Car seat use w/o shoulder straps for medical issue

Hi all. I have a 22 month old that weighs 24lbs and is Rear Facing in an Evenflow Triumph Advance. He's a shorty, so no height restriction issues.


He has had a Brachial Plexus injury from birth and has had some recent regression with his motor skills in his left arm and the pedi has ordered that nothing be placed on his shoulder, no holding hands, backpacks etc. and she also does not want a shoulder harness strap on that left side.

Now, I have no choice but to take him out in the car-he cannot stay at home forever! I have been strapping in his right arm, doing the hip harness and the chest clip and sliding it up as high as I dare, and just leaving his left arm out.

I google for some sort of assistive carseat, but I was unable to find anything for a unilateral injury.

Anyone have any ideas?

thanks!

There is no way to restrain a small child in a car without using both shoulder straps. In an accident, those shoulder straps keep the child in the seat. Without them, the child will most likely fly out of the seat and be injured way worse.

What I would do in your situation would be to limit car seat time as much as possible. But, when I put my child in the car, I would tighten the straps as tight as needed to have them snug, but not overly tightened. I might even consider putting my child forward facing at almost 2, because forward facing, the straps don't touch the top of the should in most seats. The straps will come across at the collar bone, but not wrap around the shoulder like it does rearfacing.

We have a member here with a BPI, I'm sure she'll see this and give you some suggestions. My best friend also has a BPI from birth so I know it can be difficult. BUT, the shoulder harness is a must. The results could be catastrophic. A BPI is much better than an ejected child. I'd rather turn the child FFing with the tether anchor attached than leave the child essentially unrestrained. I'm shocked that the doctor suggested no shoulder harness. Could you call back and see what a safe solution would be? I imagine they deal with plenty of car seat aged kiddos due to the nature of the injury.

Thanks for the reply. I haven't FF yet, so could you clarify one thing? When FF the straps don't touch the shoulders when fully tightened? I am having a hard time picturing this.

Thanks!

keri1292 said:

We have a member here with a BPI, I'm sure she'll see this and give you some suggestions. My best friend also has a BPI from birth so I know it can be difficult. BUT, the shoulder harness is a must. The results could be catastrophic. A BPI is much better than an ejected child. I'd rather turn the child FFing with the tether anchor attached than leave the child essentially unrestrained. I'm shocked that the doctor suggested no shoulder harness. Could you call back and see what a safe solution would be? I imagine they deal with plenty of car seat aged kiddos due to the nature of the injury.

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Her first suggestion was a high backed booster on the right side of the car so the left shoulder was uninvolved entirely.

I was wondering about an increased angle of recline when RF, but I don't know if that is safe or would reduce the pressure on the shoulder.

Unfortunately for the next few months keeping pressure off his BPI is essential to having function later in life; he is going through a growth spurt and it is a very crucial time in his OT as well. It may come down to this; safe in the car vs. use of his arm later in life.

I contacted my car seat tech/police officer. She said that the law is very loose when you have a MD's note on a prescription pad.

Unregistered said:

Her first suggestion was a high backed booster on the right side of the car so the left shoulder was uninvolved entirely.

I was wondering about an increased angle of recline when RF, but I don't know if that is safe or would reduce the pressure on the shoulder.

Unfortunately for the next few months keeping pressure off his BPI is essential to having function later in life; he is going through a growth spurt and it is a very crucial time in his OT as well. It may come down to this; safe in the car vs. use of his arm later in life.

I contacted my car seat tech/police officer. She said that the law is very loose when you have a MD's note on a prescription pad.

Click to expand...

If this were my child, I would make the choice toforward face with the straps above the shoulder so there would be no pressure from the straps on the shoulder. Limit the time in the car.

To comment on the bolded parts, "safe in the car vs. use of his arm later in life" If he isn't properly restrained there could be no "later in life." :twocents:

Also, it really doesn't matter that the law is "loose when you have a MD's note". Law or not, it's not safe to alter the use of a carseat.

Unregistered said:

Her first suggestion was a high backed booster on the right side of the car so the left shoulder was uninvolved entirely.

I was wondering about an increased angle of recline when RF, but I don't know if that is safe or would reduce the pressure on the shoulder.

Unfortunately for the next few months keeping pressure off his BPI is essential to having function later in life; he is going through a growth spurt and it is a very crucial time in his OT as well. It may come down to this; safe in the car vs. use of his arm later in life.

