongly recommended.

 

Physical Needs

 

Children with special needs that are physical in nature may need modifications that cannot be made to standard car seats and safety practices.

  • Casts or braces
  • Limited range of motion
  • Poor muscle tone
  • Hydrocephalus
  • Airway concerns
  • Positioning needs
  • Low/high weight

For more information on special needs transportation click here.  If transporting your child presents challenges, plan to discuss this with your child’s physician and/or therapist. You may also wish to seek the assistance of a child passenger safety technician who is trained to assist with patients with special health care needs. You can search for a technician here.

Physical or Supportive Child Passenger Safety Concerns

Introduction

One common concern that we work with when we connect with the families of special needs children is that parents or caretakers often believe their special needs child must have a special needs car seat. Depending on the situation, that belief can be the furthest thing from the truth! We know you want the best for your child, and we often find that conventional car seats suit special needs kids just as well or even better than an expensive medical seat. We recommend connecting with a CPST in your area to make sure that your child’s conventional seat fits them appropriately and is being used correctly. It’s important to listen to their opinion and take any education they may offer to heart, even if it’s not what you had in mind for your child. Don’t forget CPSTs are advocates and educators who take keeping little ones safe on the road very seriously! With that said, there are situations that warrant creative solutions or medical seats.

Scenario 1: My child slumps over in their car seat or booster seat! It’s like they do not have adequate tone or trunk control to stay seated upright.

This is usually a problem that surfaces when kiddos with certain disorders or physical impairments who are riding in the forward-facing position, either in a harness or a booster seat. Luckily, there may be some simple solutions to help!

  • Is your child riding in a forward-facing harness but still small enough to ride rear-facing per the height and weight range given for their seat? The answer may surprise you!
    1. Double check your child’s weight and height and compare it to the upper ranges given for their seat in the rear-facing position. If your child is still under both, you should consider keeping them rear-facing until they outgrow it. This is a very supportive and safe position for little ones to ride in, and many times for small low-tone children this position works well to provide needed support until they outgrow the rear-facing position by height and weight. Sometimes parents turn their child forward facing as soon as they can legally in their state based on age, but this is no longer considered best practice per the American Academy of Pediatrics recommendation. Another common concern we hear from parents is that their kids are folding or pushing their legs against the back of the seat when rear-facing. As long as the child is under the upper weight and height range for their seat rear-facing, we actually say this is ok and even recommend it! Riding cross-legged is normally a comfortable position for toddlers, and we remind parents that even if a leg injury does occur from riding in this position in a crash, that it is much easier and less serious to manage a leg injury than a head injury from being turned forward facing before their bodies are big enough!
  • Is your child riding in a booster seat but still small enough to ride in a forward-facing harness car seat per the height and weight range given for their seat? The answer may surprise you!
    1. Sometimes parents transition their child to booster mode as soon as they reach the legal age for their state. The reality is this is not always the best solution, especially for low-tone kids. As long as your child fits by height and weight in their forward-facing harness, consider keeping them there until they outgrow it.
  • There are some conventional convertible or all-in-one seats on the market that can offer a small amount of forward-facing recline. You can research many of them online, and you will need to double check the height and weight ranges for the levels of recline and I what positions they can be used in (rear or forward facing). A common error we see is parents with these types of seats keep the seat in a recline position that is only supposed to be used for rear-facing, but they are using that recline level in the forward-facing position. This may sound a little confusing, so try to connect with a CPST in your area if you need help figuring out how to use your seat or you aren’t sure which ones may be options.

Scenario 2: My child is able to stay seated upright fine in their car seat, booster seat, or special needs seat. The only problem is they can’t hold their head up!

  • Make an appointment with your child’s doctor, and/or physical or occupational therapist to discuss using a soft foam collar for head support during transportation.
    1. It’s important to note here it may not be appropriate to use a soft foam collar for transport depending on your child’s medical condition. Your child’s doctor or care team will be able to make that determination with you.
    2. You should never use a hard neck brace or any kind of hard shell neck brace that will hold your child’s head back. This can cause severe internal neck injuries in the event of a crash.
    3. With physician and/or care team approval for use, a soft foam collar should only be used for head support during active transportation.
    4. You should never use bands, straps, or anything to physically restrain your child’s head back to their car seat or vehicle seat. This can cause severe internal injuries in the event of a crash.

Scenario 3: I have reviewed the options above, and none of them are going to work for what my child needs. What do I do next?

The first thing you need to do is connect with a special needs CPST or a physical or occupational therapist in your area to get you pointed in the right direction. There are a couple of other things you should be aware of and consider before moving forward.

  1. Are you going to purchase the seat out of pocket or try work with insurance to get the seat covered?
    1. The first thing you should know is if your child is well under 65 lbs, it could be very difficult to get insurance to cover the cost of the seat. That is because, in relation to the Introduction at the very beginning of this section, many times conventional seats are adequate for meeting the needs of children under that weight range. It’s not impossible to get a medical seat under that weight, and there can be exceptions that are solely determined by the insurance company, but it’s still a possibly challenge you may face.
  2. How urgent is the need? Is there a conventional option that can hold you over until you get your special-needs option?
    1. Be prepared that obtaining a special needs seat through insurance can be a very lengthy process. The length of time can vary widely from state to state, and can be further complicated by denial/appeal processes. In the very best case scenario, you may obtain your special needs seat in 1-2 months, but it can often take up to a year or even more.
    2. You may need to connect with a CPST to discuss temporary options while waiting for the seat to arrive.

