Car Seats for Special Needs: Best 2022 Guide for All Parents!

The guide below contains crucial factors to consider when choosing car seats for special needs for your children. Parents will find all about:

- Behavioral challenges

- Physical needs

- Physical or supportive child passenger and safety concerns

- Availability of special needs car seats.

So, without further delays, let's dive right into it.


Car Seats for Kids With Special Needs. What You Need to Know?

Special needs car seats are a little different than conventional car seats. They offer more support for your children for better body postures and more comfort.

Please examine the guidelines below if you need the right car seat for your special needs children.

Special needs kids & behavioral challenges

Here are some of the most common behavior types requiring special needs seats and special health care for your kids.

car seats for special needs babies

1. A child still rides in a five-point harness and easily unbuckles the chest clip or the crotch buckle. What can parents do?

You have three options:

  • Ensure the proper installation of your seat - If your child weighs less than 65 pounds, you must schedule an appointment with a verified Child Passenger Safety Technician. They will ensure you are using the child's safety seat correctly. In addition, they will help and guide you through the installation process, and you may find some irregularities to fix in the future.
  • Check if it’s time for a new seat - If you're still using an old child restraint (more than a few years), it's likely that the car seat is worn out, and the straps are loosened. So, kids can open the crotch buckle or chest clip without much effort. Consider obtaining a new car seat with a new, stronger harness to accommodate your kiddo adequately. The harness will have stronger buttons for more support, and kids can't unbuckle so quickly.
  • Positive reinforcement - Positive encouragement and reward can help keep your children with special needs properly restrained in the car seats. The common issue is that parents always stimulate the kids to unbuckle and open the buckles to check the correct use of the seats. However, once they have permission, little ones won't know when to stop and how dangerous unbuckling can be.

2. A child is still riding in a booster seat and easily unbuckles the seat belt, putting the shoulder portion behind their back. What should parents do?

If you have small children fit to ride in a harness, here is what you can do:

  • Place kids in appropriate seats, meeting their size - Many children with special needs unbuckle their seat belt and put them behind as the shoulder portion is digging into their neck. You should accommodate them in a forward-facing harnessed seat as long as kids fit in the seat's weight and size limits. The same issue arises with backless booster seats, as they don't have a belt-positioning clip. Using belt-positioning booster car seats will help position the seat belt to the central collarbone area and keep it from digging into the child's neck.
  • Keep children harnessed as long as possible - Many parents place their children into a booster seat as soon as they fit the manufacturer's recommendation for the seat. This is not always the best option. You should keep your children in a forward-facing harness as long as possible. It is essential for children with special needs, as they may need more time to understand the importance of seat belt restraint and safety standards. The AAP recommends smaller kids should ride in a harness as long as they fit the car seat's weight and size limits, regardless of age.
  • Inspect your seat - Again, it would help to contact your local CPST to inspect your seat. The technicians will notice if something needs immediate fixation and find the right fit for the kiddo. Remember that a special needs child requires more support, so the technician will eliminate discomfort and make your little one ride safer.
  • Positive encouragement - Of course, positive reinforcement also helps encourage children to stay properly buckled in the child restraint system.

3. A child is too big for a car seat or booster seat. Additionally, a child is diagnosed with multiple behavioral concerns. They are a danger to themselves, other passengers, parents, or even other motor vehicles on the road. What is the best solution?

It is advisable to keep a child in their regular car seat, if possible. However, the regular car seat won't work when the child shows severe behavior issues (aggressiveness, escaping restraints, distraction, etc.).

But, parents can find multiple after-market and third-party products to keep their child restrained adequately, including a seatbelt buckle shield locking chest clip. These units are not recommended due to safety reasons. However, many parents purchase these items to protect their special needs child on the road.

However, the National Center for the Safe Transportation of Children with Special Health Care Needs has issued a list of approved special needs car seats and safety vests for children and adults with severe behavioral concerns (more about them further in the article).

