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Hip spica casts and other devices, such as splints, can make it impossible for a baby or toddler to sit in a standard car safety seat. The Spelcast convertible car seat is designed for babies and toddlers in casts. It is used rear-facing for babies 10 to 20 pounds and forward-facing for toddlers up to 40 pounds and 40 inches. A tether strap is available for use forward-facing. Other options for young children in hip spica casts may be car beds for babies or combination car seat/booster seats with low sides for toddlers.
Babies and Toddlers With Tracheostomies
Most babies and toddlers with tracheostomies (a breathing tube placed into the windpipe) are able to use standard car safety seats. However, avoid using child restraints with tray or shield harness systems. In a crash or sudden stop, these could come in contact with the tracheostomy, and injure your child or block her airway.
Many child restraints that are designed for children with special needs must be installed with a tether strap and a seat belt. A tether strap limits forward movement of the child safety restraint in the vehicle. It attaches to the restraint and is bolted into your car at a vehicle anchor point. The tether strap and hardware come from the car safety seat or restraint manufacturer. If your car safety seat requires a tether, be sure to take your vehicle to a dealer who can help you find the hole or drill one for you in your vehicle if necessary. Never drill a hole yourself. You could puncture the gas line or damage your vehicle. If you have a newer car, you may already have tether anchors. However, these anchors are for use with standard car safety seats and may not be strong enough to tether heavier, specialized medical restraints. Follow the child restraint manufacturer's instructions and vehicle owner's manual regarding tether installation.
Babies are safest riding rear-facing until they are at least 1 year of age and weigh at least 20 pounds. In a rear-facing car safety seat, a baby sits back at an angle to help prevent his head from falling forward and affecting his breathing. This position helps to support his head and back and spreads the forces of a crash over these areas instead of his neck.
The rear-facing position also can help children who:
· Break their bones easily
· Have trouble breathing
· Are small for their age
Many car safety seats allow babies and small children to ride rear-facing until they reach about 30 to 35 pounds or the top of the head is near the top of the seat. If a car safety seat holds children rear-facing to higher weights, the child should remain rear-facing until reaching the top weight or height allowed for the car safety seat for best protection. Check the labels on your car safety seat and the instruction manual for the seat for rear-facing weight and height limits.
Older Children in Hip Spica Casts
The modified E-Z-On Vest is designed for children 2 to 12 years of age who weigh 20 to 100 pounds. It allows a child to lie down in the back seat of the vehicle. The vest must be installed with two seat belts. One seat belt is secured under the chest strap of the vest, and the other seat belt is secured under the hip strap of the vest. Older children in hip spica casts also may fit in a combination car seat/booster with low sides.
Remember, never use a reclined vehicle seat to transport a child. In some instances, professional transport may be needed.
Babies and children who can bend at their hips or sit up in their casts
Most babies and children who can bend at their hips or sit up in their casts can use standard car safety seats. Make sure the cast does not get in the way of the buckle and fits inside the restraint. A Spelcast car safety seat, forward-facing car seat/restraint, or combination car seat/booster seat with low sides can be useful for children in broomstick casts whose legs are spread widely apart. A convertible car seat with a 5-point harness is an option for children who have a thick, long leg cast that prevents buckling of a tray or T-shield harness.
If an older child is in a cast and can sit up, she may be able to use a belt-positioning booster seat or a seat belt if she is big enough. Make sure she is using the booster seat or seat belt properly and has enough legroom. The lap belt should be worn low and snug across the thighs. The shoulder belt should be across the chest, never behind the back or under the arm. Put padding or blankets on the floor so that the child's legs will be better supported during travel.
Children and Wheelchairs
Most wheelchairs are not crash tested. When possible, buckle your child in a car safety seat or restraint that fits her size and positioning needs. If you must transport your child in a wheelchair, install it in a forward-facing position with 4-point tie-down devices attached to the main frame of the wheelchair (see picture). Then restrain your child separately with a shoulder/lap belt. Positioning belts used with wheelchairs are not safety restraints. Lap trays attached to the wheelchair should be removed and secured separately during transport.