Car seats are all about keeping children safe in the vehicle. Driving in a car is one of the most dangerous things we do. In fact, it’s one of the leading causes of accidental death in the U.S. However, driving nearly every day is almost unavoidable, so vehicle and car seat safety should be a number one priority. This can be more complicated when you have children with disabilities or complex medical needs.
The car seat shopping experience for most families is fairly simple with the help of a car seat buying kit. You find a seat that fits in your vehicle and is appropriate for the height and weight of your kiddo. And then the rest comes down to personal preference and lifestyle. But, if you have a child with special needs, the car seat buying process is more challenging. A child with disabilities may need to be in a car seat for much longer than other kids their age. And they may need extra support tools or special features to accommodate their needs.
When choosing a car seat for a child with a disability or medical consideration, the best option is to find regular car seats that meet the child’s unique needs. And to use those regular seats for as long as possible. Conventional car seats from companies like Graco, Safety 1st, and any other popular baby gear brand are easier to and cheaper to obtain. And much more user-friendly than specially-designed adaptive car seats. But adaptive car seats fill an important need for children who have outgrown all standard car seats or who need more support than regular car seats can provide. So, today, we’re sharing a round-up of car seats that can work well for children with unique transportation needs.
Car Seats For Special Needs
Car Seats for Premature Babies
Babies born before 37 weeks and babies who weigh less than 5.5 lbs (2.5kg) at birth should have a car seat tolerance test done before they leave the hospital. And even if your baby doesn’t check either of those boxes, their pediatrician may request a car seat test if they needed certain types of respiratory support after they were born. This important test makes sure that high-risk infants can tolerate the semi-upright posture of a standard rear-facing car seat — usually, they must sit fully buckled in their seat for 90 minutes to two hours. And they must keep their oxygen saturation and heart rate at normal levels that entire time.
These tiny, fragile passengers can have some unique needs when it comes to car travel. They may be too small to safely fit in many car seats, even those with 4 or 5-pound minimums. Fortunately, we’re here to help you navigate this challenge!
This is one of our favorite infant seats for premature or low birth-weight babies. With approval from the manufacturer, this seat can be used with babies as small as 3 pounds or 15.75 inches long. Like our other favorite car seats for preemies, the Litemax offers special harness adjustments that let the seat fit the tiniest passengers perfectly — the harness height is very low, the crotch buckle can be shortened and placed very close to the baby’s body, and the overall positioning is excellent! When this seat is adjusted properly, most healthy preemies can pass their car seat test with flying colors. So if a soon-to-be NICU graduate has failed their car seat test in a different seat, even when the other seat is fitted correctly, the Litemax is a seat we commonly recommend as a next step — and you can find our full review of it here.
But what if baby’s harness fit in the Litemax is perfect, and they still can’t keep their oxygen levels high enough when they’re buckled in? Or what if you’re bringing home a baby with complex airway, skeletal, or neurological problems who can’t be safely buckled into a normal infant car seat at all? Well, in that case, it might be time to consider a car bed!
When a baby can’t maintain their oxygen saturation and heart rate in a semi-upright infant car seat, they should travel lying flat on their backs in a car bed. This unique child restraint installs sideways on the vehicle seat, with the child lying down — this is why car beds have their name! — and their head positioned towards the center of the car. Some hospitals provide loaner car beds to patient families. While some parents may need to purchase one on their own; fortunately, the Dreamride has a wonderful price point! The Dreamride can be installed with either the vehicle seatbelt or the lower anchors, similar to a more conventional car seat.
But unlike other US car seats, the Dreamride has a 3-point harness that anchors at the child’s shoulders and crotch. Between the 3-point harness and the laying position, this product certainly looks stranger than the car seats we’re used to! But it serves an important purpose for medically fragile infants. And babies can use this restraint until they reach 20 pounds or 26 inches long.
Car beds are not suitable for healthy children.
They’re less safe than a rear-facing car seat in a crash. So when a baby needs a car bed, parents should avoid travel and keep the baby at home except for travel to medical appointments. And car beds are very hard to install and adjust properly compared to normal car seats — so families using one should collaborate with a CPST who has experience with them. When a baby is discharged from the hospital in a car bed, their medical team should make an appointment for about 4-6 weeks away to try another car seat test in a regular infant seat. As soon as baby passes their car seat test, they should transition to the regular car seat and leave the car bed behind!