I contacted my car seat tech/police officer. She said that the law is very loose when you have a MD's note on a prescription pad.

Click to expand...

Oh my word.

I am sure your doctor means well, and wishes to protect your child's shoulder, but the 'advice' she has given you could lead to grave, even fatal consequences for your child in even a mild-to-moderate accident. While your child not losing the use of his arm is of serious importance, sacrificing his spinal cord...or his life...seems a rather uneven trade off.

There are several special needs technicians on the board and I am sure they will come along with suggestions.

A belt positioning booster is absolutely not appropriate for a 1 year old child. A bare minimum for booster use is 4 years and 40 pounds. Not only is a one year old not mature enough to sit in a booster (simply wiggling in the wrong direction at the wrong time could make the booster useless), a child of such small stature could easily be ejected from the seatbelt.

The same goes for not putting the shoulder straps of a child restraint on. He will be ejected, head first, out of the seat, in a front-end impact.

There is a member here who almost lost his 18 month old grand son, about a year and a half ago, due to being in a forward facing seat too early.

In addition to his broken neck, the child also suffered the same injuries your child has, in BOTH arms, so I conjecture that a forward facing harnessed seat is in fact not a good choice for your child.

That child currently rides rear facing in an imported seat with the harness correctly placed and adjusted. The use of the car seat is in no way affecting the recovery from his injury.

I suggest keeping him out of the car as much as possible, and I would consider placing a cloth diaper over his arm and shoulder prior to tightening the strap, while being very careful not to 'over'-tighten, but under no circumstance should you fail to correctly place the harness or use a booster.

I'm gonna throw this out there and hope that a tech evaluates it, because I don't know if it would be a legitmate option, but I wonder if it might at least help some of the problems.

I think that some of the problems, whether RF or FF, are going to remain the same due to the seat you have. The thing with the EFTA is that the nature of its infinite adjust harness is such that it's always *at* the child's shoulders, whether RF or FF.

I wonder if it would make sense to get a seat with a very tall shell (Complete Air, Radian, maybe TF although those slots are further apart) and keep him RF, but use the slots above his shoulders? It would be against manufacturer's suggestions, but with plenty of room above his head, it would not endanger him in regards to ramping up above the seat shell. If you left the maximum amount of safe slack in the harness (tight enough, but just barely so,) I would think that would put limited pressure on that shoulder. In that event, the only time there would be significant pressure on the shoulder is in a crash, at which point, I think his immediate safety (ie not being ejected, ergo possibly killed, in a crash) would trump the long-term use of his shoulder.

Even if you opt to FF him, I would consider getting a new seat, so that you can place the harness significantly above his shoulder. I don't think a bpb is a satisfactory answer.

Only other thought would be something like -- what are those seats called, Kiddy X-Fix I want to say? -- a shield seat. I don't think there are any available in the US, but they are available in Europe and this might be a legitimate reason to import one. They restrain the child with a dense foam shield around the torso, and leave the shoulders/head totally free.

Hopefully someone who knows more than I do can chime in and evaluate either of those options, but since no one had pointed that out about the EFTA I wanted to make that point.

ETA: I mixed up the names of two seats, it is a Kiddy seat but the X-Fix is something totally different. Kiddy is the company, here is an example of the type of seat I was talking about...

http://www.kiddy.de/gb/infinity-pro-dessins

Maedze said:

Oh my word.

I am sure your doctor means well, and wishes to protect your child's shoulder, but the 'advice' she has given you could lead to grave, even fatal consequences for your child in even a mild-to-moderate accident. While your child not losing the use of his arm is of serious importance, sacrificing his spinal cord...or his life...seems a rather uneven trade off.

There are several special needs technicians on the board and I am sure they will come along with suggestions.

A belt positioning booster is absolutely not appropriate for a 1 year old child. A bare minimum for booster use is 4 years and 40 pounds. Not only is a one year old not mature enough to sit in a booster (simply wiggling in the wrong direction at the wrong time could make the booster useless), a child of such small stature could easily be ejected from the seatbelt.

The same goes for not putting the shoulder straps of a child restraint on. He will be ejected, head first, out of the seat, in a front-end impact.

There is a member here who almost lost his 18 month old grand son, about a year and a half ago, due to being in a forward facing seat too early.

In addition to his broken neck, the child also suffered the same injuries your child has, in BOTH arms, so I conjecture that a forward facing harnessed seat is in fact not a good choice for your child.

