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 can be difficult and confusing, especially when car seat guidelines seem to keep changing. If your child has certain medical conditions or other special needs, they may need a specially made child restraint system for the car. But in many cases, a conventional car seat will be suitable if it has certain features or characteristics that meet your child's needs, such as a higher rear-facing capacity or deeper recline.

When Is a Specially Designed Car Seat Needed?

All children need to be in an appropriate car seat that meets federal safety standards and accommodates their specific needs. Medical conditions that might require car seat modifications include prematurity, cerebral palsy, unrepaired giant omphalocele, and some cases of osteogenesis imperfecta. Babies who must lie flat (either prone or supine) because they are unable to tolerate a semi-upright seating position will also need special car seats.

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.

Additionally, many children, including those with hyperactivity, autism, or emotional problems are more prone to unbuckle or squirm out of their car seats. So, they may need modified car seats that will keep them secure when traveling.

Safe Car Travel Tips for Children Who Unbuckle Themselves

Many children have issues with impulse control that may lead them to unbuckle their harness straps. In fact, research shows that by age 4, most children are able to get out of their car seats on their own—and some are able as young as age 1. Alarmingly, in one study, over 40% of the families surveyed reported that their child had unbuckled while their parent was driving, with boys more likely to unlock themselves than girls.

Below, are several helpful strategies you can try to prevent children from unbuckling themselves while in a moving car.

Pull Over When Needed

If your child unbuckles while you're driving, be sure to pull over as soon as possible to get their car seat refastened. Aim to react calmly, so as not to unintentionally encourage them to do it again to get a big response from you. If a child repeatedly unbuckles, you may need to have another adult sit with them to keep them in their seat.

Follow Car Seat and Position Guidelines

Always follow the recommended car seat guidelines for your child. Never put a car seat in the passenger seat, as this is not a safe location for a child. Also, even if your child struggles to get out of their car seat, they need to stay in it until they reach the recommended age and weight to transition to a booster seat. A pediatrician or child passenger safety (CPS) technician can let you know exactly what type of seat your child needs and where to put them in the car.

Note that while older kids may lobby to sit in the front seat—and it may feel like you can keep a better eye on them, the protection afforded by riding in the back seat until age 13 is essential. That may mean that an adult has to ride in the back seat to monitor the child's behavior and keep them buckled or secured in their car seat.

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 for many children.

Use 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 straps to block the child's access.

Try Chest Clip Locks and Crotch Buckle Guards

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

Some children are only able to undo the chest clip and don't have the hand strength or dexterity to undo the crotch buckle. These kids may only the chest clip lock. Note that the chest clip lock and crotch buckle guard will not fit on every car seat so make sure the one you buy is compatible to your child's specific car seat.

Resources for Special Needs Car Seats

A pediatrician is a great source of information on the optimal car seat to fit your child's needs. They can direct you to the appropriate brand or modification to best keep your child safe while in the car.

Special car seats are usually available through a durable medical equipment provider using a prescription from a 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, as well options for restraints for children with special healthcare needs and answers to frequently asked questions about safe transportation for kids with special needs. The organization also offers information relating to specific medical conditions that affect car seat use and how to address them.

Additionally, the Automotive Safety Program's toll-free hotline is 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.

A Word From Verywell

It can be a bit overwhelming to navigate your options when figuring out which car seat may work best for your special needs child. However, know that there are many options out there as well as modifications and strategies that can help keep your child safe in the car. A pediatrician or certified child passenger safety technician can also help you land on the car seat solution that will work best for your child.

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6 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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