The Apgar score is a quick and simple assessment tool used to evaluate the health and well-being of a newborn immediately after birth. Developed by Dr. Virginia Apgar in 1952, this scoring system helps healthcare providers determine if a baby requires immediate medical attention. The Apgar score assesses five key factors: heart rate, breathing effort, muscle tone, reflex response, and skin color. Each factor is scored from 0 to 2, with a total score ranging from 0 to 10. The higher the score, the healthier the baby is at birth, providing essential information for making timely decisions regarding newborn care.
What Is the Apgar Score?
The Apgar score is a test given to newborns shortly after birth to assess their health and determine if they need immediate medical attention. It evaluates key physical signs such as heart rate, muscle tone, and breathing.
Babies are typically tested twice: once at 1 minute after birth, and again at 5 minutes. If there are concerns, the test may be repeated.
What Does It Measure?
The Apgar score assesses five important factors, each rated on a scale from 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)
Healthcare providers—doctors, midwives, or nurses—sum the scores of these five factors, resulting in a total score between 0 and 10. A perfect score of 10 is rare because many babies have bluish hands and feet until they warm up.
| Apgar Sign | 2 | 1 | 0 |
| Appearance (skin color) | Normal color all over (hands and feet pink) | Normal color (hands and feet 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 | Grimace with stimulation | 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 breathing and crying | Slow or irregular breathing, weak cry | Absent (no breathing) |
What Does My Baby’s Score Mean?
A score of 7 or above is considered good. A lower score doesn’t necessarily indicate poor health but may suggest that the baby requires immediate care, such as clearing the airways or providing oxygen to improve breathing. Healthy babies sometimes receive slightly lower scores in the first minute after birth.
Common reasons for a slightly low score include:
- High-risk pregnancies
- Cesarean deliveries (C-section)
- Complicated labor and delivery
- Premature birth
If the initial score is low, the test is repeated at 5 minutes. If the score does not improve or if there are other concerns, the baby will receive further medical care and close monitoring.
What If My Baby Has a Low Score?
Many babies with low scores are still healthy and adapt well to life outside the womb with a little time and care. If healthcare providers are concerned about your baby’s score, they will explain what might be causing the issue and what treatments are being administered.
What Else Should I Know?
The Apgar score is a quick assessment of a newborn’s overall condition at birth. It helps healthcare professionals decide if urgent medical care is necessary but is not meant to predict the baby’s long-term health, intelligence, or personality.
With time to adjust to the new environment and any necessary medical intervention, most babies thrive and do very well.