That child currently rides rear facing in an imported seat with the harness correctly placed and adjusted. The use of the car seat is in no way affecting the recovery from his injury.

I suggest keeping him out of the car as much as possible, and I would consider placing a cloth diaper over his arm and shoulder prior to tightening the strap, while being very careful not to 'over'-tighten, but under no circumstance should you fail to correctly place the harness or use a booster.

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thank you for your response, and I know that a booster is a bad idea. But I must say, I am sitting here in tears. Because I know that safe will mean a shoulder harness, unless there is an assistive device/seat that I am unaware of. And I HAVE to take him in the car to therapy and the doctor at least x2 week. I was so hoping that someone would give me a tip I hadn't thought of and he'd be safe and no causing any injury.

It is so hard; am I hurting him and his future potential in the car? He had been doing so well and to see him regressing and losing function in his arm is so heartbreaking.

Carrie_R said:

I'm gonna throw this out there and hope that a tech evaluates it, because I don't know if it would be a legitmate option, but I wonder if it might at least help some of the problems.

....

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These are some excellent suggestions.

In particular, I would consider a rear facing seat with a very tall shell, and the harness placed slightly above his shoulders, so it won't be pressing down on them, or an imported forward facing impact-foam harnessed seat.

http://www.eurekakids.net/en/babycare/cybex/child-safety-seat-pallas-cinnamon/33150012

This is the shield seat. You can see the dense impact foam rises high on the child, to roughly the nipple line, but there are no straps on the shoulders.

Carrie_R said:

I'm gonna throw this out there and hope that a tech evaluates it, because I don't know if it would be a legitmate option, but I wonder if it might at least help some of the problems.

I think that some of the problems, whether RF or FF, are going to remain the same due to the seat you have. The thing with the EFTA is that the nature of its infinite adjust harness is such that it's always *at* the child's shoulders, whether RF or FF.

I wonder if it would make sense to get a seat with a very tall shell (Complete Air, Radian, maybe TF although those slots are further apart) and keep him RF, but use the slots above his shoulders? It would be against manufacturer's suggestions, but with plenty of room above his head, it would not endanger him in regards to ramping up above the seat shell. If you left the maximum amount of safe slack in the harness (tight enough, but just barely so,) I would think that would put limited pressure on that shoulder. In that event, the only time there would be significant pressure on the shoulder is in a crash, at which point, I think his immediate safety (ie not being ejected, ergo possibly killed, in a crash) would trump the long-term use of his shoulder.

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This is exactly what I was going to suggest - RF with the harness slightly above his shoulders.

FYI, I don't have an ETFA, but I assume that you can place the straps higher than at the shoulders if you choose to.

BookMama said:

This is exactly what I was going to suggest - RF with the harness slightly above his shoulders.

FYI, I don't have an ETFA, but I assume that you can place the straps higher than at the shoulders if you choose to.

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You can, but they'll pull down when you tighten the harness...it's the position of the shoulders which puts the harness in place.

oh ladies! thank you thank you thank you!


My DH is currently abroad for a week and I can make him carseat shop! Those foam seats without the shoulder strap would be ideal for our situation!


And I don't want anyone to think that I don't believe in the merits of tight shoulder straps to prevent ejection, because I do, I really do. It's just, so horrible to think that something I do to keep my son safe could hurt him in the long run. I'm sorry, it's just hard

And I guess that's what my tech meant with the law is loose? An imported seat?

Maedze said:

You can, but they'll pull down when you tighten the harness...it's the position of the shoulders which puts the harness in place.

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Thanks for clarifying - I think I've only ever installed one EFTA. (I generally work seat check events where everyone gets a new seat, and they're not EFTAs. I wish! )

OP, I agree that you might want to consider a new seat. The My Ride is pretty affordable - I've seen it as low as $129 lately, or the Avenue is under $100 if you can track one down. Both have decently tall shells if your child is short.

Also, putting the seat upright as far as you can will help right? Then you could minimize the amount of force on the shoulders in an accident, and personally I'd feel more comfortable have the straps a bit above, rather than at or below, since the child wouldn't necessarily ramp up in a more upright seat.

I do believe something other then the EFTA would be better though.

I'd like to add that while the instructions on a carseat say to put the straps at/below the shoulders rearfacing, this is from back when rearfacing seats were only infant seats and those seats only had 3-point harnesses... aka... no lap straps to hold the body down during a roll-over type crash.