The Hope Car Bed is another option for infants and toddlers who can’t tolerate a normal rear-facing car seat. This car bed can be used until 35 pounds and has a flexible height limit. It also offers several restraint options. Even a “bag”-type device to accommodate medical conditions such as spinal or abdominal birth defects, brittle bone disease, and hip dysplasia. And with physician approval, a child in the Hope Car Bed can lie on their back, stomach, or side. It’s a very versatile option for infants with chronic medical needs who will need to use a car bed for months or years.
This product sits sideways and must be installed behind the passenger seat extending into the center. It occupies two vehicle seating positions and requires two vehicle seatbelts to install. It also has tether straps that secure the seat to the rails of the front passenger seat. This car bed is ten times more expensive than the Dreamride. So parents may be able to obtain one through a hospital or medical equipment rental company. With proper physician documentation, insurance might cover the purchase of a Hope car bed as well.
Rear-Facing Special Needs Car Seat Options
This widely available car seat can come in handy for several unique travel situations! It has a manually rethreaded harness and a flat backrest without a bulky headrest. This makes it a good option for children with airway issues or babies who need cranial helmets. Because the flat surface can minimize forward head slump. And with its wide seating area and low sides, it can even work for some children in spica casts, depending on the hip angle of the cast. It rear faces up to 40 pounds and 40 inches. And parents should remember to include their child’s helmet, cast, or other medical device when they check their child’s height and weight for their car seat.
The Sonus has one recline setting for rear-facing. So it’s not very upright or compact — but it’s not enormous either. It works well for newborns, as long as they meet the 5 pound and 19 inch minimums for this seat. And it’s a long-lasting option overall, with forward-facing limits of 49 inches and 65 pounds!
Evenflo is dedicated to working with parents and caregivers to ensure all children can travel safely. Parents of children with unique or complex travel needs, such as spica casts or airway concerns, should contact Evenflo for personalized help to see if the Sonus will meet their child’s needs!
While rear-facing as long as possible is the safest option for every child, it can be extra important for children with airway concerns or low muscle tone. Rear-facing children are able to travel in a much more reclined position than forward-facing passengers. And this recline helps children with poor head control keep their heads back and their airways open. The Graco Extend2Fit 3-in-1 allows children to rear-face until they reach 50 pounds or 49 inches tall. And it allows any rear-facing passenger to ride at a newborn-safe recline. And its headlining feature, the extendable leg rest panel for added legroom rear-facing, means that older, bigger rear-facing kids have plenty of space. Even if they have limited range of motion in their legs, or wear AFOs (ankle foot orthotics)!
Once rear-facing is outgrown, this seat can be installed at a considerable recline in forward-facing mode if the child still needs postural assistance with head control. And it can also be used as a familiar, supportive booster seat once a child outgrows the 65-pound, 49” forward-facing harness limits! While such a large seat isn’t always our favorite in booster mode, it can work very well for older kids with mild physical disabilities, who just need a bit more support from their booster than lower-profile options can offer.
Read our Graco Extend2Fit 3-in-1 Review here.
This car seat is a wonderful example of a mainstream product that also happens to be extremely accessible for people with disabilities! The Evenflo Revolve Extend swivels with an easy, one-handed release mechanism so that the car seat can face the vehicle door for loading and unloading. This feature can be a game-changer for parents of children with physical disabilities, making it a breeze to lift a child in or out of the car when the child can’t climb in alone or even help hold their own weight. And it can be a great tool for adults with mobility limitations as well!
Like the Extend2Fit 3-1, the Revolve Extend has rear-facing limits of 50 pounds and 48”. So it allows children with low tone, airway issues, or poor head control to rear face for a very long time — and while the manual requires rear-facing children to sit more upright after they reach 20 pounds, Evenflo is happy to work with caregivers individually if a larger child needs to be more reclined. Once the rear-facing limits are reached, the seat offers forward-facing harness and high-back booster modes — and the swivel feature works in all three modes! This car seat is truly impressive. And it can be a wonderful and long-lasting option for families who need the accessibility of a swiveling, easy-to-load car seat.
Read our Evenflo Revolve Extend Review here.
