Apgar 101: Specifics and Scoring

Immediately after your baby is born, he or she is given a very important test. The Apgar test is given and an Apgar score administered; generally within 1 to 5 minutes after birth. This test was introduced by Dr. Virginia Apgar as a way to quickly and effectively measure the overall health of a newborn baby. The test gives doctors a general idea of how the baby is health wise and if there are things that need immediate attention.

The score is given on a scale of 1-10; the lower the number, the greater the cause for concern. If the score is lower than a 3, the test may be re-administered after some time has gone by. The Apgar score is in no way an indication of major problems with your baby or long term issues; it simply lets doctors know where your child is at when they first make their entrance into the world.


While the test was named after Dr. Apgar, it has since also become an acronym for the basic things that doctors check:

A-Appearance: The baby’s skin is observed for any abnormalities or discoloration. Most babies have a pinkish skin tone.

P-Pulse: Doctors take a look at the baby’s heart rate and rhythm to make sure everything is healthy and functioning.

G-Grimace: This is a check of the baby’s reflexes, commonly called “reflex irritability.” Babies are “programmed” to have certain reflexes and all of these are checked at this point in the Apgar test.

A-Activity: This just takes a look at how active your baby is; if they are moving about and everything works. Muscle tone is also assessed at this time. Premature babies often get low Apgar scores because they have very little muscle tone.

R-Respiration: Baby’s breathing rate is analyzed as well as the amount of effort that it takes for baby to breathe in and out.

How Scoring Works

Once the doctors have taken a look at every aspect mentioned, your baby is given a score in each area and then an overall score.


Your baby should have skin that is one solid color all over; no spots or discoloration of any kind. His hands and feet should be a nice healthy pink. Abnormal signs include blue hands or feet or if they are pale or a blue-gray color all over.


A perfectly healthy baby should have a pulse that is over 100 beats per minute. There is often a cause for concern if the pulse is lower than 100 and emergency care is needed if the pulse is completely absent.


When stimulated, a healthy baby should appear somewhat “irritated.” They have just been pulled from a warm and cozy home they have inhabited for 9 months, so a lack of response is concerning. Generally they will pull away, sneeze, cough, or cry. The test will often be redone within a few minutes if the baby shows only facial signs of irritation or shows no reaction at all.


Obviously babies have little or no coordination right out of the womb, but they should have very active movements that are somewhat spontaneous. Healthy babies will flail around as they try and figure out what has just happened. Causes for concern are if the baby is flexing his arms or legs (or both) but not moving much otherwise. Attention is often needed immediately if the baby is showing no signs of movement at all and is motionless or floppy.


A good strong cry is usually an excellent indication that baby’s lungs are in working order. Your baby should not be struggling to cry or fighting for air. A weak cry or an irregular breathing pattern are often signs of concern and emergency attention is of course needed if baby is not breathing at all.

What Parents Should Know

In most cases, the Apgar score is given within a minute after birth and then recalculated again after about 5 minutes. Just because your baby does not score a perfect “10” does not mean that you need to be concerned.

Any score that is a 3 or lower often means that your child needs extra attention to get him to where he needs to be. This is not an indication of a serious issue or long term problem, it simply means that your child needs some extra attention for certain reasons.

A median score of 4-7 generally means that your baby is in good health but may need a little bit of medical attention in certain areas, or just needs to be watched closely for a little while. Babies need time to adjust to this bright new place, and some take longer than others.

A score of 8-10 means that your baby is in good health overall and there are no issues or concerns that need to be addressed. During your stay in the hospital and at your following check-ups, your baby will continue to be checked to make sure that that good health continues.

It’s important to keep in mind that there are some issues that don’t manifest themselves until a few days or even weeks after birth. These are not evident during the Apgar and will not influence the score at the time. Some of these issues may include jaundice or pyloric stenosis.

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