It would be best to contact your occupational therapist or special needs CPST to help you find the best car seats and ensure the insurance company will cover the costs, as these models might be too expensive.

What are the physical needs of a special needs child?

best car seats for special needs

A child with special physical needs requires more support and modifications that a typical car seat cannot offer. The requirements can include:

  • Low/ high weight - children with special needs might suffer from obesity or be too slim due to prematurity and similar factors. It would be best to find the special needs car seat to fit their needs after a consultation with your occupational therapist or pediatrician.
  • Positioning needs - kids need the best body position to help them with everyday activities. You can find various safety seats and other products (activity chairs, standers, floor sitters, etc.) to keep their position optimal and add more support to stand or sit better.
  • Airway concerns - kids suffering from respiratory illnesses (terrible cough, risk of aspiration, progressive kyphoscoliosis, upper airway obstruction, etc.) also require a special needs car seat to prevent similar health issues.
  • Poor muscle tone - also known as hypotonia. It's a disorder caused by damage to the spinal cord, brain, muscles, or nerves, resulting in more effort to maintain the proper body posture and increased joint flexibility. A seat is necessary after the scheduled consultation with a pediatrician.
  • Limited range of motion - referring to a joint or a body part that cannot move through its normal range of motion. You need a special needs car seat to keep their body parts well-positioned in the proper place.
  • Casts or braces - are used to keep the body parts in one position. Casts, splints, and braces protect and support dislocated joints, broken bones, and injured soft tissues - tendons and ligaments. You can find a special safety seat to keep their support optimal.
  • Cerebral palsy - disorders affecting a person's ability to move and maintain a proper body posture and balance. A special car seat must keep the body secure and ensure the child can adequately sit while riding in the vehicle.
  • Spinal muscular atrophy - a genetic (inherited) neuromuscular disease that causes muscles to become weak and waste away. You need to find a proper car seat and position your child to meet their needs after a consultation with your OT (Occupational Therapist) or another physician.

For similar medical conditions and requirements, please refer to this page. And, if your child shows transportation challenges, do not hesitate to alarm your physician or a verified CPTS for special needs.

Additional child passenger safety concerns

If your OT or CPTS states there's no need for your child to use a special car seat, you don't need to purchase such a child restraint. Your child might regularly use a conventional safety seat. You only need to have your child restrained and ensure they are secure and safe in the seat.

Let's look at the examples below, so you understand better.

1. A child slumps over in the car seat or booster. They may not have enough trunk or tone control to remain seated upwards. What to do?

The issue occurs when children with specific disorders ride in forward-facing harness seats or boosters.

If the child doesn't fit either rear-facing or forward-facing position, please double-check the size and weight range of the seat, and if possible, keep your child rear-facing as long as possible. Many children are more comfortable in rear-facing positions, and the AAP states it's the safest method for younger kids.

In addition, riding cross-legged is standard for toddlers, so the risk of injuries is reduced. The same rule applies for a forward-facing to a booster seat conversion. Keep your little ones in harness as long as possible, as they're not ready for boosters at certain ages. See more information here.

Use a convertible car seat that can be both rear and forward-facing, with a five-point harness.

2. A child can sit upright in a car seat, but they can't hold their head up. What to do?

Book an appointment with your child's doctor or an OT to discuss using a soft fabric collar for more head support during the rides. You can comply with the facts below:

- You may not need to use the foam as head support - your doctor will determine the conditions for use.

- Never use a neck brace, straps, bands, or similar support to hold your kiddo's head back - such instruments can cause internal neck injuries in a car accident.

