Your Baby's Apgar Score

The first test most babies are given — and which most pass with good scores — is the Apgar test. Here’s what you need to know about your baby's Apgar test and scores.

What is the Apgar score?

The Apgar score is a simple assessment telling doctors your baby’s general condition based on observations in the first moments of life. This test is done to check whether your baby needs help breathing or is having heart problems.

Apgar is an acronym, standing for the following criteria:

• Appearance
• Pulse (heart rate)
• Grimace (reflexes)
• Activity (muscle tone)
• Respiration (breathing effort)

A pediatrician, OB/GYN, midwife or nurse will assign your newborn an Apgar score from 0 to 2 on each of the five criteria, with a total of 10 possible points. The higher the Apgar score, the better your baby is doing.

What is considered a normal Apgar score?

The Apgar test measures your baby's heart rate, breathing, muscle tone, reflex response and color in the first minutes of life.

• An Apgar score is 7 to 10 means a newborn is in good to excellent health, usually only requiring routine post-delivery care.
• An Apgar score of 4 to 6 means a baby is in fair condition and may require some resuscitation measures.
• An Apgar score under 4 means a newborn is in poor condition and needs immediate medical attention.

How does the Apgar score work?

Here’s how the scoring works in Apgar tests:

Appearance/Skin Color

Is your baby’s skin pink (healthy) or blue (unhealthy)?

• Pale blue: 0
• Pink body, blue extremities: 1
• Pink all over: 2

Pulse/Heart Rate

Using a stethoscope, the doctor or nurse will listen to your baby’s heart.

• Heartbeat is not detectable: 0
• Heartbeat of fewer than 100 beats per minute: 1
• Heartbeat of 100 beats per minute or more: 2

Grimace/Reflexes

Reflex irritability, also called the grimace response, is how your baby reacts to stimulation like a light pinch (don’t worry, it doesn’t hurt).

• No response to stimulation: 0
• Grimacing: 1
• Grimacing with a cough, sneeze, or lusty cry: 2

Activity/Muscle Tone

This category measures how much your baby is moving around.

• Loose, floppy or inactive muscles: 0
• Some movement of arms and legs: 1
• A lot of activity: 2

Respiration/Breathing Effort

Here the doctor, midwife or nurse will check how well your baby is breathing.

• No breathing: 0
• Slow or irregular breathing: 1
• Good breathing (crying): 2

Does a low Apgar score mean my baby won't be healthy?

While the Apgar test can tell a lot about your baby’s condition in the few minutes after birth, it doesn’t tell you much about anything long-term. In fact, even babies whose scores remain low at 5 minutes usually turn out to be completely healthy.

All babies get at least two Apgar scores in the delivery room. The first test will be done 1 minute after birth to see how well your newborn made it through the labor and delivery process.

At 5 minutes after birth, the test will be repeated to see how he’s doing now that he’s out in the world. Most low scores at 1 minute are normal 5 minutes later. Once in a while, a baby with a low score at 5 minutes may get tested again at the 10-minute mark.

If your baby gets a low Apgar score, she may need oxygen or to have her airway cleared out, or she may need some physical stimulation to get her heart rate up. Most of the time, a low Apgar score is the result of difficult birth, a C-section or fluid in the baby’s airway.

What else do I need to know?

The Apgar test was created in 1952 by anesthesiologist Virginia Apgar, M.D., to check whether babies needed resuscitation after their mothers got anesthesia during delivery. In the past, it was used to predict whether a baby would survive or have neurological problems, and doctors used it to diagnose asphyxia during birth.

Since then, research has shown that a baby’s Apgar score is not a good indicator of asphyxiation, and it doesn’t predict neurological issues in term or preterm babies. Today, your baby’s Apgar score isn’t considered a sign of anything other than how he’s doing during the first few minutes of life.