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Pediatric Seating System Assessment

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Seating systems are a vital part of 24-hour postural management programs. They provide a stable and functional position for children to access their surroundings and engage with everyday tasks. However, seating systems are only beneficial if they fit correctly.

24-hour postural care clock
24-hour postural management

24-hour postural management is a means to protect body shape, prevent or alleviate pain, and enhance function through optimum positioning and equipment.

Typically, seats should be reviewed every six months to assess for changes in a child's size or shape. However, differences to daily routine (such as being out of school) can increase the likelihood that body shape has changed, and increase the frequency with which the seat should be reviewed. This resource outlines steps to review the seat with some common signs that a child's seating system is not fitting properly and/or may need some adjustments.

8 steps to review a pediatric seating system for fit

Illustration of a child in a pediatric seating system
  1. Look at my face. Do I seem comfortable and relaxed or am I not my usual self?
  2. Next, is my bottom snug against the back support with my trunk upright? Sliding forward could mean that I've changed shape or the belt has loosened. Re-adjust my position if necessary.
  3. Now check my belt - it should be firmly attached over the top of my thighs with space for one finger to fit underneath. If it's too loose or too tight, I may need to be reassessed.
  4. Feel under my bottom and thighs; am I bearing weight equally under each side? The weight should be equal unless I have underlying asymmetry.
  5. Next, how much space is there behind my knees (between the front edge of the cushion and my calves)? If there is more than two fingers' width, my legs have grown and my seat should be re-adjusted.
  6. Feel underneath the front of my thighs. Am I bearing weight here? This is important. If it is easy to get your hands between my thighs and the cushion, then my lower legs have grown and my footplates need to be adjusted to improve the pressure distribution.
  7. Feel the space around my lateral and pelvic supports - if you can't get your hand in easily with my normal clothing, then I've probably changed shape or grown and need to be reassessed.
  8. Finally, back to my face, is my head positioned centrally on the head support? If the trunk laterals are too low, my head and trunk may fall to the side, making it difficult to sit up.

Note: every child and every set-up is unique. This is generic information and does not apply to molded/contoured seating or asymmetric set-ups.

Published: 12/04/2021

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