What Is the Apgar Score?
The Apgar score is a test given to newborns
soon after birth. This test checks a baby's heart rate, muscle tone, and other signs
to see if extra medical care or emergency care is needed.
The test is usually given twice: once at 1 minute after birth, and again at 5 minutes
after birth. Sometimes, if there are concerns about the baby's condition, the test
may be given again.
What Does "Apgar" Mean?
Apgar stands for "Appearance, Pulse, Grimace,
Activity, and Respiration."
In the test, five things are used to check a baby's health. Each is scored on a
scale of 0 to 2, with 2 being the best score:
- Appearance (skin color)
- Pulse (heart rate)
- Grimace response (reflexes)
- Activity (muscle tone)
- Respiration (breathing rate and effort)
Doctors, midwives,
or nurses add up these five factors for the Apgar score. Scores are between 10 and
0. Ten is the highest score possible, but few babies get it. That's because most babies'
hands and feet remain blue until they have warmed up.
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 Does My Baby's Score Mean?
A baby who scores a 7 or above on the test is considered in good health. A lower
score does not mean that your baby is unhealthy. It means that your baby may need
some immediate medical care, such as suctioning of the airways or oxygen to help him
or her breathe better. Perfectly healthy babies sometimes have a lower-than-usual
score, especially in the first few minutes after birth.
A slightly low score (especially at 1 minute) is common, especially in babies born:
At 5 minutes after birth, the test is given again. 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. The baby will be monitored closely.
What if My Baby Has a Low Score?
Many babies with low scores are perfectly healthy and do just fine after adjusting
to life outside the womb.
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.
What Else Do I Need to Know?
This test was not designed to predict a baby's long-term health, behavior, intelligence,
personality, or outcome. It was designed to help health care providers tell a newborn's
overall physical condition so that they could quickly decide whether the baby needed
immediate medical care.
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!
Date reviewed: February 2018
