Cerebral Palsy Car Seat Advice

[Ashley]

My son is 2 years old and lives with moderate cerebral palsy affecting one arm & both of his legs. His head/neck control is good, though a little less than a typical 2yo. His CP causes increased tone in his hips & hamstrings and he wears AFOs (solid, not hinged) on both legs. We are having increased difficulty getting him in his car seat in a rear facing configuration (Diono Radian 3QX) and are wondering if it would be better to forward face at this point.

He weighs 25lbs & is 36” tall. He meets all minimum requirements in our state for forward facing in a car seat, however I have always felt best ERFing with my other children & I’m wondering what others thoughts are on the situation. We’re also dealing with him getting carsick regularly & my husband thinks FF would help with that as well.

 

[Carrie]

Hi Ashley!

I’m not logged in, but I’m a long-time member (10+ years) who works f/t as a car seat tech in pediatric healthcare, including lots of work with kids who have special needs (commonly CP).

Generally speaking, the “RF as long as possible” rule of thumb is doubly true with kids who have special needs. However, if his head/neck/torso tone is typical for his age, I don’t know that he’s at more risk FF than any other two year old.

My biggest concern at that point would be that the Diono sits *very* upright, and he is likely to have head slump. If he’s like many of my kids with high tone, he’s likely to kick into extension once he goes FF, which will make slumping worse. Pulling up his knees may help; although we generally don’t recommend adding anything to the car seat, sometimes placing a rolled towel under the knees is the best option we have vs extensor thrust. If you opt to go that route, a) make sure the roll is not under his bottom, only knees, b) make sure it’s in front of the buckle/completely outside of the harness system, and c) load him already “folded” (more below).
The advantage to staying RF is that it keeps his knees/hips bent, so he’s less likely to extend out of the seat. The Radian is pretty good for space; I do have some families who have chosen the Extend2Fit for a bit more room (as long as their kids can tolerate the headrest). There are a couple of swivel seats on the market that may make good options as well - I worked with the Evenflo recently and was pretty pleased with the leg room, but I haven’t worked with them enough to have a good opinion yet.
Loading him “folded” may also help - one arm under armpits, one under knees, keep hips in flexion. This is true for either RF or FF. If he gets PT, they may be able to help with strategies for loading - possibly OT too, but this is an area where PT may be stronger (I adore my OTs though, and mine have done enough car seat stuff that they could effectively strategize - so YMMV!).
Hopefully this is a good start - I’m happy to swing back later (and maybe find my login!) to follow up. My goal is always to partner with families, so if there’s something here that I misunderstood or does not reflect your kiddo’s needs, let me know and I’m happy to tweak my advice.

Take care!

-Carrie (CPST-I, Safe Travel instructor, etc.)