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What Is the Apgar Score?

Reviewed by: Mary L. Gavin, MD
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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.

Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born. If there are concerns, a baby may get the test again.

What Does It Check?

The Apgar score measures five things to check a baby's health. Each 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 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 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, babies get the test again. If a baby's score was low at first and isn't better, or there are other concerns, the doctors and nurses will continue any needed medical care. They'll watch the baby closely.

What if My Baby Has a Low Score?

Many babies with low scores are healthy and do just fine after getting used to life outside the womb.

If your doctor or midwife is concerned about your baby's score, they'll 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 Should I Know?

This test helps health care providers tell a newborn's overall physical condition so they can quickly decide if a baby needs medical care right away. It isn't meant to predict a baby's long-term health, behavior, intelligence, personality, or outcome.

With time to adjust to their new environment and with any needed medical care, most babies do very well.

Reviewed by: Mary L. Gavin, MD
Date reviewed: February 2018