March 2003

A Child's First Seating System

By Cathy Mulholland, OTR

Never underestimate the impact that a child’s first seating system has on the family and the child. If the family is prepared correctly, the experience can be positive for all concerned.

Unfortunately, many times this preparation does not occur, and the system is seen as something chosen by others, which becomes only a greater burden. It inevitably is used in school, but rarely used functionally in the home. The process to improve acceptance is really quite simple. The rehab tech supplier or clinician needs to involve the family in the selection.

The family will not likely have any understanding of seating, but they do understand the demands of the child in their home. Usually, these demands fall into three categories: 1) positioning for feeding, 2) transportation issues, and 3) positioning for play. By sitting down with the family and discussing each of these categories, it is quite typical that the family will be able to identify most of the postural support and mobility requirements that the child will need. If the family is asked, “If I gave you five sets of hands while you were feeding your son, where would you put them?,” frequently, the family will give the clinician the same postural support sites that he or she would consider for proper positioning. The family also might offer added information that will affect the choice in seating, such as an imminent gastrostomy tube placement, or self-feeding training.

Regarding transportation, a question like “When you leave the house, where do you go, how often, and what would make it easier?” will add to the requirements that the seating system must meet for successful use. A family that takes the child out continuously to events such as sibling soccer games and off-road walks will have very different requirements than the family that is not as active. This question should also address car transport issues and how the system will interface with these needs.

When discussing positioning for play, self-mobility and transfer issues should be addressed. If the child has potential to self-propel, then that can be stressed with the family at this point to ensure the system chosen will allow for independent mobility.

Once all of these requirements are discussed, the choice of the seating system may become less intimidating to the family. They are able to examine their options with some understanding of what they are looking for. Can the child self-propel? Does the system provide enough support? Is it able to meet the transport needs? Is it at peer height? Can it be cleaned if used for feeding? What does it weigh? How does it grow? Will any of the components be reusable on later systems?

When the system is delivered, the family is more likely to accept it positively and use it appropriately if they have been part of the process. In the end, an appropriate seating system is not only a mobility system, but a piece of equipment that optimizes the entire spectrum of the child’s functional skills and self-esteem.

Cathy Mulholland, OTR, is president of Pacific Rehab Inc, Scottsdale, Ariz, and a frequent speaker on seating and positioning.

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