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What To Know About an Apgar Score

Reviewed by Dan Brennan, MD on June 05, 2021

You may not even realize it, but right after your baby is born, the doctor completes a test to determine your baby’s overall health. The results of the exam provide what's called an Apgar score. If your baby doesn’t score high enough, it may be a sign that additional medical attention is needed.

Understanding the Apgar Test

The Apgar test checks your baby’s heart rate and muscle tone and looks for other vital signs of health. It is usually given twice: one minute after birth and then around five minutes after birth. If the doctor has concerns, they may check your baby a third time to see if their concerns are resolved.‌

"Apgar" is an acronym that stands for appearance, pulse, grimace, activity, and respiration. Each of the five Apgar indicators is rated zero, one, or two, with two being the highest and best score. ‌

Appearance. Your doctor assesses your baby’s skin color for signs of poor circulation. A score of two is given for normal appearance. If your baby’s hands and feet are bluish, they score a one. Being bluish-gray or pale all over scores zero. It’s common for your baby’s hands and feet not to be of normal color until they warm up.

Pulse. Normally, a baby’s heartbeat is over 100 beats per minute. This heartbeat level earns a score of two. Anything under 100 beats per minute is a one, and no noticeable pulse is a zero.‌

Grimace response. At birth, your newborn should be highly irked by any stimulation. The doctor checks for your baby for these responses: pulling away, sneezing, coughing, and crying. These combinations score a two. If your baby grimaces but doesn’t make a sound, the score is a one. No response at all to stimulation is a zero.‌

Activity. Your baby should show sufficient muscle tone at birth. Movements that are active and happen on their own receive a score of two. A newborn with arms and legs that are flexed but don’t move receives a score of one. If your baby doesn’t respond or is floppy, the score is zero.

Respiration. Your baby should have a strong cry, a sign of normal breathing that receives a score of two. If your newborn’s breathing is slow or irregular or their cry is weak, the score is a one. Lack of breathing or crying is scored as a zero. ‌

The doctor or nurse adds up the score. Very few babies receive a 10, the highest possible score, because discolored hands and feet are so common at birth. A score that is seven or higher is healthy. 

Anything less than seven is considered unhealthy, and your doctor must determine what medical care is needed. It may include suctioning your baby’s airways to remove fluid or applying oxygen.

Even perfectly healthy babies may score below a seven immediately after birth. That’s why the doctor repeats the test at five minutes. Common reasons for a low score in a healthy baby include:

  • High-risk pregnancy
  • Birth via cesarean section
  • Difficult labor or delivery‌
  • Premature birth

If your baby’s score doesn’t improve at the five-minute mark, the medical team may pursue additional care to help your baby thrive. As long as your baby causes concern, they will be watching the situation closely.

Keep in mind that this test isn’t designed to predict anything about your child’s future. It doesn’t provide any information about long-term growth, behavior, or health outcomes. It only serves to help your doctor identify if your baby needs additional medical above what every newborn receives.

Limitations of the APGAR Test

The Apgar score is very subjective, and a number of factors can affect it. Babies are individuals, and how each one makes their way into the world may look a bit different from how others respond. Despite what the score says, "normal" can vary.

And the Apgar score doesn’t diagnose any conditions. Additional testing or monitoring may be necessary to determine any specific needs your baby has.

Specific Causes for Concern

While the Apgar score doesn’t diagnose or predict any future health conditions, there are specific relationships between scores and medical conditions that doctors have observed. They include the following:

  • A one-minute Apgar score between zero and three correlates with a higher risk of infant mortality.
  • A low five-minute Apgar test correlates with an increased risk of cerebral palsy. ‌
  • A score of three or less at the 10, 15, or 20-minute marks increases your infant’s risk of developing neurologic conditions.‌

If your baby’s score is five or less after five minutes, the doctor may take a sample of the artery blood gas from your baby’s clamped umbilical cord. They may also examine your placenta to learn more about why your baby’s score is low.

Show Sources

SOURCES:

American College of Obstetricians and Gynecologists: “The Apgar Score.”

Connecticut Children’s: “What Is the Apgar Score?”

Healthy Children: “Apgar Scores.”

Merck Manual: “Gestational Age.”

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