Written by: Sarah Duckworth OTR/L, OTD

*These are general recommendations. For car seat and vehicle specific information, please read both your car seat and vehicle manuals or ask your local Child Passenger Safety Technician* 

Ensuring the safety of children in vehicles is a top priority for parents while traveling to school, therapy appointments, and around the community. Sensory sensitivities and difficulties with transitions can make car rides difficult and unsafe. Primary concerns of caregivers include the child negatively affecting the driver as well as the child removing the seatbelt.  

Sitting in a car seat can be an uncomfortable experience for children with sensory sensitivities. It is important to identify what is bothering them and provide supports to make it an enjoyable and safe experience. Here are a few examples of uncomfortable sensory inputs that could be impacting your child while riding in the car: 

• Visual: bright lights or increased visual input from items passing the window 

• Provide sunglasses or secured window shades 

• Auditory: Busy highways, unexpected honking horns 

• Provide noise canceling headphones or preferred music while driving 

• Tactile: the seatbelt rubbing against their neck or chest 

• Make sure the seatbelt is properly secured 

• Ensure that your child is at the proper weight and height to use a standard seatbelt. 

• Proprioceptive: difficulties with sitting still 

• Provide a weighted toy or blanket to increase calming input while driving.  

• Difficulty with transitions: use timers, provide a map of the journey, use a visual schedule while in the car or prior to the ride, or provide toys specifically for car rides.  

It is important to choose a car seat that not only fits your child’s current size and age, but also that it is installed correctly. Caregivers should check the fit and installation of their child’s car seat every time the car seat is reinstalled, if the child is growing, or every six months.  

• If your child is unclipping their seatbelt, it may be necessary to see if there is a 5-point harness car seat that fits their weight and height until they are able to safely stay buckled.  

• For children who have outgrown commercial car seats, but are still not remaining safe in a vehicle, please consult your local Child Passenger Safety Technician for assistive technology options.  

• If a child is removing their arms or body from their 5-point harness, please check to make sure the fit is correct.  

• The chest clip should be at or just below the arm pits 

• The harness should fit snuggly over the child.  

1. When you put your child in the car seat, make sure to tighten the harness. You can do this by pulling out any slack from the hips before tightening it at the shoulders. Too much slack at the hips can leave enough room for your child to get their arms or body out.  

2. Pinch Test: A caregiver should not be able to pinch the straps at the shoulders. If you are able to pinch the straps, use the harness adjuster button and strap to tighten the harness (check the car seat manual for more information).  

• The harness should also be threaded through the correct harness holes. For a child that is rear facing, the harness should start at or below the child’s shoulders. If the child is forward facing, the harness should start at or above the child’s shoulders. 

• If your child is opening the doors or windows while the vehicle is in motion, please use the child safety locks on windows and doors for every car ride.  

Checking car seat installation and fit is important for your child’s safety.  

When to Replace your Child’s Car Seat:  

1. When your child outgrows the height and weight limits (refer to sticker on side of car seat).  

• Keep your child in the car seat with a harness until the seat is completely outgrown by height and weight. 

• Most children are between 8 and 12 years old before an adult seat belt will fit them correctly. Do the Seat Belt Fit test (see below) to see when your child is ready. If your child does NOT meet all three conditions, your child should continue to use a car seat or booster seat.  

• The Seat Belt Fit Test: 

1. Your child’s knees bend at the edge of the seat when their back and bottom are against the vehicle seat back. His/her feet should touch the floor for comfort and stability. 

2. The vehicle lap belt fits snugly across the hips or upper thighs. 

3. The shoulder belt fits across the shoulder and chest, NOT across the face or neck. 

2. When the car is involved in a crash call the manufacturer for more instructions.  

3. If the car seat expires (about every 6 years, refer to sticker on bottom of car seat, example pictured below)  

If you are not sure if your child is properly secured in the car seat, you can visit your local police department, fire department, or find a Child Passenger Safety Technician near you at: https://cert.safekids.org/  

Please visit Safe Kids Worldwide for more installation and safety tips. Additionally, if your child is not safely riding in the car due to sensory sensitivities or difficulties with transitions, please consult your child’s occupational therapist.  

References: 

• https://saferide4kids.com/blog/why-do-car-seats-expire/ 

• https://ucsg.safekids.org/ 

• https://www.hopebridge.com/blog/car-safety-for-kids-with-autism/ 

• https://www.nhtsa.gov/vehicle-safety/car-seats-and-booster-seats 

• Plummer, T., Bryan, M., Dullaghan, K., Harris, A., Isenberg, M., Marquez, J., Rolling, L., & Triggs, A. (2021). Parent experiences and perceptions of safety when transporting children with autism spectrum disorder. American Journal of Occupational Therapy, 75, 7505205010. https://doi.org/10.5014/ajot.2021.041749