What’s the best wheelchair seat-to-floor height for very young children? Mala Aaronson OTR, ATP, CRTS, National Seating & Mobility explains how she typically makes that decision. — Ed.

As appropriate, I begin mobility evaluations for children with fair to normal cognition at about 9-12 months of age. At this stage of development, able-bodied children are beginning to be able to explore their environment independently through crawling or walking. It is our responsibility as clinicians and mobility providers to enable physically disabled children to do the same.

I generally do 17″ to 18″-plus seat-to-floor heights for children. Unless climbing into the chair is at the top of the priority list, I feel that a developing child’s independent mobility system needs to provide him or her with optimal performance and independence equal to his/her able-bodied peers to facilitate optimal cognitive and perceptual development. This means access to toys, desks, tables, bookshelves, sinks, etc., in a typical home and preschool environment, and to be as close to eye level as possible with his or her peers.

We know that many neurological functions such as depth perception and special relations do not develop without independent means of traveling and negotiating distances.

Some of the early wheelchairs targeted for this population were very heavy, designed with front-wheel-drive configurations to accommodate the short arm length of very small children. Also, the extremely low seat heights did accommodate some independent transfers.

But once those children are seated in the chairs, they are prisoners of this low height, resulting in an environment that continues to be somewhat inaccessible to them. Fortunately, the manufacturers of ultralight wheelchairs have developed some great little chairs over the recent few years that are configured with these small children’s needs in mind and weigh in at almost half of those earlier models. Clinicians and parents have come to understand the non-necessity and detriment of a crossbrace folding-frame style, which has driven manufacturers to mobility devices that are far lighter, perform better, and facilitate greater independence and cognitive development than ever before.