Aims The American Academy of Paediatrics recommends the car seat challenge (CSC) is performed when discharging babies of <37 weeks from neonatal units as they are at risk of apnoeas, bradycardias and desaturations when seated in infant car safety seats. This test is not routine in many units. We present the results of our 18-month experience.

Methods Babies <2.5 kg or <37 weeks gestation on discharge, or with underlying respiratory or neuromuscular problems undergo a CSC pre-discharge. Baseline observations are monitored lying flat in a cot (30-min) then seated in their car seat (60-min). Desaturation, bradycardias, apnoeas, sleep state, colour and respiratory effort are noted. Babies who fail are re-challenged after repositioning or treatment of the underlying problem.

Results Results of 181 babies challenged over 18-months were retrospectively analysed for various variables including sex, and gestational age and weight at birth and testing. 4/181 (2.2%) failed the initial challenge and a further three (total 3.8%) only passed after removal of a chair cushion. All failures were male, birth-weight 1731–4202 g, gestation 31–40 weeks; age at testing 35–45 weeks; weight 2182–5045 g. One was on anti-reflux medication and another had a neuromuscular problem. All 4 babies passed after repositioning. Six babies discharged on home oxygen, and 13 on anti-reflux medication passed first time.

Conclusion The CSC, although time consuming, is well received by parents. Only a few babies failed initially. In our experience, it is useful in identifying babies who may have problems when in an upright position, allowing treatment prior to discharge.