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.

Babies usually take the test twice: 1 minute after birth, and again 5 minutes after they're born. If there are concerns, a baby may take the test again.

What Does It Check?

The Apgar score measures five things 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 Sign





Normal color all over (hands andfeet are pink)

Normal color (but hands and feetare bluish)

Bluish-gray or pale all over

(skin color)


Normal (above 100 beats per minute)

Below 100 beats per minute


(heart rate)

(no pulse)


Pulls away, sneezes, coughs, orcries with stimulation

Facial movement only (grimace) withstimulation

Absent (no response to stimulation)

("reflex irritability")


Active, spontaneous movement

Arms and legs flexed with littlemovement

No movement, "floppy"tone

(muscle tone)


Normal rate and effort, good cry

Slow or irregular breathing, weakcry

Absent (no breathing)

(breathing rate and effort)

Each category is scored with 0, 1, or 2, depending on the observed condition.

Breathing effort:

  • If the infant is not breathing, the respiratory score is 0.
  • If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
  • If the infant cries well, the respiratory score is 2.

Heart rate is evaluated by stethoscope. This is the most important assessment:

  • If there is no heartbeat, the infant scores 0 for heart rate.
  • If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
  • If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.

Muscle tone:

  • If muscles are loose and floppy, the infant scores 0 for muscle tone.
  • If there is some muscle tone, the infant scores 1.
  • If there is active motion, the infant scores 2 for muscle tone.

Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:

  • If there is no reaction, the infant scores 0 for reflex irritability.
  • If there is grimacing, the infant scores 1 for reflex irritability.
  • If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.

Skin color:

  • If the skin color is pale blue, the infant scores 0 for color.
  • If the body is pink and the extremities are blue, the infant scores 1 for color.
  • If the entire body is pink, the infant scores 2 for color.

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:

  • after a high-risk pregnancy
  • through a C-section
  • after a complicated labor and delivery
  • early

At 5 minutes after birth, babies get the test again. If a baby's score was low at first and isn't better, or there are other concerns, the doctors and nurses will continue any needed medical care. They'll watch the baby closely.


What if My Baby Has a Low Score?

Many babies with low scores are healthy and do just fine after getting used to life outside the womb.

If your doctor or midwife is concerned about your baby's score, they'll 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 Should I Know?

This test helps health care providers tell a newborn's overall physical condition so they can quickly decide if a baby needs medical care right away. It isn't meant to predict a baby's long-term health, behavior, intelligence, personality, or outcome.

With time to adjust to their new environment and with any needed medical care, most babies do very well.


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