In europe, they permit having the straps above the shoulders rearfacing AND forward facing.

I would keep him rearfacing, indeed get him a seat where you can put the straps ABOVE the shoulders... and make the parental decision (because of his age, I would want him rearfacing... and to protect him more... his body won't move against the straps if he's rearfacing... he'll move against the shell... the straps will just keep him contained in that shell) to have the straps above his shoulders instead of below.

And your doctor is nuts if she thinks a highback booster is appropriate for ANY child under age 4-6, even for such a condition.

The risks of the harness on the shoulder outweigh the benefits of not using it... I'd rather my child lost the use of his arm than suffered a spinal injury or worse due to being ff too soon or not having his harness on properly, let alone the abdominal and other injuries that can happen from being in a booster too soon.

the risks of the shoulder harness being above the shoulder rearfacing are barely there... because the lap straps are nice and low on the seats recommended and would keep him in the seat in a rollover... and so those risks are outweighed by the benefit of less pressure on his shoulder.

It's all a matter of weighing risks and benefits.

Forward facing is definitely not the answer - in a rear facing seat the seat absorbs the crash forces, in a forward facing one, the CHILD does. FF will put MORE stress on the shoulder, not less. Leaving one shoulder out of the harness could be deadly. Your doctor means well, but needs to not give out such dangerous (and medically unsupported) advice.

I do agree with the others that a different RF seat is a good idea. Something with a super-tall shell that will allow you to have the straps just above (preferably touching, but high enough not to press down) his shoulders.

I have had a child with this type of injury and I am completely shocked and downright appalled that your physician would suggest a booster seat for a child this young! Makes me question their medical judgment when they suggest to endanger the child's life verses the child's arm!

Anyways, I met with the physical therapist, local safe kids director, the physician as well as my foster care agency to try out seats and see what the best option was for this child. I was so thankful everyone took time out of their very busy schedules to help this child on a Saturday morning. Anyways, we ended up using a shield seat rear facing for my almost 2yo tiny child. Yes shield seats are dangerous, but the harness was above the child's shoulders and not really touching them, the shield wasn't a huge issue because the child was rear facing and everyone thought this was the best option. I found literally 1 seat available. Will likely have an older DOM since they are discontinued but should hopefully get you to a decent booster age.
http://www.carseatconnection.com/st...verhead_Barrier_Convertible_Car_Seat_by_Cosco


The second best option which if you can't get a hold of that one seat that I found available is a seat with a really high shell so you could get the straps up above their shoulders rear facing therefore putting less weight on the child's shoulders even if they wiggle a bit. I at that time had 2 vehicles and couldn't get another overhead shield seat since I didn't know how long I would have that child and didn't want to purchase another seat I wouldn't use for long. Anyways I use the Britax Marathon which while it was an ok fit not touching the shoulders too much it wasn't as good as the shield seat. The thing that made it really fit well though was when it was very upright! The more upright it was the more the child wasn't touching the straps. Also remember to take the hugs off the seat if you choose this, but there are other options out there with nice tall shells.

I think the best option in this scenario is RF, with the straps above the shoulders. The EFTA has a quite tall shell and I would not worry about potential "ramping-up" in the seat since I'm sure he has loads of shell above his head. Also, the EFTA is a seat that is very easy to get over-tightened; make sure you tighten just enough so that you can't pinch a horizontal fold over the collarbone. That will help alleviate pressure on his shoulder.

Unregistered said:

oh ladies! thank you thank you thank you!


My DH is currently abroad for a week and I can make him carseat shop! Those foam seats without the shoulder strap would be ideal for our situation!


And I don't want anyone to think that I don't believe in the merits of tight shoulder straps to prevent ejection, because I do, I really do. It's just, so horrible to think that something I do to keep my son safe could hurt him in the long run. I'm sorry, it's just hard

And I guess that's what my tech meant with the law is loose? An imported seat?

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I'm sorry your going through this. I have fibromyalgia (which isn't as serious) and I make decisions everyday about things I want to do/feel obligated to do vs. what will help or hurt me in the long run. Its hard to make these choices for me. I couldn't imagine having to make them for a child. I think the idea of a new shield booster is great! Certainly an improvement from what you have now. Only other suggestions I have are public transportation or walking. Don't know if its possible. I hope you find a solution and that he heals quickly!