Big Producers Thinking Small

Specialization and adaptation characterize the medical product industry. From custom fit mattresses to pediatric walkers, products are designed to adjust to a range of sizes and abilities. For an industry devoted to the comfort and aid of such a variety of people, it seems only appropriate that manufacturers should take specific pediatric concerns into account for production. In the pediatric market, home medical equipment providers are increasingly selecting colors, design and function specifically for children, rather than taking adult products and simply making them smaller.

Fitting and Adjustability

Not long ago, medical product manufacturers took a one-size-fits-all approach to their products. Wheelchairs, for example, were designed in a standard steel and vinyl design only a decade ago. They were not commonly fitted to the size of children, but ordered larger to allow for future growth. Now much of that has changed, due to the growing market for health products designed specifically for children.

"A lot more attention is given to every little detail, unlike years ago," said Abraham Goldstein, president of Wenzelite Re/hab, Brooklyn, N.Y. "Fitting is where most of the changes have been made." Wenzelite Re/hab specializes in seating systems, walkers, standers and strollers for children. In addition to an array of models that expand to account for the growth of children, custom fits are available.

The products are now being designed specifically with children in mind, instead of scaled down versions of adult equipment.

The growth of children is a major concern of parents purchasing long-term products. Many parents worry that their children will quickly outgrow the equipment and that they will have to invest in an expensive replacement. Like Wenzelite Re/hab--and a growing number of other manufacturers--Levo USA Inc., Peachtree City, Ga., is working to address that concern. Levo carries kid and junior models of pediatric chairs, in which fitting is based on seat depth and the height and leg length of the individual. The company carries pediatric chairs that can expand by about four inches in width to account for the growth of users.

"The products are now being designed specifically with children in mind, instead of scaled down versions of adult equipment," said Susan Mocek of Maddak Inc., Pequannock, N.J. And Maddak does just that, with products such as a rolling shower chair with an adjustable headrest and straps, eating and drinking aids and ambulatory aids.

Children do have specific needs that can be better fulfilled by products designed for them than merely smaller adult products.

"Children are generally weaker," said Mervyn Watkins, president of Convaid, Torrance, Calif., which specializes in compact folding strollers. "They don't have the muscle strength, so it's important to give them good positioning." Convaid's strollers feature a fixed 30-degree tilt-back, which helps them to nestle into the positioning adaptations of the strollers.

Pediatric products are usually fitted for children based on size and ability rather than on age. And for many companies, the pediatric range extends up to age 25. Clearly, the scope of sizes and skills for which manufacturers design is as varied within pediatric products as it is in the larger health product industry. Accordingly, the fit and ability to alter pediatric products for size remains a key factor in the selection of health equipment for children.

Appearance and Appeal

Recent changes in attitudes regarding injuries and disabilities, due in part to the Independent Living Movement and Americans with Disabilities Act of 1990, are resulting in an increasing focus on the appearance of health products and bolder, brighter colors for kids.

"In the last 10 or 15 years, people are kind of coming out of the closet. They are not ashamed of their handicapped kids, as they should not be," Watkins said. "If the handicap is serious enough, you cannot disguise the fact. But many parents are no longer concerned with that."

Participation of children in the selection process is adding to the increase in kid-friendly colors and designs in health products.

"Children are certainly involved in the selection process," Mocek said. "Whether it's for an eating utensil or a mobility product, parents want the children to test the products and make sure they feel comfortable with them."

Capturing the interest of children also is a challenge of parents with children who must use products on their own. Mallinckrodt Inc., St. Louis, Mo., manufactures an asthma monitor designed to appeal to children. Children blow into the device, and a whistle sounds if the attack is under control. Intended for children ages four to 15, the monitor's data also is easy to decipher.

With a progressive realization that the appearance of products is important to children, especially in the older pediatric range, manufacturers are adjusting with friendlier looking designs and colors.

"There's no question that fashion is entering the picture," Watkins said. "There used to be purely function, but so many people want nice-looking products."

Function

Health products for children must adjust to a lifestyle that is different than that of an adult. Children need products that will be useful in a variety of situations and that can be transported between home, school and other places.