The Wallenberg is designed specifically for kids who are in hip casts. It has many adjustments to help fit your child while they are casted. It is a convertible seat, meaning it has both rear and forward-facing modes. The rear-facing limits are 5 to 40 pounds, and the forward-facing limits are 25 to 80 pounds. The maximum height limit for this seat is 60 inches. The manufacturer recommends using the seat in the rear-facing configuration to the limits before using it forward-facing, which is in line with what we always say!
This seat is only 17″ wide, so it will even fit in some 3 across configurations if needed. It is fairly large front to back when the rear-facing mode is being used.
Although this seat can be installed with lower anchors, the lower anchor weight limit for rear-facing is 24 pounds. And the forward-facing limit is 31 pounds. Due to the low limits for this installation method, we do recommend installing it with the seat belt. The lower anchor weight limit is your child’s casted weight.
Once the cast is removed, your child should move back to a traditional car seat immediately.
The next car seat is a specially designed rear-facing option for children with omphalocele, who can’t have harness straps constricting their abdomen. It can recline up to 50 degrees based on your child’s needs. And features advanced safety elements, such as an anti-rebound bar. (Learn more about advanced car seat safety features here.)
Your child can fit in this car seat from birth to 40 pounds. Which means it’ll get you well into toddlerhood! (And, hopefully, by the time your child outgrows the seat, their omphalocele will be surgically corrected. Then, you can shop for a standard, less-spendy car seat using one of our buying kits!)
Special Needs Car Seat for Children
The Chicco MyFit is the tallest harnessed car seat available currently, with a maximum height limit of 54 inches! While it has the same harness weight limit as other car seats — 65 pounds — taller children can stay harnessed in the MyFit for a year or two longer than other seats with 49-inch height limits. Once a child graduates from a harness to a booster seat with the vehicle seatbelt, maturity is crucial so that the child can stay seated in the correct position. So for kids with ADHD, autism, or other conditions that affect impulse control, that extra harness time can be so important!
The positional support of a harness is also helpful for children with low muscle tone or certain physical disabilities, as well — and the MyFit also features a slight recline that can also be helpful. Most children are ready for the responsibility of a booster seat around 5 to 7 years old, but for those of us whose kids need to stay harnessed until the last possible moment, the MyFit is a great option!
The MyFit does not work well in vehicles that have non-removable headrests, especially if they protrude forward. And in some cars, it can be a bit challenging to install, even when there isn’t any headrest interference. But as the longest-lasting conventional harnessed car seat on the market, it definitely deserves a spot on this list!
Read our Chicco MyFit Review here.
The Ride Safer Travel Vest is a niche product that falls somewhere between a harness and a booster. It’s like a booster because its job is to position the adult-sized seatbelt correctly on a child-sized body — though it brings the seatbelt down to the child, instead of boosting the child up to the seatbelt. And it’s like a harness because it offers a lot more movement restriction than a normal booster with the vehicle seatbelt, thanks to the top tether attachment. This makes it great for many things: it’s a popular travel option for parents of elementary-aged kids who don’t want to bring larger car seats or boosters along. And it’s a good option to bridge the gap between harness and booster for kids who fall in between those two stages!
The minimum age for safe booster use is 5, but the highest harness weight limit available is 65 pounds. (We know, we’d love to see higher-weight harnessed seats again, but the reality is that it’s very difficult to engineer a harness that can restrain a larger child and still pass strict federal crash testing requirements. We’ll discuss some high-weight harnessed seats below, but these products require special installation techniques that we won’t ever see on affordable, conventional child restraints.) It’s not uncommon for three or four-year-olds to surpass that 65lb mark and outgrow their harnessed car seat before they’re old enough to be safe in a booster seat.
The Ride Safer Travel Vest is usually the easiest and most affordable solution to this dilemma!
The Ride Safer Travel Vest offers a top tether, similar to the one on your forward-facing car seat, that hooks directly to the shoulders of the vest — restricting how far a wiggly child can move in the backseat. It also allows the vehicle seatbelt to be locked, another way to help a child stay in a safe position (remember, it’s not safe to lock the seatbelt for a kid in a regular booster because the vehicle seatbelt needs to activate in a crash, just like it does for the adults in the car). Parents also have the option of adding a crotch strap to help improve seatbelt fit. With all these added features, The Ride Safer Travel Vest can be a great option while a child grows and matures to booster readiness. It can also be useful for families in the long waiting process for a customized, adaptive car seat!