….So what are some of the special needs seat options out there?

By reaching this section, you should have ruled out any other possibility outlined above in conjunction with a special needs CPST or physical/occupational therapist. This is by no means a comprehensive list both in the devices listed and the types of conditions/considerations for each seat.

WARNING: The misuse rate for conventional car seats is very high (90%+ misuse rate), and it the misuse rate is even higher for special needs seats. Once again, this is why it is so important to connect with a special needs CPST in your area. If the seat is not installed and used properly it will not work in a crash and can result in severe injury or even death.

  • Roosevelt:
    1. Weight range: Min 35lbs – Max 115lbs
    2. Height range: Min 33.5 in – Max 62 in
    3. How does it support my child? The Roosevelt works similarly to a regular car seat; however, it offers a higher weight harness compared to conventional options. The Roosevelt also comes with a tilt bar for use under a certain weight threshold (check the manual for details) which can offer some forward-facing recline. Two other key features of Roosevelt include a cap that velcroes to the seat which can offer head support, and the Roosevelt can also come with scoliosis padding that can be sculpted to support the seat occupant. Please be aware physical and/or occupational therapists are the professionals to do the sculpting.
    4. What are the limitations? This seat is very large and doesn’t always work well in very small or compact vehicles. As with all special needs seats, it’s going to be best to consult a special needs car seat technician to be certain the seat is being used and installed correctly.
  • Spirit:
    1. Weight range: Min 25lbs – Max 130 lbs.
    2. Height range: Less than 66 inches
    3. How does it keep my child restrained? This seat, alike to the Roosevelt, works similarly to a typical car seat. However, it can also come with lateral (side) and leg supports that swing out to help keep your child positioned in the seat in addition to the harness.
    4. What are the limitations? This is another large seat. Parents may find adjusting the harness height as the child grows to be a little confusing or difficult. As with all special needs seat, it’s going to be best to consult a special needs car seat technician to be certain the seat is being used and installed correctly.
  • The Churchill
    1. Weight Range: 65 lbs. to 175 lbs.
    2. Height Range: Min 48in – Max 72in
    3. How does it keep my child restrained? The Churchill can offer some positional assistance for sitting upright, with the seatbelt doing the restraining in the event of a crash. There are leg straps that help position the legs, and you can get a cap to help keep the head held back.
    4. What are the limitations? The Churchill starts at a higher weight range and may not provide adequate support for very low-tone kids. One common mistake with this device is that parents will recline the vehicle seat keep their child sitting back, but this is not safe beyond a very slight recline.
  • The Chamberlin
    1. Weight range: Min 81lbs – Max 225 lbs.
    2. Height range: Min 48 inches – Max top of ears cannot exceed top of vehicle seat back or headrest.
    3. How does it keep my child restrained? This seat works very similarly Churchill. It offers positional support for sitting upright with the seatbelt doing the restraining in the event of a crash.
    4. What are the limitations? This seat, like the Churchill, requires the use of the seatbelt over the top of the restraint. The seatbelt is what will hold the occupant in place in the event of a crash, it also has an even higher minimum weight limit, but does have a higher maximum weight limit that works for larger kids. It may not offer enough support for low-tone kids. One common mistake with this device is that parents will recline the vehicle seat keep their child sitting back, but this is not safe beyond a very slight recline.
  • The Ride Safer Travel Vest
    1. Weight Range: Min 30 lbs. – Max 110 lbs.
    2. Height Range: Min 35 inches – Max 64 inches
    3. Minimum age: Varies by size.
    4. How does it keep my child restrained? This device, like the Churchill and the Chamberlin, works by keeping the seatbelt positioned with the child strapped into the vest. You must use the vest with the seatbelt to do restraining. This may be a more affordable out-of-pocket option that’s easily transferrable between vehicles.
    5. What are the limitations? Again, like the Churchill and the Chamberlin, this vest must be used with the seatbelt which actually does the restraining in a crash. This option may not offer enough support for low-tone kids and the vehicle seat cannot be significantly reclined when using this device.
  • Persistent unbuckling of chest clip or crotch buckle
  • Refusal to wear the seatbelt across the chest
  • Safety risk to self or others
  • Inability to understand safety risk
  • Poor impulse control or hyperactivity due to diagnosis

Parents should not modify the harness chest clip, buckle, or straps on a child’s seat, but rather, try out seats that have different kinds of clips that are more difficult for a child to unbuckle. In these cases, there are safeguards to accommodate these behaviors and keep children safe.

In addition to finding the right restraints, it can be helpful to introduce soothing techniques to relax children while they are in their seats. Many parents also have success using iPads or other tablets to calm and distract their children with games designed specifically for children with special needs.

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