What Is the Apgar Score?

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 Sign 2 1 0
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 minute Absent
(no pulse)
Grimace
("reflex irritability")
Pulls away, sneezes, coughs, or cries with stimulation Facial movement only (grimace) with stimulation Absent (no response to stimulation)
Activity
(muscle tone)
Active, spontaneous movement Arms and legs flexed with little movement No movement, "floppy" tone
Respiration
(breathing rate and effort)
Normal rate and effort, good cry Slow or irregular breathing, weak cry Absent (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