My 40 lb son has almost zero neck control. We've used this in his car seat, when he sits in his wheelchair, and when he's in a backpack kid carrier. He uses it every day for 30 minutes in the bathroom. The button on the front is a critical component to its effectiveness. The shape in the front is also wide, while the neck is narrow. These things make it more comfortable and effective at ergonomic positioning. It washes well in our frontload washer on cold. I air dry it.
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