Car Seats for Kids With Special Needs

Enthusiastic boy cheering in back seat of car

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Finding the right car seat and using it correctly is difficult enough, especially when car seat guidelines seem to keep changing. If your child has certain medical conditions, they may need a specially made child restraint system. But in may cases, a conventional car seat will be suitable if it has certain features or characteristics (such as a higher rear-facing capacity or deeper recline, for example).

These medical conditions might include cerebral palsy, unrepaired giant omphalocele, some cases of osteogenesis imperfecta, and babies who must lie flat (either prone or supine) because they are unable to tolerate a semi-upright seating position. Sometimes children have issues with impulse control that lead them to unbuckle their harness straps.

If your child uses a wheelchair and is transported by car or bus in the wheelchair, you will need to make sure that the wheelchair has been crash-tested, is properly secured to the vehicle, and that the seat belt is being used properly to restrain the child in the wheelchair.

Transporting a Child Who Has Challenging Behavior

If your child has hyperactivity, autism, or emotional problems, the protection afforded by riding in the back seat in accordance with the guidelines for all children under 13 is still essential. That may mean that an adult has to ride in the back seat to monitor the child's behavior. For children who unbuckle their seat belt, use a five-point harness for as long as possible (look for a car seat or booster seat with higher height and weight limits). A harness is harder to undo than a seat belt.

The Button-Down Shirt Trick

For children who cannot undo small buttons, try The Car Seat Lady's button-down shirt trick for preventing the child from opening their harness without needing to use the chest clip lock. Have the child wear a shirt with small buttons. Leave it unbuttoned while you secure the child snugly in the harness. Then button the shirt over the the straps to block the child's access.

Chest Clip Locks and Crotch Buckle Guards

For kids who still fit in their five-point harness (are under both the height and weight limits) but are opening the harness while the car is moving, use a chest clip lock and crotch buckle guard.

If the child is only able to undo the chest clip (they don't have the hand strength/dexterity to undo the crotch buckle), then only the chest clip lock is needed. Note that the chest clip lock and crotch buckle guard will not fit on every car seat.

Resources for Car Seats for Special Needs

Special car seats are usually available through a durable medical equipment provider using a prescription from a child's pediatrician or occupational therapist. If you need help finding a car seat for your child (whether a conventional seat or an adaptive one), a certified child passenger safety technician with extra training in seats for kids with special needs may provide assistance, in conjunction with your child's care team. 

The Automotive Safety Program at Indiana University School of Medicine has several helpful resources.

  • Options for restraints for children with special healthcare needs
  • Medical conditions that affect car seat use, and how to address them
  • Answers to frequently asked questions about safe transportation for kids with special needs
  • A toll-free hotline staffed by child passenger safety technicians who are experienced in issues associated with transporting children with special health care needs (help is also available via email)
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Article Sources
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  1. O’Neil J, Hoffman B. Transporting children with special health care needsPediatrics. 2019;143(5):e20190724. doi:10.1542/peds.2019-0724

  2. Weaver NL, Brixey SN, Williams J, Nansel TR. Promoting correct car seat use in parents of young children: challenges, recommendations, and implications for health communicationHealth Promot Pract. 2013;14(2):301–307. doi:10.1177/1524839912457567