Bilateral Leg Amputee Baby and Car Seat Safety

Hi! My 13 month old is a bilateral lower leg amputee. In about a month, he will have his first set of prostheses to begin to learn to stand/walk.

I know that the current ideology supports extended rear-facing, but what about a baby fitted with prosthetic legs??? It might not always be feasible to remove them (clothing, his tolerance with new devices, etc.) prior to riding in the car. But rear facing + prostheses seems dangerous to me!!

He is a little peanut (you know, minus a lot of typical bones and all) and weighs in now at about 19 pounds.

I want to know if car seat safety studies take into account children with limb differences?

Bump

What are your safety concerns? I'm notcoming up with any off the top of my head but you'd know better than I. Can you elaborate so we can help you think it through?

I think I understand. The prostheses are going to be ackward to move and scrunch up in a rearfacing seat'?

Out of curiosity I did a little googling and found a small study that showed that the increased upper body mass in men with lower limb amputations gave them more or less equal weight and nutritional goals as they had had prior to their amputations, so his weight might not actually be very much less than he might have had without amputations.

I would not think that prostheses would be harmful to a rfing child at all. Children rfing in casts and hard braces all the time. There is even a special carseat made specifically for kids with hip casts with cut away sides to allow the legs to spread.

I might look at putting him in a seat with rebound control so it doesn't bounce up toward the back of the seat as much, but I really see no problem even without it.

One sensitive point to discuss...you don't need to share just take note if it applies...if his amputations were a result of something which could affect the growth rate or density of bone tissue, his cervical spine may need more time to develop than most kids and rfing may not be safe for him until he catches up to a minimum bone age of 4.

safeinthecar said:

his cervical spine may need more time to develop than most kids and rfing may not be safe for him until he catches up to a minimum bone age of 4.

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Good thought, but did you mean to say FFing (forward-facing) may not be safe for him?

LISmama810 said:

Good thought, but did you mean to say FFing (forward-facing) may not be safe for him?

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yes, ffing.

safeinthecar said:

There is even a special carseat made specifically for kids with hip casts with cut away sides to allow the legs to spread.

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my son was in a hip spica cast (armpits to toes) for 5 weeks when he was 11 months old. The car seat the hospital lent us was ff only, not to mention I was seriously unhappy about having to use an old borrowed seat, but what choice did I have? I wish I had known there was a hip spica convertible seat, of course this was 8 years ago, so maybe it's newer.

I have a 16 month old - no medical problems but I've tried out a ton of seats. I just wanted to say that the Graco MyRide and the Maxi Cosi Pria 70 have a ton of leg room and her legs don't even touch the back of the vehicle seat when she's rear facing in those.

safeinthecar said:

Out of curiosity I did a little googling and found a small study that showed that the increased upper body mass in men with lower limb amputations gave them more or less equal weight and nutritional goals as they had had prior to their amputations, so his weight might not actually be very much less than he might have had without amputations.

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I believe the key to your finding is "men". My little guy hasn't had enough time to develop much strength in his upper body.

And, wow! a lot of good feedback already!

But I'm still nervous! Here are my concerns a little more specifically.

1. prostheses will not react in an accident as biological legs would. Imagine your baby riding with a stick in the backseat! Make that two sticks, attached to short residual limbs. Straight sticks, with no bending ability. (mechanical knees are down the line, but not for a baby!) So, to my thinking, is that an impact could cause these legs to shove into my son, and it would be too much pressure for his body to absorb without much damage. is it truly always better to remain rear facing? is that a certainty?

2. he's currently in a chicco keyfit 30. I never even used an infant seat with my older two children (14 and 7, now grown-up sized and in a booster, respectively) just a convertible. but my baby is small and the infant seat still fits him comfortably. If I look for a seat with more leg room to accommodate his new legs (being manufactured right now, so exciting!) I am so worried that because his weight is almost all above the waist, he could slip out of the straps somehow. does that ever happen?

I appreciate you all thinking about my situation, thanks!

I am not concerned about the straps restraining him.

You could minimize the risks by selecting a seat with rebound control features.

More limbs are injured forward than rear facing; I think that's relevant in that forward facing his prosthetics are just as likely to slam into him, if not more (depending on type of crash.)

I wouldn't be concerned about him slipping through the straps. Properly positioned and tightened straps will keep him in the carseat.

I showed your post to my Safe Kids director who is special needs trained and has seen a lot of SN cases. She suggested contacting Marilyn Bull at Riley Children's Hospital: http://www.preventinjury.org/specNeeds.asp . Marilyn Bull and her team at Riley are the experts at SN transportation.

If you do contact them, please post back here what they recommend for you.

bannerday said:

1. prostheses will not react in an accident as biological legs would. Imagine your baby riding with a stick in the backseat! Make that two sticks, attached to short residual limbs. Straight sticks, with no bending ability. (mechanical knees are down the line, but not for a baby!) So, to my thinking, is that an impact could cause these legs to shove into my son, and it would be too much pressure for his body to absorb without much damage. is it truly always better to remain rear facing? is that a certainty?

2. he's currently in a chicco keyfit 30. I never even used an infant seat with my older two children (14 and 7, now grown-up sized and in a booster, respectively) just a convertible. but my baby is small and the infant seat still fits him comfortably. If I look for a seat with more leg room to accommodate his new legs (being manufactured right now, so exciting!) I am so worried that because his weight is almost all above the waist, he could slip out of the straps somehow. does that ever happen?

I appreciate you all thinking about my situation, thanks!

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My bet is he is stronger than you think. Kids with astounding disabilities have this amazing ability to fight for independence and motion.

Kids in cast don't have bendable knees and rfing is safe for them. In fact, he at least will still be able to bend at the hips, which is not possible with a spica cast. The primary restraint when rfing is the tops of the shoulders. The child moves into and up along the shell of the car seat and the harness catches on their shoulders and holds them in. This is why the harness needs to be at or below the shoulders rfing. We don't want a child sliding up before the harness catches them, we want them to stay seated firmly. Hip straps help with this a little, but more as a fail safe if the harness wasn't as tight as it should be (you shouldn't be able to pinch a fold in the webbing at the collarbone) and to make it so a child can't wiggle out sideways.

Hip straps are instrumental in ffing seats, but honestly, as long as he has leg below where the hip straps go I doubt this would affect seat performance.

His prosthesis does need to be included in his weight when choosing a car seat BTW, and depending on how it wraps around his hips may change his seated height and cause a change in what harness height is needed.

Oh wait! I just thought of something! One of the techs here has extensive experience with a company that makes prosthesis. I'll go track her down and see if she can add her opinion.

Hello, so far the responses seem great. I'm going to discuss this thread with a retired president of the American Academy of Orthotics & Prosthetics. Then I will reply from the laptop (phone is frustrating).