"Maybe the family likes to camp, or maybe they like to spend a lot of time outdoors," said Kathy Sarah, pediatric product manager at Sammons Preston Inc., Bolingbrook, Ill. "All the social, economic factors have to be a part of that evaluation also."

An increasing pressure exists for pediatric products to be lightweight and convenient to carry--which usually means higher costs, because lightweight materials are often more difficult to obtain. Some companies have tried using carbon composites, a material used in aircraft manufacturing. But many more are sticking with conventional materials, contending that the huge increase in cost for material outweighs the benefits. Convaid makes lighter chairs through the use of steel for strength and aluminum to decrease weight.

Levo USA Inc., also with versatility in mind, carries stand-up wheelchairs that allow for increased mobility in school and other social settings.

"So for instance if children are in school, they can actually press a lever, and it powers them up to a standing position so they could write on a chalkboard," said Rick Klusovsky, general manager of Levo USA Inc., Peachtree City, Ga. The chairs also have a number of health benefits, including relief from the constant pressure of sitting, along with benefits for the bowel and bladder functions and the circulatory system.

In addition to convenience, pediatric products must adapt to the needs of children, who may not be as capable as adult users.

"Children may have less dexterity than an adult, so they may not have the ability to grasp objects such as writing or eating utensils," said Kathleen O'Neill, new products manager at Maddak. "Also, they may not understand as readily how to use the products."

Safety

Recently, more emphasis has been placed on safety features of pediatric products, especially on the vehicle transportation of pediatric chairs. Features such as anti-tippers and reliable brakes, locks and footrests can prevent accidents for users. In addition, car safety is often a concern for parents. Crash testing wheelchairs is something Convaid has specialized in since 1990. The company crash tests their pediatric chairs at the University of Michigan, involving the chairs in a 30-mph crash with a 20-g deceleration.

"Twenty g means that at the moment of crash, everything weighs 20 times what it normally would," Watkins said. "A 15 pound head is going to weigh 300 pounds at the second of the crash, so it's a very severe crash."

Convaid uses the information obtained from the crashes to design chairs that will not fracture, bend or collapse upon impact.

Funding

Many manufacturers will agree that paying for home health products presents a number of problems for parents, especially when kids outgrow the products. Even with all of the advances being made toward products that can expand with a child's growth, parents have to contend with insurance regulations.

An increasing pressure exists for pediatric products to be lightweight and convenient to carry.

"Most insurance companies and Medicare try to get five years out of a chair for someone who is disabled," Klusovsky said. "If you have a pediatric patient who is in his or her first chair at 12 months for instance, there's going to be a lot of growth from 12 months to five years. So trying to keep them in one chair and not having to buy a new chair at every growth spurt tends to be a little difficult."

All around, the funding situation looks a little grim. Summarizing the comments of many, Goldstein said, "It's getting worse and worse, which means less and less money is available. So although theoretically a particular product would be most beneficial to this child, if the funding source will not pay for it, they won't get it."

Reimbursement also plays a role in the product selection process and has caused some therapists to focus more on teens.

"The changes in PPS did drive a lot of therapists into pediatrics," Sarah said. "But the early intervention programs also have shown that there is more money for early intervention and more interest in starting to catch these children with disabilities and developmental delays early on so that they can start when they're very young to avoid further disabilities."

Future

Clearly, changes in the lifestyles of people are reflected in the products they purchase. As people travel more, factors such as durability and compact folding play larger roles than in the past. The appearance of pediatric products also will continue to play a larger role, as children take part in the selection process and begin to take an interest in the colors and designs. And manufacturers are picking up on that.

"I think there's a growing recognition that this is a market that is still not fully tapped," said Watkins. "And it's attracting more attention."

Quality, usefulness, appearance and the ability to accommodate the growth of a child have been determining factors for selection for some time, according to Mocek. While the basic needs of parents and children looking for pediatric products may remain the same, the product industry is just beginning to develop into one that can offer a wider selection of kid-friendly products.

This article originally appeared in the October 2001 issue of HME Business.

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