What Is the Apgar Score?

Print this page Bookmark and Share
Parents

About the Apgar Score

The Apgar score, the very first test given to a newborn, occurs in the delivery or birthing room right after the baby's birth. The test was designed to quickly evaluate a newborn's physical condition and to see if there's an immediate need for extra medical or emergency care.

Although the Apgar score was developed in 1952 by an anesthesiologist named Virginia Apgar, you also might hear it referred to as an acronym for: Appearance, Pulse, Grimace, Activity, and Respiration.

The Apgar test is usually given to a baby twice: once at 1 minute after birth, and again at 5 minutes after birth. Sometimes, if there are concerns about the baby's condition or the score at 5 minutes is low, the test may 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, with 2 being the best score:

  1. Appearance (skin color)
  2. Pulse (heart rate)
  3. Grimace response (reflexes)
  4. Activity (muscle tone)
  5. Respiration (breathing rate and effort)

Doctors, midwives, or nurses combine these five factors for the Apgar score, which will be between 10 and 0 — 10 is the highest score possible, but it's rarely obtained.

Apgar Scoring

Apgar Sign210
Appearance
(skin color)
Normal color all over (hands and feet are pink)Normal color (but hands and feet are bluish)Bluish-gray or pale all over
Pulse
(heart rate)
Normal (above 100 beats per minute)Below 100 beats per minuteAbsent
(no pulse)
Grimace
("reflex irritability")
Pulls away, sneezes, coughs, or cries with stimulationFacial movement only (grimace) with stimulationAbsent (no response to stimulation)
Activity
(muscle tone)
Active, spontaneous movementArms and legs flexed with little movementNo movement, "floppy" tone
Respiration
(breathing rate and effort)
Normal rate and effort, good crySlow or irregular breathing, weak cryAbsent (no breathing)

What Apgar Scores Mean

A baby who scores an 8 or above on the test is generally considered in good health. However, a lower score doesn't mean that a baby is unhealthy or abnormal. It might just mean that a baby needs some special immediate care, such as suctioning of the airways or oxygen to help him or her breathe, after which the baby should improve.

At 5 minutes after birth, the Apgar score is recalculated. If a baby's score was low at first and hasn't improved, or there are other concerns, the doctors and nurses will continue any necessary medical care and will closely monitor the baby.

Some babies are born with conditions 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 that are a little low 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, intellectual status, personality, or outcome. Very few babies score a perfect 10, since their hands and feet usually remain blue until they have warmed up. And perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth.

Keep in mind that a slightly low Apgar score (especially at 1 minute) is common for some newborns, especially those born after a high-risk pregnancy, cesarean section, or a complicated labor and delivery. Lower Apgar scores are also seen in premature babies, who usually have less muscle tone than full-term newborns and who, in many cases, will need extra monitoring and breathing help because of their immature lungs.

If your doctor or midwife is concerned about your baby's score, he or she will let you know and will explain how your baby is doing, what might be causing problems (if any), and what care is being given.

With time to adjust to the new environment, and with any necessary medical care, most babies do very well. So rather than focusing on a number, just enjoy your new baby!

Reviewed by: Larissa Hirsch, MD
Date reviewed: July 2014



Related Resources

Web SiteNeonatal Jaundice This Web site contains information about jaundice, treatment options, and links.
OrganizationMaternal and Child Health Bureau This U.S. government agency is charged with promoting and improving the health of mothers and children.
OrganizationAmerican Academy of Pediatrics (AAP) The AAP is committed to the health and well-being of infants, adolescents, and young adults. The website offers news articles and tips on health for families.
Web SiteZero to Three Zero to Three is a national nonprofit organization that promotes the health and development of infants and toddlers.
OrganizationAmerican College of Obstetricians and Gynecologists (ACOG) This site offers information on numerous health issues. The women's health section includes readings on pregnancy, labor, delivery, postpartum care, breast health, menopause, contraception, and more.
Web SiteSafe to Sleep This safety campaign teaches parents and other caregivers to always place babies on their backs to sleep. Babies who sleep on their backs are much less likely to die of SIDS than are babies who sleep on their stomachs or sides.


Related Articles

Looking at Your Newborn: What's Normal When you first get to see, touch, and inspect your newborn, you may be surprised by what you see. Here's what to expect.
Your Child's Checkup: Newborn Find out what this doctor's checkup will involve after your baby arrives.
Cord-Blood Banking Should you bank your newborn's cord blood? This article can help you decide.
Bringing Your Baby Home Whether your baby comes home from the hospital right away, arrives later, or comes through an adoption agency, homecoming is a major event.
Birth Plans In the happy haze of early pregnancy, the reality of labor and birth may seem extremely far off - which makes this the perfect time to start planning for the arrival of your baby by creating a birth plan that details your wishes.
Bonding With Your Baby Bonding, the intense attachment that develops between you and your baby, is completely natural. And it's probably one of the most pleasurable aspects of infant care.
The First Day of Life Your baby's first day of life is one of the most eventful days in your own life. Here's what to expect on that special day.
When Your Baby Is Born With a Health Problem If you're expecting a baby, it's important to understand that certain health problems and complications can't be prevented, no matter how smoothly the pregnancy goes.
Pregnancy & Newborn Center Advice and information for expectant and new parents.
Birthmarks Birthmarks that babies are born with, or develop soon after birth, are mostly harmless and many even go away on their own, but sometimes they're associated with certain health problems.
When Your Baby's in the NICU The neonatal intensive care unit may seem like a foreign place, but understanding what goes on there can help reduce your fears. Here's how to familiarize yourself with the NICU.
Growth and Your Newborn A baby's growth and development is measured from the moment of birth. How much should your baby weigh?
Medical Care and Your Newborn By the time you hold your new baby for the first time, you've probably chosen your little one's doctor. Learn about your newborn's medical care.
Newborn Screening Tests Newborn screening tests look for harmful or potentially fatal disorders that aren't apparent at birth. Find out which tests are done and which disorders they're designed to detect.
A Guide for First-Time Parents If you're a first-time parent, put your fears aside and get the basics in this guide about burping, bathing, bonding, and other baby-care concerns.
Jaundice in Healthy Newborns A common condition in newborns, jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood.




Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

© 1995-2014 The Nemours Foundation/KidsHealth. All rights reserved.



 

Upcoming Events

5k Run/Walk/Roll fundraiser for a universally accessible park

Car Seat Safety Check at Xenia Township Fire Station 51 on Brush Row Road

Car Seat Safety Check - no appointment necessary!

All parents, siblings and grandparents of students working with IEPs from preschool through high school are invited to hear the guest speaker from the Bureau for Children with Medical Handicaps.

View full event calendarView full event calendar

Health and Safety

Your child's health and safety is our top priority

Accreditations

The Children's Medical Center of Dayton Dayton Children's
The Right Care for the Right Reasons

One Children's Plaza - Dayton, Ohio - 45404-1815
937-641-3000
www.childrensdayton.org