Information for parents

Allied health professionals, like occupational therapists and physiotherapists, usually support children with their vehicle seating and transport needs. Rehabilitation engineers working in rehabilitation settings may also be involved.

Allied health professionals will work with you to assess and prescribe the most suitable vehicle restraint option and strategies for your child, after assessing the specific needs of your child and family.

This website supports allied health professionals in their important role helping you with your child's transport needs.

Until the establishment of MACA, there was no national expert body to support and advocate for best practice transport for children living with disabilities and medical conditions.

So it’s not surprising that many health professionals don’t have access to the information they need to assess the transport needs of these children.

The MACA website was launched to address this knowledge gap. MACA also provides training for allied health professionals to support them in their critical role.

Tell your allied health professional about this website and our training, as they may not know about us yet. If they want more support, they are also welcome to contact us.

Cars are not designed with the safety of children in mind. Child car seats prevent injury to children in a crash. They prevent a child from being ejected from the vehicle and distribute the extreme crash forces over the strongest parts of the child’s body.

Best practice guidelines, developed by experts, outline the safest ways for children to travel in motor vehicles.

Although the guidelines have been developed for children who are able to be safely and comfortably seated in Australian standard car seats (regular) , the general principles apply to transporting children with disabilities and medical conditions.

The general guidelines recommend that:

• it’s safest for children to continue to travel in their current car seat for as long as they fit. The shoulder height markers on the restraint indicate when a child has outgrown it.
• children 12 years of age and under are safest in the rear seat.
• the car seat (or booster seat) is installed correctly by following the manufacturer’s instructions.
• the 5 step test should be used to decide when the child is ready to move into a vehicle seatbelt (usually at about 10-12 years old). The test should be applied to each vehicle the child travels in, as each vehicle is different.

Best practice recommendations:

• Children under 6 months: rearward-facing car seat.
• Children 6 months to under 4 years: rearward- facing car seat until height marker is reached, then forward-facing car seat with built-in harness.
• Children 4 years to under 7 years: stay in built-in harness until height marker reached, then transition to booster seat.
• Children 7 years to under 16 years: stay in the booster seat until 11-12 yrs or until the vehicle seatbelt fits correctly.

Yes. There is a type of child car seat with a built-in harness that is labelled as suitable for children from 6 months to 8 years. However, many children will still fit in this car seat up to at least 10 years of age. Children may need to transition to a special purpose car seat once they have outgrown this seat.

The 5 step test should be used to determine when the child is ready to move into a vehicle seatbelt (usually at about 10-12 years). The test should be applied to each vehicle the child travels in, as each vehicle is different.

1. Back: Can the child sit all the way back against the vehicle seat back?
2. Knee: Do the child's knees bend comfortably in front of the front edge of the vehicle seat?
3. Lap belt: Is the lap belt sitting low across the hip bones touching the thighs?
4. Sash belt: Does the sash (shoulder) belt sit across the middle of the shoulder, not on the neck or out near the arm?
5. Stay: Can the child stay seated like this for the whole trip?

WARNING - Despite some manufacturers claiming that their product complies with Australian standards, no manufacturer has yet developed a chest cross strap that is certified to the Australian accessory standard (AS 8005). Manufacturers are providing misleading information for consumers.

MACA is advocating for manufacturers to develop products that are certified to Australian standards.

If you are experiencing challenges with your child’s transport, get in contact with an allied health professional for help.

Child car seats can be expensive. It’s fine to buy and use a second hand car seat, but use this checklist to guide your decision making.

Make sure the child car seat:

• meets the Australian Standard (or if it’s a special purpose car seat, that it meets an overseas standard and is included on our national register)
• has not been in a serious crash
• is not more than 10 years old (note that special purpose car seats may have a shorter life span - for example, six years)
• has no splits, cracks or stress marks on its shell
• does not have frayed, worn or damaged straps
• has buckles that work properly.

The design of a car and its safety features help reduce the severity of or even avoid a crash.

When you’re looking to buy a new vehicle it’s important to find out what safety features it has. The How Safe is Your Car website is a good place to start. You can find a 4 or 5-star safety rated vehicle for under $5,000, so no matter what your budget is there will be a vehicle to suit you.

When travelling in a car, seatbelts and child car seats provide protection in the event of a crash. It is very distressing and potentially dangerous when children are able to get out of their child car seat while the vehicle is moving. Stories from Australian families show how challenging this situation can be.

If this is happening to you, contact an allied health professional as soon as possible to reduce the immediate risk and develop strategies to improve car travel.

