How to Know If a Wheelchair Fits

A wheelchair fits if the child's
  • head and trunk are upright and in the midline with or without support
  • shoulders are over the hips and level
  • legs are slightly abducted or neutral
  • pelvis is level, in a neutral tilt, and all the way back in the seat
  • weight is on the thighs and buttocks
  • feet are on the footrest
  • knees are no more than 2-3 finger breadths in front of the seat edge in a growing child
  • skin is healthy and has good integrity – check the coccyx and ischial tuberosities (if the seat is too deep, the child will lean back to reach the support surface, the pelvis will be in a posterior tilt, and the child may have redness behind the knees)
  • vision is forward
  • chest harness is supportive and does not cut into the neck or present a choking hazard (the child should not be "hanging" on support)
  • wheelchair has a snugly fitting pelvic positioning belt (seat belt), with padding if needed
  • wheelchair is in good repair
  • and the child is comfortable for at least 2 hours at a time in the chair
Special or Problem Situations
  • If a child has severe deformity and/or contractures, a wheelchair may not fit as described above. With a fixed deformity, the seating/positioning should accommodate the deformity and comfort and skin integrity may become the primary goals.
  • If the wheelchair does not fit properly, a referral to a PT/OT should be made to resolve the problem or recommend a new chair or other alternatives.
  • If repairs are needed, the parent should contact the vendor. If needed, the physician should write a prescription/referral for the wheelchair repairs.



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Author: Terry Holden, PT - 1/2009