What Is an APGAR Score?

Soon after a baby is born, doctors or nurses perform a test called the APGAR test to check the baby’s health. The test checks five of a baby’s vital health signs: breathing, heart rate, skin color, reflexes, and muscle tone.

The labor and delivery team scores the baby’s health in all five categories, coming up with a total score. The APGAR score can help determine if your baby needs extra care after birth.

What Is the APGAR Test?

APGAR is a test that doctors or nurses give to a baby after birth to determine its health. It’s named after Virginia Apgar, who developed the test in the 1950s. It is also the acronym of the five areas tested:

  • Appearance (skin color).
  • Pulse (heart rate).
  • Grimace (reflexes).
  • Activity (muscle tone).
  • Respiration (breathing rate).

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How Is the APGAR Score Determined?

The team typically tests the baby twice: at one minute after birth and at five minutes after birth.

The one-minute test measures how well the baby is doing after delivery. The five-minute test shows how they’re doing outside their mother’s body or how they’ve responded to resuscitation.

They assign the baby a 0, 1, or 2 in each APGAR category, depending on the baby’s health in the category.

  • Appearance (skin color): A 2 means a baby has normal color all over their body, including their hands and feet. A 1 means they have normal color on their body but that their hands and feet are bluish. A 0 means that they are bluish or gray all over.
  • Pulse (heart rate): A 2 indicates that a baby’s heart rate is over 100 beats per minute. A 1 is for heart rates below 100. A 0 means that the baby has no pulse.
  • Grimace (reflexes): This measures a baby’s reflex response to a small stimulus. If they grimace and cry, sneeze, cough, or pull away, they score a 2. If they grimace only, they score a 1. If there is no reaction at all, they score a 0.
  • Activity (muscle tone): If a baby has active movement, they score a 2 for activity. If they have muscle tone but aren’t actively moving, they score a 1. If the muscles are loose and floppy, the score is a 0.
  • Respiration (breathing rate): If a baby is breathing at a normal rate, with normal effort, and is crying well, they score a 2. If they have slow or irregular breathing and are not crying well, they score a 1. If they are not breathing, they score a 0.

The care team adds up the scores for each category to determine the baby’s total APGAR score. An APGAR score can be between zero and 10.

What Is a Normal APGAR Score?

According to the American Academy of Pediatrics (AAP), most babies have an APGAR score of 7 or higher.

A score of 10 is rare because of the “appearance” category. Very few babies have normal color all over after birth. Most often, babies are bluish in the hands and feet. It is also rare for a baby to have an APGAR score under 5.

If a baby’s five-minute AGPAR score is below 7, clinicians repeat the test every five minutes until 20 minutes after birth.

What Does the APGAR Score Mean?

A baby’s APGAR score is a measurement of their health right after birth. The American College of Obstetricians and Gynecologists, in partnership with the AAP, developed a system that defines the scores. According to their definitions:

  • Five-minute APGAR scores of 7 to 10 are reassuring.
  • Five-minute APGAR scores of 4 to 6 are moderately abnormal.
  • Five-minute APGAR scores of 0 to 3 in full-term or nearly full-term infants are low.

Lower scores could be a sign that there may have been problems during the birth process.

For example, the AAP says a 1-minute APGAR score between 5 and 7 could mean lower oxygen levels in a baby’s blood. That is because of problems during birth. AAP adds that premature babies and babies delivered by C-section are more likely to have low APGAR scores.

It’s worth noting that the APGAR score only measures a baby’s health right after birth. The APGAR score does not show anything about their future health or cognitive development.

What Happens If My Baby Has a Low APGAR Score?

A low APGAR score just means they may need more immediate care, such as breathing help, fluids, or medications.

If a baby still scores low after immediate treatments, they may need additional care in a neonatal intensive care unit (NICU). The baby’s care team will explain the situation to you.

Most babies with a low score at first will be fine once given time and proper care.

American Academy of Pediatrics, Apgar Scores. Link

The American College of Obstetricians and Gynecologists, The Apgar Score. Link

Nemours KidsHealth, What Is the Apgar Score? Link

Leslie V. Simon, Muhammad F. Hashmi, and Bradley N. Bragg, StatPearls, APGAR Score. Link

U.S. National Library of Medicine, Apgar Score. Link

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.