Restraints for Children with Special Health Care Needs

Restraints for Children with Special Health Care Needs

2 / 1 2 / 2 0 2 2 Lecture Overview • Considerations for Restraint Selection • Basic Guidelines • Conventional Restraints

Considerations for Restraint Selection • Child’s size and age • Medical condition or procedures • Optimal safety and positioning

Considerations for Restraint Selection • Recommended position during travel: • • • Does the child need to travel flat? Prone? Supine? Does the child need to travel on his/her side? Can the child breathe when sitting? Can the child bend at the hips? Can the child sit unsupported?

Considerations for Restraint Selection • • Availability and/or affordability of restraints Vehicle(s) Other occupants Family choices

Basic Guidelines • Avoid use of non-approved products • Never modify structure unless crash tested with modification to meet FMVSS 213 • Seemingly minor modifications can compromise performance of the restraint Infant using nonapproved support pad

Basic Guidelines • Minimize travel • Make frequent stops • Position child in back seat with adult Adult in back seat observing child

Basic Guidelines • On-off switch for air bag if necessary • Travel with medical care plan • For long trips, have list of health care providers and durable medical equipment providers, if applicable • Have enough power for medical equipment for twice the length of travel • Have enough oxygen for twice the length of travel

Basic Guidelines • Securing medical equipment: • Place on floor of vehicle wedged with pillows, foam, or blankets • Secure with adjacent, unoccupied seat belts • Check vehicle owner’s manual about placing items under vehicle seat Apnea monitor being wedged under vehicle seat with towel roll

Conventional Restraints

Conventional Restraints • Use conventional restraints whenever possible • Easier to find • Easier to use • Less expensive • Rear-facing as along as possible • Use restraint with higher-weight harness as long as possible

Conventional Restraints • Features helpful for children with special health care needs: • Multiple harness slots and buckle strap positions • Accessories, such as preemie inserts, or extra padding • Rear-facing weight limits up to 40 -50 pounds

Conventional Restraints • Forward-facing with recline • Forward-facing harnesses up to 65 -85 pounds • Boosters with weight limits up to 120 pounds and/or adjustability features

Rear-Facing Only Infants born prematurely positioned in rear-facing only car seats designed with positioning inserts

Rear-Facing Only Infants born prematurely positioned in car seats with blanket rolls

Rear-Facing Only Child who is 1 year with diagnosis of achondroplasia

Rear-Facing to Higher Weights Child who is 18 months old, with diagnosis of Down syndrome

Rear-Facing to Higher Weights Child who is 3 years old with diagnoses of developmental delay

Rear-Facing to Higher Weights Child approximately 14 months with diagnosis of an encephalocele

Forward-Facing with Recline Options • Recline options can improve positioning for many children • Many conventional car seats have multiple recline options • American Academy of Pediatrics Car Seat Listing 2021 • Rear-Facing Only, Convertible, All-in-One, Combination, Booster • Price Ranges, Weight Limits and Height Limits, Recline Options in Forward-Facing, Travel Vests • www. healthychildren. org/English/safety-prevention/on-the-go/pages/Car -Safety-Seats-Product-Listing. aspx

Forward-Facing Harness to Higher Weight • Children who have outgrown convertible or combination seats and cannot sit unassisted or who have behavior issues • Can use towel rolls and/or soft cervical neck collar for positioning • Can be used as an interim solution if ordering adaptive restraint Child who is 5 years old with diagnoses of cerebral palsy and scoliosis

Soft Cervical Collars • Replace rigid neck collars with soft cervical collars during travel • Crash tests indicate rigid collars decrease neck flexion Child with soft cervical neck collar

Booster Seats Child who is 10 years old with diagnosis of achondroplasia in booster and head support seat with adjustable sides Child who is 6 years old, weighing about 100 pounds, in booster seat

Vests and Harnesses Child who is 5 years old with diagnosis of autism in Ride Safer Vest 86 Y-Harness for child with halo 86 Y-Harness from EZ-ON Source: EZ-ON

Misuse Exercise

Misuse Child with diagnosis of Autism who was getting out of her harness

Misuse Child who is 9 years old, >50 pounds with diagnosis of achondroplasia

Misuse Infant with diagnosis of Down syndrome

Misuse Child who is 4 years old, 41 pounds, 42 inches with diagnosis cerebral palsy

Misuse Child with behavioral condition and who weighs >40 pounds

Misuse Child who is 2 years old with diagnosis of autism

Misuse Child with trach and medical equipment; mother concerned because child’s head would fall forward

Misuse Child who is 8 months old, 15 pounds with diagnosis of hydrocephalus; mother using head strap so child’s head would not fall forward