What Is the Apgar Score and What Do the Test Results Mean?
The moment your baby is born, she will be in great hands, and her care team will be busy. During the first few minutes of your little one’s life, she'll receive two quick tests that measure her overall responsiveness, resulting in what’s called an Apgar score. This information helps your healthcare provider assess whether your little one needs any immediate help to adapt to the outside world. Read on to find out what exactly the Apgar score is, how it’s calculated, and what the results may mean.
What Is the Apgar Score?
The Apgar score is your healthcare provider’s assessment of your newborn’s Appearance (skin color) Pulse (heart rate) Grimace response (reflexes) Activity (muscle tone) Respiration (breathing rate and effort). The test is usually given one minute after your baby’s birth, and again five minutes after birth. It will be done by your healthcare provider or by one of the nurses. The goal of the test is to see if your little one needs any extra medical care in the time immediately after birth. It’s not an assessment or a prediction of your baby’s long-term health. It’s just a way for your baby’s healthcare provider to quickly determine what, if any, extra medical care is needed right away. Your healthcare provider will assess or measure each factor and give your baby a score for each. If it’s needed, additional medical care will be given based on the test results.
How Is the Apgar Score Calculated?
Each of the factors (appearance, pulse, grimace, activity, respiration) are given 0, 1, or 2 points. Then these are tallied to give your baby an Apgar score, with 10 being the highest possible result. Most babies score around 7 or above, with few babies receiving a score of 10. We’ll explain why this is in the next section.
To get an idea of what your baby’s healthcare provider looks for when assigning points, take a look at this Apgar score table:
| Apgar Scoring System | |||
|---|---|---|---|
| 2 | 1 | 0 | |
| Appearance (skin color) | Normal color all over (hands and feet are pink) | Normal color; hands or feet are bluish | Bluish gray or pale all over |
| Pulse (heart rate) | More than 100 beats per minute | Fewer than 100 beats per minute | No pulse |
| Grimace (reflexes) | Grimaces and coughs or sneezes when an object like a bulb syringe is placed in the nose | Grimaces | No grimace, cough, or sneeze |
| Activity (muscle tone) | Active movement | Some flexing of arms and legs | Limp |
| Respiration (breathing rate and effort) | Normal rate and effort, good cry | Slow or irregular breathing, weak cry | Absent (no breathing) |
As an example, if your newborn has a normal body color with bluish feet; has a heart rate lower than 100 beats per minute; is grimacing and sneezes when stimulated; is active; and is breathing well with a good cry, she would score 1 for appearance, 1 for pulse, 2 for grimace, 2 for activity, and 2 for respiration. Her Apgar score would be 8.
What Do the Results Mean?
Most babies get an Apgar score of 7 or above. However, even a perfectly healthy baby can sometimes get a lower score, especially for the 1-minute test, and very few babies are assigned a score of 10. This is because many babies need to warm up a little before their hands and feet are no longer bluish. Remember, the score is an assessment of your newborn’s general condition at birth and whether any additional support is needed; it’s not reflective of your baby’s long-term health prospects. If your baby’s score doesn’t improve in the second test, your baby’s healthcare provider will continue to give medical care and keep a close eye on your baby. A lower score, especially during the first test, may be more common if
yours was a high-risk pregnancy
your baby was born via cesarean section
you had a complicated labor or delivery
your baby was born prematurely.
What If Your Baby Has a Low Score
If your baby gets a low score overall or in one specific area, your baby’s healthcare provider will assess what may be the problem. Try to remember that your baby is receiving expert care, and that steps will be taken to help resolve any issues. For example, the care team may begin suctioning the airways or giving oxygen to help your little one breathe better. Or, they may hold oxygen under his nose and dry him vigorously at the same time to encourage him to breathe deeply. In some cases, an oxygen mask may be placed over your newborn's face to help him breathe. If your baby still isn’t breathing well even with the help of the oxygen mask, a tube may be placed into his windpipe to provide extra help. Sometimes, fluids and medications may be given via a blood vessel in the umbilical cord to help strengthen his heartbeat. If your baby still needs a little extra support, he may go to a special-care nursery for additional observation or treatment. As you can see, the Apgar score helps your healthcare provider decide what, if any, of these extra care steps are needed. Your baby will be getting the best possible treatment, and the Apgar test helps make this happen as quickly as possible.
FREQUENTLY ASKED QUESTIONS
Most babies score 7 or above. Keep in mind that your baby’s test results will be used to determine whether any immediate medical care is needed.
The Bottom Line
The Apgar score is a useful tool for your baby’s healthcare provider to make a quick assessment of your baby’s overall physical condition in the minutes immediately after birth. Although most babies score 7 or above, no matter what your little one’s score is, your provider knows how to best care for your newborn and treat any issues there may be. Soon enough, these first few tests will be over and you’ll be able to enjoy skin-to-skin contact with your little one. If your due date is almost here or perhaps you’ve just recently given birth, take this time to read up on the postpartum period so that you know more about what lies ahead during this time.
How We Wrote This Article
The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.