Buckle covers are products commonly prescribed by allied health professionals for a child with disability or behavioural challenge who is getting out of their child car seat and/or seatbelt.

There are two types of buckle covers:

• Child restraint buckle cover: an accessory product placed over the top of the buckle release on the built-in harness of a child car seat.

• Seatbelt buckle cover: an accessory product placed over the top of the vehicle seatbelt buckle to prevent the occupant from accessing the seatbelt’s release button.

At MACA we acknowledge that there’s a real need for solutions to help prevent children from getting out of their car restraint or seatbelt during travel. However, there are some serious safety considerations you need to be aware of.

• There is no buckle cover that is certified to Australian standards (despite some manufacturers claiming they do).
• Many buckle covers need a key or other device to undo the buckle. In the event of a crash or emergency, this could prevent the child from being quickly and easily released from the vehicle.
• Some buckle covers are supplied with a seatbelt cutter which is recommended to always be kept in the vehicle when the child is using the buckle cover. In an emergency the child can be released by cutting the seatbelt or child restraint webbing. If the buckle cover you have been prescribed is not supplied with a seatbelt cutter, we recommend you buy a seatbelt cutter to be kept in the vehicle (these are low cost and available online).
• In some cases, having the buckle cover applied encourages the child to find another way to get out of the restraint. For example some children find they can lift the sash and/or lap parts of the seatbelt away from their body and slip out from under the seatbelt. This is a significant road safety risk.

MACA recommends seeking guidance from an allied health professional who can prescribe buckle covers and provide strategies to support safe travel.

Parents report that some children can easily undo buckle covers. If you are prescribed a buckle cover for your child, your allied health professional will advise you to supervise and observe your child closely. They may also recommend another person go with you in the car for the first few trips. This will reduce distraction for you and provide support if your child undoes the buckle cover.

Where possible, choose travel routes that allow you to pull over safely if needed.

There are differences in state and territory requirements for the legal use of both child restraint and seatbelt buckle covers. To use a child restraint buckle cover, most state and territories require a medical certificate to be carried in the car the child is travelling in.

To use a seatbelt buckle cover, some states and territories require an exemption from vehicle standards as they consider the use of a seatbelt buckle cover as a modification to the vehicle. Your child’s allied health professional can give you the documents you need, plus advice to make sure you’re complying with your state or territory's road laws.

No. Seatbelt and child restraint buckle covers do not comply with Australian standards. MACA is concerned that some buckle cover manufacturers publish misleading information which may suggest compliance with Australian standards. Even though buckle covers are often needed to reduce road safety risks, there’s a lack of research and knowledge about their safety, features and appropriate use.

If you’re experiencing challenges with your child’s transport, get in contact with an allied health professional for help.

While you are able to buy buckle covers online and from mainstream shopfronts and disability product suppliers, due to the risks associated with using buckle covers, we recommend that you talk to your allied health professional about your child’s transport needs.

Allied health professionals are best placed to assess your child’s needs and recommend suitable strategies and/or restraint products to improve your child’s safety and comfort in the car. They will also review your child’s transport needs on a regular basis and give you advice around legal requirements for use in your state or territory.

This depends on the design of the buckle cover. Some products slide easily over a seatbelt or child restraint buckle, whereas others use Velcro and ‘wrap’ around the buckle.

In 2020/21, MACA and La Trobe University received funding from the Commonwealth Office of Road Safety, Road Safety Innovation Fund. This project found that complete vehicle safety solutions are needed to respond to buckle release challenges.

This project developed a report aimed at inspiring vehicle manufacturers, product designers and innovators to develop better solutions for buckle release challenges.

No. Harnesses/vests do not comply with Australian standards as there is currently no standard for harnesses and vests.

However, Standards Australia is currently developing a new standard (AS 5384 Accessories for seat belts used in motor vehicles). The development work started in February 2022 and is considering the inclusion of harnesses and vests.

MACA is represented on the standard committee responsible for developing this standard.

Despite harnesses and vests being the most commonly prescribed device by Australian allied health professionals, there is a lack of standards and research relating to their design, construction, safety performance and use.

To address these gaps MACA sought funding support and is now leading an Austroads project, in collaboration with The George Institute for Global Health, to research and investigate harnesses/vests for both Australia and New Zealand.

Most of the harness and vest manufacturer’s instructions advise that the products must always be used with the vehicle seatbelt.

