The infant car seat challenge (ICSC), or period of observation in a car safety seat before discharge to monitor for episodes of apnea, bradycardia and desaturation, is one of the most common tests performed on preterm neonates in the United States. However, the utility of the ICSC to identify infants at risk for adverse cardiopulmonary events in the car seat remains unclear. Minimal evidence exists to guide clinicians in performance of this test including appropriate inclusion criteria and failure criteria. In this article, the origins of the ICSC are discussed as well as potential etiologies of desaturations and bradycardia in the car seat position. Current literature on implementation, inclusion and failure criteria, incidence of failure and data on the meaning of a 'passed' vs 'failed' ICSC are discussed. Emphasis is made on minimizing time in car seats and seated devices given concern over the risk of desaturations.