3. All of the options above are not helpful. What to do?

Firstly, you should again consult your child's doctor or OT to determine your next steps. Then, consider the following factors:

  • Who will purchase a seat: you or the insurance company? - If your child weighs less than 65 pounds, having the insurance company cover the costs may be challenging. Many conventional seats will meet the child's needs, so there's no reason for companies to buy medical seats, and the official might reject you. 
  • How urgent is your child's need? - Be prepared that it might be a long process if your insurance covers the costs. In the best scenario, you may obtain your car seat in one to two months, but sometimes you may have to wait for one year or more due to denial/approval procedures. Therefore, you might have to find alternative means of support the CPTS suggests until the seat arrives.

Finally, you should choose the special safety seats if your doctor determines they would help your children during the transportation. Let's see our best options below.

Special needs car seats: Types and purposes

does medicaid pay for special needs car seats

Here is the list of the favorite special needs seats for specific medical requirements. Please note that the list doesn't include all the models, and you can refer to the NTCS brochure to get a better insight into the medical seats.

Below you can find the main types of special child restraints:

  • Rear-facing seats - a rear-facing seat accommodates children 35-40 pounds. The AAP claims that the restraints are explicitly designed to keep infants in the safest positions with exceptional body support. Remember that your child might need to use a seat longer than other children, so follow the guidelines. Smaller-sized seats also better accommodate smaller internal dimensions, so they are ideal for premature infants and offer lateral support.
  • Convertible car seats - a convertible car seat follows your child's growth and is an adaptive vehicle-transport seat. The car seat helps keep your little one rear-facing as long as possible, and you can adjust the system as your child grows. It also fits kiddos up to 40 pounds and 40 inches, benefiting kids with low muscle tone and poor body control. Finally, you can use it forward-facing when the child is ready.
  • Forward-facing car seats - the child restraint is ideal for kiddos up to 90 pounds of weight, suffering from positional issues, obesity, or behavior problems. The semi-reclined adjustments offer more adjustments for poor neck and head control. And extra padding or positional inserts accommodate a child with bone or neuromuscular dysplasia.
  • Belt-positioning booster seats - these booster mode systems are valuable for little ones with a higher weight range (larger children) and obesity, but also kiddos with achondroplasia. They offer an excellent lateral base for head, neck, and trunk control.
  • Car beds - car beds are specifically designed for infants. They are an excellent option if your child cannot ride rear-facing in an infant car seat. The special needs car seat is designed to keep your child lying down during transport when they have cardio-respiratory disorders, neuromuscular disorders, cerebral palsy, etc.
  • Hip-cast car seats - the restraints are ideal for children with inadequate seating positions in your vehicle and those with general issues with proper body positions. The convertible seats are both forward and rear-facing. They accommodate children with special needs in hip casts.

The Most Popular Models of Special Needs Car Seat

Here are some of the best special needs car seats on the market. Let's see.

EZ-ON Adjustable Zipper Vest for Family Vehicle
  • Weight range: 31-168 pounds
  • Height range: N/A

The vehicle vest zips up at the back and offers a zipper to cover it to make it harder to unbuckle it.

You can secure the vest on the floor of your vehicle via a floor mounting system. The system then alarms you to use the vehicle seat belt, keeping your little one secure and stable with the mounted harness.

However, the drawback is that the system is designed specifically to use the vehicle's floor. Thus, you must hire a professional mechanic who understands how to install a child restraint in your cars properly.

In addition, parents must be trained well or read the manual with the CPST to ensure the system works properly. Otherwise, it won't offer protection in a crash.

The Roosevelt Standard Special Needs Seat w/EZ Up Head Rest
  • Weight range: 35-115 pounds
  • Height range: 33.5-62 inches

The special seat works similarly to a regular car seat but has been crash-tested. Thus, it's approved by the NCST for medical use. The kit contains two components:

- Locking chest clip that works by looping behind the kid's neck to prevent them from pushing the chest clip down. It also has a turnkey hole in the central position that locks the clip into place. The kiddos cannot undo it without turning it to the release position.

- The crotch buckle cover makes a shield over the buckle and makes it impossible to release the pin from the upright position the child would use.

