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What Is the Apgar Score?

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:

  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 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 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 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!

Reviewed by: Mary L. Gavin, MD
Date Reviewed: 14-02-2018

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