Cincinnati Children's Blog

Special Needs Car Seat: Find The Best Fit For Your Child

Special Needs Car Seat: Find The Best Fit For Your Child

Finding the right car seat for your child can be a daunting process. It can be even more difficult when your child has special behavioral or physical needs.

But there is good news; you’re not alone. Whatever challenges you and your child face—physical or behavioral, temporary or ongoing—there is a solution and an expanding network of resources and experts to help you find a seat that will meet all of your family’s needs.

We’ve known for decades that a properly installed car seat can dramatically reduce the incidence of injury and death in vehicle crashes. But until just a few years ago, there were only a handful of manufacturers who made seats for children with special needs. This meant that parents had an extra challenge with integrating their children into their family’s day-to-day activities if a typical safety seat couldn’t meet their needs.

In recent years, however, the tide has begun to turn. Various parent advocacy groups have grown stronger, and parents of children with special needs have come together to ask for products that better fit their families’ needs. In response, manufacturers developed a range of specialized seats and equipment that can protect child passengers of all shapes, sizes, abilities, and developmental stages.

An increasing number of families are benefiting from this trend. With proper equipment, more and more parents have the ability to transport their children safely and include the entire family in all types of activities.

Below are some of the most common situations that call for special car seats:

Behavioral Needs

Many children with special needs can exhibit disruptive behaviors as part of their disability, some of which may interfere with customary passenger safety procedures. In these cases, there are safeguards to accommodate these behaviors and keep children safe.

Children with a propensity to unbuckle, loosen or reposition their restraints may require a special vest or harness to keep them secure. Parents should not modify the clips and 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 addition to finding the right restraints, it can be helpful to introduce soothing techniques to relax children while they are in their seats. Some adaptive boosters come with internal speakers to hook into an mp3 player, which can be calming for children with autism and other sensory or behavioral disorders. Many parents also have success using iPads or other tablets to calm and distract their children with games designed specifically for children with developmental delays.


Children with autism may face challenges with hyperactivity. Proper restraint is key because these children often don’t understand the danger of roaming around the vehicle. Parents should consider car seats with chest clips that the child can’t push down as well as models with additional guards to prevent the child from unfastening their straps. There are also vests that zip up the back for this purpose.

Restraints can also present challenges for children with autism who have sensory issues. Some children prefer a tight fit to the lighter touch of straps. A close-fitting vest called a Churchill, which is used with a lap and shoulder belt, is available for older children with sensory issues.

Physical Needs

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

Generally, children with poor motor control will need a restraint that helps them sit up straight or stay in place. Large, specialized seats provide extra support to children who have outgrown a forward-facing car seat, but may be unable to use a booster seat.

Children who are smaller or larger than their peers may also require special accommodations. Small children should remain in a rear- or forward-facing car seat with a five point harness until they have outgrown the height and weight limits of the seat. Large children may require seats with higher height and weight limits.

Injuries Requiring Large Casts

Children in hip and leg casts may not fit comfortably or safely in a conventional car seat. Depending on the child’s size, she will need to be transported using a car bed, a specialized medical seat, or a modified vest. Ask the doctor when having the cast fitted.

Cerebral Palsy

Children with cerebral palsy can lack control of their head and upper body.  Because forward-facing seats are upright and are less supportive of the head, children should stay rear facing in traditional car seats for as long as possible. Once they have outgrown their rear-facing seat, it’s important to find a large car seat or medical seat that will support their entire trunk and can still be reclined while forward facing. In this position, they are able to lean their head back and maintain a clear airway.

Spina Bifida

Children with spina bifida are at much higher risk of having hydrocephalus, which means fluid accumulates in the brain. For this reason, many children with spina bifida have larger than average-sized heads, making it more difficult and more important to keep their head supported at an appropriate angle. As an alternative, small children will use a car bed, which allows them to lie flat on their backs.

There are many additional resources available to families who are investigating these options:

If you think it would be beneficial to your child and your family to have a seat that meets particular needs, please discuss those needs with a member of your child’s care team (physician, OT, PT, care manager) so he or she can help locate the most appropriate in-person resources for you.

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