The Apgar score assesses your newborn’s condition in the minutes after birth. Our Apgar score chart shows how the Apgar scale works and what a low score means.
IN THIS ARTICLE
- What is the Apgar score?
- When is the Apgar test done?
- What does “APGAR” stand for?
- How is the Apgar score calculated?
- Apgar score chart
- What is a normal Apgar score?
- What does it mean if my baby has a low Apgar score?
- What causes a low Apgar score?
- What if my baby has dark skin? How will that affect the Apgar test?
What is the Apgar score?
The Apgar score is a simple numerical assessment that rates how a baby is doing at birth. The Apgar test helps the doctor quickly determine whether your newborn might need additional medical assistance.
Anesthesiologist Virginia Apgar developed this scoring system in 1952, and modern hospitals worldwide still use the Apgar scale to make an immediate assessment of how ready your baby is to meet the world.
While it’s your baby’s first “test,” don’t be disappointed if he doesn’t ace it. Many babies just need a little time to adapt to life outside the womb. It’s perfectly normal – expected, even – for a baby’s hands and feet to not become pink until they’re warmed up, for example (see “appearance” in chart below).
The Apgar score is not used to predict your baby’s long-term health, behavior, or intelligence.
When is the Apgar test done?
A healthcare provider will assess your baby at one minute and at five minutes after birth.
- The one-minute test reflects how well your baby handled the delivery.
- The five-minute test indicates how well she’s doing being on her own.
Occasionally, the test is repeated every five minutes for up to 20 minutes – for example, if your baby’s breathing is being monitored.
What does “APGAR” stand for?
APGAR stand for:
Activity, Pulse, Grimace, Appearance, Respiration
How is the Apgar score calculated?
Calculating the overall Apgar score is a two-step process.
First, a healthcare provider assigns a number from 0 to 2 (see chart below) to describe five Apgar “signs,” which include your baby’s:
- Activity: how much your baby’s moving around
- Pulse: how well his heart is beating
- “Grimace” (responsiveness): how his reflexes are working in response to stimulation, such as his airways being suctioned
- Appearance: how much his coloring has pinked-up, indicating that his blood is oxygenated
- Respiration: how well he’s breathing
Apgar score chart
This Apgar score chart details how numerical ratings are assigned to describe the five Apgar signs used to assess a baby’s condition at birth.
| Apgar sign | 0 | 1 | 2 |
|---|---|---|---|
| Activity (muscle tone) | Limp, no movement, muscles are floppy and loose | Some muscle tone, some flexing of arms and legs | Active, spontaneous motion; flexed arms and legs that resist extension |
| Pulse (heart rate) | No heart rate | Fewer than 100 beats per minute | At least 100 beats per minute |
| Grimace (reflexes) | No response to stimulation | Facial grimace during stimulation | Pulls away, coughs, cries vigorously, or sneezes during stimulation |
| Appearance | Entire body is blue or pale | Good color in body with bluish hands or feet | Good color all over |
| Respiration (breathing) | Not breathing | Slow or irregular breathing, weak cry, whimpering | Normal rate and effort of breathing; good, strong cry |
What is a normal Apgar score?
A score of 7 to 10 is considered normal for both the one-minute and five-minute Apgar tests. A score in this range usually means that your baby’s in good shape and doesn’t need more than routine post-delivery care.
If you have any questions or are worried, ask the doctor about your baby’s Apgar score. She can detail for you exactly why your baby received a certain Apgar score and how any concerns are being taken care of.
What does it mean if my baby has a low Apgar score?
One-minute test
An Apgar score lower than 7 means that your baby might need some help. Keep in mind, though, that a low score at one minute after birth doesn’t mean that your baby won’t be just fine – maybe even by the five-minute test.
If your baby scores between 4 and 6 on the first Apgar test, he may need some help breathing. This could mean something as simple as suctioning his nostrils or massaging him, or it could mean giving him oxygen. These measures will likely result in your baby breathing more deeply, so that his five-minute score will be between an 8 and 10.
If your baby scores 3 or less on the first Apgar test, he may need immediate lifesaving measures, such as resuscitation and intensive care.
Five-minute test
For the five-minute test, a score of 6 or less may mean that your baby isn’t progressing or responding to medical treatment. He may need more medical help. Your provider will determine what steps need to be taken.
What causes a low Apgar score?
Your baby might have a low Apgar score if:
- She was born prematurely.
- She was delivered by cesarean section.
- You had a high-risk pregnancy.
- You had a complicated labor and delivery. In one large Swedish study, a long second stage of labor was associated with an increased risk of a low Apgar score at five minutes.
What if my baby has dark skin? How will that affect the Apgar test?
It will be a little harder to tell if your newborn has a bluish hue if his skin is dark. The doctor or a nurse will check the color of his nail beds and tongue, and inside of his mouth – areas that are less affected by the natural pigment of the skin.
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