My first Early Intervention home visit always involves seeing the child sitting in their high chair. I learn a few things. I learn how the child is handled by the parent or caregiver, including whether they use the available strapping to secure them. Many don’t, and don’t realize that it is part of the problem. I learn how well the child fits into the chair, and how well the child can balance and reach in this chair. And I hear about what problems the parent or caregiver is having with using this seating system.
This post is intended to share some of what therapists know about seating, and how to pick a better chair for kids that have challenges.
Every parent reading this post should know that their child’s therapists are their best source for getting the right high chair. Never consult Dr. Google when you have licensed professionals available. There is a reason for that license! The folks you meet online cannot evaluate your child and provide safe recommendations for you. This includes me; my comments are meant to educate, not prescribe. That would be unethical and unsafe.
Typical children need a high chair when they can maintain their head balanced in the center and can start reaching and holding a bottle or finger food. Before that, they use a feeding seat. Feeding seats are slightly-to-moderately reclined and do the job of a parent cradling a child while feeding. A child in a feeding seat usually isn’t expected to independently steady their head or hold a bottle. There are usually straps that stabilize a child’s chest and shoulders as well as a strap that stabilizes their pelvis.
Again, not every adult uses these straps correctly to give a young child the best support. I will always do some education on methods to correctly position and adjust strapping. The adult’ reaction (relief, curiosity, resistance, disinterest) tells me a great deal about what is coming down the pike. Some special needs kids will use a feeding chair well past 12 months of age. The commercially-made feeding chairs aren’t large, so some kids won’t fit into one much past 18 months. After that happens, we have to think about either a commercial high chair or adaptive seating.
Commercially-made high chairs in the US are gigantic. They could hold a 4 year-old! This is always a problem for special needs kids. Too much room to move in the wrong way isn’t helpful. These chairs may or may not have chest/shoulder straps, and they may not have an abductor strap (the one between a child’s legs, that prevents them from sliding under the waist belt). The best chairs have the waist belt low enough that it sits across a child’s lower hips like a car’s seat belt. This is always preferable to sitting at the bellybutton level. It provides more stability.
If a special needs child collapses their posture while sitting in a high chair, when I stabilize their hips in a way that doesn’t allow them to collapse, they might complain. They were allowed to slouch so much that this new position, with appropriate core activation, feels wrong to them. It can take a while for a child to learn that eating and playing in a chair requires them to use their core. I allow them to gradually build up their abilities with short periods of eating and playing. Not every parent is comfortable finding out that they were contributing to core weakness by allowing a collapsed posture. I don’t add to that feeling; you know more, you do better. Simple as that. No guilt.
Some providers insist that every child, at every age and stage, have a place to put their feet. The strongest proponents of this idea are usually not therapists but educators or speech therapists who attended a positioning lecture or inservice. Occupational therapists know that a child that doesn’t have the hip control and emerging knee and foot control to place weight into their feet will not be able to use their feet to steady their trunk. They will, however, figure out how to use a footplate incorrectly. Unless a child is older than 2 and requires lower leg stabilization to avoid tightening their hamstrings (which will derail their positioning) and sliding forward, or to prevent sensory-seeking or ataxic movements, I don’t strap a child’s feet onto a footplate, or even worry about providing a footplate. A child that is in a feeding chair, or just beginning to use a high chair, isn’t going to use a footplate correctly, and is more likely to use one to ruin previously decent positioning. A child that is able to bench-sit or is starting to take weight into their feet? That child can use a footplate to build sitting control. Here is a post to help you use one well: A Simple Strategy To Improve Your Child’s Posture In A Stokke Tripp Trapp or Special Tomato Chair
Special needs kids that have very limited head and trunk control will often need an adaptive seat that gives them more support. It can transform them! More support can allow more freedom, not less. These chairs are able to be customized, are obtained through DME vendors and can be paid for by insurance or EI. They are expensive, and considered medical equipment, not chairs. Parents need instruction in their use to avoid harming a child by too intensive strapping and incorrect adjustments. But when done right, they can transform a child’s abilities in ways that no commercially-available chair can accomplish. Giving a child a seating system that frees them to reach and look and eat and communicate is a wonderful feeling. Those of us that are trained in seating evaluation know that the right chair can build skills, not substitute for them!