What is Apgar Score?


Reprinted with Permission by KidsHealth


The Apgar score is the very first test given to your newborn, and it occurs right after your baby's birth in the delivery or birthing room. Developed in 1952 by an anesthesiologist named Virginia Apgar, the test was designed to quickly evaluate a newborn's physical condition after delivery and to determine any immediate need for extra medical or emergency care. Five factors are checked: heart rate, breathing, color, muscle tone, and reflex response.


The baby is given a score of zero to two in each category, and the resulting five numbers are added together. This total is called the Apgar score. The evaluation is done again at 5 minutes. This quick and easy test is given mainly to see if the baby needs help breathing. A score of 7 to 10 is generally considered normal, and if your baby receives this score, no special actions usually need to be taken. A lower score means some extra measures, such as giving the baby oxygen, may be needed initially.


The Apgar test is usually given to your baby twice: once at 1 minute after birth, and again at 5 minutes after birth. Rarely, if there are serious problems with the baby's condition and the first two scores are low, the test will be scored for a third time at 10 minutes after birth.


Five factors are used to evaluate the baby's condition and each factor is scored on a scale of 0 to 2:


        heart rate (pulse)

        breathing (rate and effort)

        activity and muscle tone

        grimace response (medically known as "reflex irritability")

        appearance (skin coloration)


Doctors, midwives, or nurses add these five factors together to calculate the Apgar score. Although 10 is the highest possible score, babies almost never receive it because the hands and feet of healthy newborns are usually still slightly bluish and not yet pink at 5 minutes after birth. (A baby has to have normal coloration all over - including pink hands and feet - to get the full score of 2 for appearance.)


Apgar Scoring

Apgar Sign




Heart Rate

Normal (above 100 beats per minute)

Below 100 beats per minute

Absent (no pulse)

(rate and effort)

Normal rate and effort

Slow or irregular breathing

Absent (no breathing)

Grimace (Responsiveness or "reflex irritability")

Pulls away, sneezes, or coughs with stimulation

Facial movement only (grimace) with stimulation

Absent (no response to stimulation)

(muscle tone)

Active, spontaneous movement

Arms and legs flexed with little movement

No movement, "floppy" tone

(skin coloration)

Normal color all over (hands and feet are pink)

Normal color (but hands and feet are bluish)

Bluish-gray or pale all over


A baby who scores a 7 or above on the test at 1 minute after birth is generally considered in good health. However, a lower score doesn't necessarily mean that your baby is unhealthy or abnormal. For example, a score between 4 and 6 at 1 minute indicates that your baby needs some special immediate care, such as oxygen to help him breathe or suctioning of his airways. A newborn with an Apgar score of less than 4 generally requires advanced medical care and emergency measures, like assisted breathing, administration of fluids or medications, and observation in a neonatal intensive care unit (NICU).


At 5 minutes after birth, the Apgar score is recalculated, and if your baby's score hasn't improved to 7 or greater, the doctors and nurses will continue any necessary medical care and will closely monitor your baby. Some babies are born with heart or lung conditions or other problems that require extra medical care; others just take a little longer than usual to adjust to life outside the womb. Most newborns with initial Apgar scores of less than 7 will eventually do just fine.


It's important for new parents to keep their baby's Apgar score in perspective. The test was designed to help health care providers assess a newborn's overall physical condition so that they could quickly determine whether the baby needed immediate medical care. It was not designed to predict a baby's long-term health, behavior, or outcome. Very few babies score a perfect 10, and perfectly healthy babies sometimes have a lower than usual score, especially in the first few moments of life.


Keep in mind that a slightly low Apgar score (especially at 1 minute) is normal for some newborns, especially those born after a high-risk pregnancy, cesarean section, or a complicated labor and delivery. Lower Apgar scores are also usually seen in healthy premature babies, who usually have less muscle tone than full-term newborns and who, in many cases, will require extra monitoring and breathing assistance because of their immature lungs. If your doctor or midwife is concerned about your baby's score, he or she will let you know. Your doctor or midwife will explain how the baby is doing, what might be causing any problems, and what care is being given - so try not to worry until then. Relax and enjoy the moment!