Read more about The Ride Safer Travel Vest here.
The Roosevelt is an adaptive car seat for children and teens. The base model fits from 35 to 115 pounds and has a padded headrest and a wide range of harness adjustment options. Where the Roosevelt shines is in its accessories. Each one adapts the car seat to the child’s specific travel needs. They have a scoliosis kit, escape-proof buckle covers, seat extensions, extra-long harnesses, and more.
Remember that car seat add-ons are completely safe when the manufacturer produces them, as they crash-test all accessories in conjunction with the Roosevelt seat base model. So, if you find a Roosevelt accessory that’s a must-have for your rider, don’t be afraid to use it!
Many families can obtain a Roosevelt, or any appropriate adaptive car seat, through their child’s health insurance. They’ll need a letter from the child’s physician explaining the child’s diagnosis or disability and why the specialized seat is needed. When families work with their child’s occupational or physical therapists, as well as a CPST who’s received extra training for adaptive car seats, they can typically select needed accessories during the ordering process so that the seat arrives ready to go.
Special Needs Booster Seats for Adolescents and Adults
The Thomashilfen Recaro Monza Nova is a favorite booster for special needs children. It’s designed for children with autism spectrum disorder, cerebral palsy, and ADHD. It can be functional for people with a wide variety of disabilities or unique travel needs.
The seat has a swivel feature that rotates the car seat towards the door opening, making loading and unloading much easier. Another unique feature of this car seat is the integrated speakers. They make it easier for you to play soothing music or sounds for an anxious or disruptive rider. This is a game-changer for some families!
This seat can be used until about 110 pounds and 59 inches with a max torso height of around 18.9″. The 5-point harness can be used the whole time, and the ventilated foam is easily adjusted for the best support. The harness is for positioning purposes only, and the seat belt must be used on top of it. The machine washable covers and added accessories keep your seat functional throughout the entire car seat journey.
The Thomashilfen Hercules Prime is one of the newest adaptive seats on the market. It can accommodate individuals who are between 40 and 176.4 pounds and 51.1 to 70.9 inches. Like the Recaro Monza, the integrated harness on this seat is for positioning only. And the seat belt goes over it. This seat has a base with a swivel and a recline function.
This seat has a much taller headrest than the Recaro Monza, so it’s longer lasting torso height-wise. It can accommodate an individual with a torso height of up to 25.2″. This seat folds up if you need to transport it.
It has rigid lower anchors to easily click it into the vehicle. So it’s very easy to move between different vehicles, unlike many of the other special needs car seats.
This belt-positioning booster is similar to the Ride Safer Vest. Instead of propping your child up like traditional booster seats, the vest pulls the seat belt down to fit appropriately. This is especially useful for a special needs booster seat. Because your child may quickly reach the height maximum on a traditional restraint system when boosted up. When sitting directly on the vehicle seat, they have a lot more room to grow!
It’s suitable for individuals 65 to 175 pounds. So this restraint system is definitely for the last stage of the car seat journey. It keeps disabled adolescents or adults upright and secure, even when they outgrow traditional seats offered. It’s a pretty simple mechanism that does a lot to keep your child safe — simply by ensuring a proper seatbelt fit and helping the passenger stay in position, this restraint allows the vehicle seatbelt to do its job!
There are car seats out there for children of all needs and abilities!
If you’re a parent of a child with a disability, medical condition, or other unique travel needs, it’s of utmost importance that you know what options are out there! Just remember, every child is unique and may require a different type of car seat or system. You may be able to work individually with a specially trained car seat safety technician who is affiliated with your child’s medical provider or hospital facility. They are experienced in the process of choosing and obtaining an adaptive restraint. And they can provide personalized recommendations for any situation. And of course, you can always meet with one of our car seat safety technicians for more help and support. Our technicians have lots of experience with disability-related travel challenges, both personally and professionally!
Our goal is to keep ALL children snug, supported, and safe in the vehicle. So, let us help you find the perfect solution for your child’s safety and comfort on the road. We can do this together!
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