In addition, two harnesses/vests, the Hemco harness and some models of the EZ-ON Vest, use the vehicle anchorage point, and convert the lap-sash seatbelt to a lap-only belt.

If you have an Australian Standard Britax car seat, it may be suitable to keep using this restraint after surgery with a Britax “hip spica adjustable crotch buckle” (crotch buckle with extended strap) that can be added to the car seat for the time your child is in the cast/brace.

Firstly, you will need to find out the brand and name of your child’s current car seat. You will find this information on the car seat or in the car seat’s instruction manual.

Britax advises that the crotch buckle with extended strap is only suitable for use with Australian Standard Britax child restraints branded:

• Britax Safe-n-Sound
• Safe-n-Sound
• Babylove
• Hipod

A crotch buckle with extended strap provides a longer adjustable crotch buckle strap, that can temporarily replace the car seat’s crotch strap, enabling a longer length to accommodate the child’s hip spica cast.

Britax supplies the crotch buckle with extended strap to approved prescribing organisations (e.g., some Australian hospitals) and safety advocates.

Some hospitals provide car seat loan programs; however, this is not always the case. Parents often find they need to loan a Britax car seat from a local car seat hiring business or purchase a Britax car seat that is compatible with the crotch buckle with extended strap.

Speak with hospital staff who may be able to direct you to organisations (e.g., MAD Foundation) who may be able to assist with the loan or purchase cost. Your child’s maternal and child health nurse may also be able to help.

Crotch buckles with an extended straps are only available from Britax approved prescribing organisations and safety advocates. Speak to your child’s hospital as soon as possible to access a crotch buckle with extended strap.

Yes. The use of a crotch buckle with extended strap modifies the car seat, which means the car seat no longer complies with the Australian Standard (AS/NZS 1754) for child restraints. You will need to comply with your state or territory road laws to legally use a modified car seat. Your allied health professional should be able to assist with this, using the referral letter templates on MACA's website.

Your health professional will provide you with the necessary documentation to comply with the road laws in your state or territory. This may include a medical certificate and an Advice to Parent form which needs to be carried in the vehicle the child is travelling in.

This type of restraint, commonly known as a special purpose car seat, has been specifically designed for children with a disability or medical condition. These car seats all comply with overseas standards and regulations.

Special purpose car seats offer an extensive range of features and optional accessories not available on Australian standard car seats. This includes, for example, abductor wedges, lateral trunk supports, hip supports, trays for upper limb positioning, built-in harnesses, anti-escape features, footrests, recline options and swivel bases. Unlike child car seats you buy in shops, special purpose car seats also cater for older and heavier children, and in some cases are suitable for adults.

Special purpose car seats are prescribed by an allied health professional in line with standards and laws.

Safe use tip: all special purpose car seats have a built-in harness, which is different to regular car seats, which include booster seats that do not have a built-in harness.

Some built-in harnesses provided with special purpose car seats are for postural support or other purposes only (e.g. anti-escape features) and the vehicle seatbelt must be used at all times. Always follow the manufacturer's instructions.

Our national product register includes a list of special purpose car seats available, or soon to be available, in Australia. This list includes independent information about the products, compliance with standards, and key features designed to support the transport needs of children with disabilities and medical conditions.

Special purpose car seats comply with one or more overseas standards/regulations, however until the establishment of the Australian Safety Assessment Program (AuSAP) we had no independent information about their safety and performance. Refer to MACA's national product register of special purpose car seats.

This depends on the child’s individual needs. If there is no Australian standard car seat suitable for a child’s transport needs then a special purpose car seat needs to be considered, regardless of the child’s age.

In most states and territories, you need to carry a medical certificate in the vehicle the child is travelling in when using a special purpose car seat, and in some states an Advice to Parent form. Your child’s allied health professional can give you the documents you need, plus advice to make sure you’re complying with your state or territory's road laws.

Special purpose car seats tend to be heavier than Australian standard child restraints as they are commonly used with optional items such as swivel bases and footrests. This means they can be difficult to move from vehicle to vehicle. It is important your child has a suitable restraint for each vehicle they travel in.

No, because special purpose car seats comply with overseas standards and regulations which have different design and performance requirements.

For example, the European regulation (ECE r129) requires the use of ISOFIX attachments only for installation (no option for using the vehicle seatbelt like Australian standard car seats) - in combination with either a foot prop or top tether.

The HERO-NXT, which complies with ECE r129, uses the foot prop instead of a top tether. This makes it easier to place a child in and out of the car, and enables the use of the swivel base feature.