Motor vehicle crashes are the number one killer of children from ages 1 to 14. About 50% of these deaths to children under 5 involved children that were unrestrained. Of those that were restrained, misuse is reported in 80-95% of cases. Injuries requiring hospitalization are even more common, and many involve the head, neck, and spine. Some of these injuries are permanent. Child restraints are VERY effective for reducing deaths and injuries.
Rear facing is safest. It is best to remain rear facing to the weight and height limits of the car seat. Most convertible car seats have 35 or 40 pound rear-facing limits. The American Academy of Pediatrics recommends that children be kept in rear-facing seats for at least 2 years.
Rear-facing reduces injuries and deaths. It is safest for both adults and children, but especially for babies, who face a greater risk of spinal cord injury during a frontal crash, which accounts for 72% of all types of crashes. Rear-facing car seats spread frontal crash forces over the whole area of a child’s back, head and neck. Rear-facing is NOT a safety risk just because a child’s legs are bent at the knees or because they can touch/kick the vehicle seat. There is no increased risk of lower extremity injuries in a crash, and most children ages 1-2 will pull their legs up in the car seat regardless of position in car.
Many manufacturers now put “expiration” dates on their car seats. Six (6) years is the general recommendation. If your car seat has a date of manufacture, add 6 years to this date to get the expiration date. Over time, the plastic in the car seat will change. The hot and cold extremes may cause splits in the plastic structure of the seat and may make it perform poorly in a crash. It is also common for the harnesses and fabric covers on older car seats to become susceptible to mold. Parts may become lost or break, and older seats will often not meet current government safety standards.
If you are unable to verify that the car seat has never been involved in a crash, do not use it. Above that, you should inspect it carefully to make sure all the parts and labels are intact, and that there are no visible stress marks. The stickers with the manufacturer, model number and date of manufacture should be legible so you can ensure that it is not expired. Finally, you need to make sure the used car seat has not been recalled. Older seats may not meet current safety standards, may be more difficult to use, and may lack the latest safety features.
The center of the rear seat is usually safest since it is farthest from a possible side impact, but only if your car seat fits well in that position. Any position in the rear seat is acceptable unless prohibited by the vehicle or child seat owner’s manual. The seat behind the passenger may be slightly safer than the seat behind the driver, since it allows you to unload the child on the curb side, allows you to see your child more easily from the driver’s seat and is very slightly less likely to be hit on that side in a side impact. The front seat is not advised for children under 13.
Is it OK to put a padded cushion under the child for comfort? Unless such items come with the car seat or are recommended by the manufacturer of the car seat as an accessory, do not use them. Aftermarket pads and cushions are not tested with the seat and any compressible material inside the harness may allow for more slack in the restraint. With a small infant, it is usually OK to put a rolled towel or receiving blanket along the sides of the head (outside the harness straps) to keep it upright. You may also put a rolled towel between a small infant and the crotch strap if there is a large gap, though you should never put towels or pads under a child in a car seat.