But, parents find the restraint inadequate, as kiddos can use special tools to turn and unlock the chest clip.

In addition, if the child unbuckles the seat belt holding the system in its place, the restraint will not have the child properly, and they will get hurt in a crash. The seat is also not suitable for small and compact vehicles.

The Churchill Standard Special Needs Seat w/18-inch Seat Depth
  • Weight range: 65-175 pounds
  • Height range: 48-72 inches

The seat comes in two options. You can use it as a locking chest clip or vest with Velcro to close in front. Either option offers a helpful solution to prevent unbuckling.

Of course, you can use both, depending on your child's behavior (aggressiveness, distractions, impulsiveness, escaping, etc.).

The negative side is that the whole restraint depends on the seat belt. The belt holds the Churchill over its top, and the seat serves only as a positioner.

So although your little one cannot escape so quickly, the seat belt might not completely protect your child in a car accident.

Spirit Car Seat
  • Weight range: 25-130 pounds
  • Height range: smaller than 66 inches

The seat is similar to the Roosevelt model and works as a typical car seat. But, it's approved for medical use since the restraint comes with add-ons to keep the crotch buckle and chest clip tight and buckled.

You can also attach accessories similar to a child-proof medicine bottle cap for both parts.

Still, the seat is large, and parents have difficulty adjusting the harness.

And, if the child unbuckles the seat belt, the whole restraint will be unstable, and it won't protect your kiddo in an accident.

  • Weight range: 81-225 pounds
  • Height range: 48 inches - Maximum: the top of ers cannot exceed the top of the vehicle headrest and seat back

The restraint system is similar to the Churchill seat with Velcro accessories.

The child cannot unbuckle the clips or buckles so quickly. They will need more strength to remove the straps and special tools to twist and open the clips.

But, the restraint also uses the seat belt over its top, holding it in the right place. So, if the child succeeds and unbuckles the system, the whole structure will be insecure and cannot protect your kiddo.

Additionally, the unit is more supportive of larger than smaller kids.

Ride Safer Travel Vest Gen 5
  • Weight range: 30-110 pounds
  • Height range: 35-64 inches

The Gen 5 works like the Chamberlain and Churchill as a new-generation vest.

The vest uses a seat belt connected to the harness to keep the child restrained and secure.

You can use it with/without the tether belt and with the lap or shoulder belt only. The device will keep the child safe when properly restrained due to solid buckles.

Unless your child unbuckles and removes the restraint harness, the vest works with the seat belt protecting them in an accident.


How do you keep an autistic child in a car seat?

It would help to restrain an autistic child in a vest with straps so that you won't put extra pressure on their aggressive behavior. The child may scream, yell, or act impulsively, so you mustn't worsen their condition.

When do you need a specially designed car seat?

You need a special seat when your kiddo shows aggressive behavior or has a physical disorder. However, your doctor or the OT must approve the use of special seats.

What is the best car seat for an autistic child?

The best car seat for an autistic child is the Ride Safer Travel Vest Gen 5 since the vest won't restrict their motion, and they can move body parts freely. You won't create additional pressure and aggravate their behavior.

What can I use instead of a car seat?

You can use the travel vests, such as the Ride Safer Travel Vest Gen 5 or the EZ-ON Adjustable Zipper Vest for Family Vehicle, as restraints for older children. You can also use car beds for infants who need to lie down.

Do special needs car seats expire?

Yes, special car seats also expire. They can expire after six, eight, or ten years, but you must find the expiration date in the manual.

The Bottom Line

We hope we have solved your dilemmas concerning using special needs car seats.

Always consult your doctors and OTs first to see if your children need medical restraints or not. And if you do, choose among our presented solutions.

Avatar of Kathy Warner

Kathy Warner

Kathy is a busy mother of two and a CPS technician for more than eight years. Her mission is to awaken parents to the importance of child passenger safety and show them the right practice. You can read more about her here

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