Apgar score

In the first few minutes after being born, your little one will usually receive what’s known as an APGAR score, which helps your midwife or doctor assess whether your baby needs any immediate help adapting to the outside world. Read on to find out what APGAR stands for, what the APGAR test is, how the test is done and what the results can mean.

What Is the APGAR Test?

The APGAR test is an assessment of your baby’s responsiveness immediately after being born. Your baby’s APGAR score will usually be recorded by your midwife 1 minute after your baby’s birth, again at 5 minutes and sometimes a third time, at 10 minutes after birth. The purpose of the test is to see if your baby 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 midwife and doctor to quickly determine what, if any, extra medical care is needed right away. Your midwife will assess or measure each five factors and give your baby a score for each of the APGAR criteria. If needed, additional medical care will be given based on the test results.

What Does APGAR Stand For?

APGAR stands for your midwife or doctor’s assessment of your newborn’s

Appearance (skin colour) Pulse (heart rate) Grimace response (reflexes) Activity (muscle tone) Respiration (breathing rate and effort).

How Is the APGAR Score Calculated?

Each of the five factors (appearance, pulse, grimace, activity, respiration) are given a score of zero, one, or two points. Then these are tallied to give your baby an APGAR score out of 10.

Most babies are born with an APGAR score of 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 midwife looks for when assigning points, take a look at this APGAR scoring system chart:

Apgar Scoring System Chart
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Appearance (skin colour)Normal skin colour all over (no blueness)Normal colour, only hands or feet are blue or bluishBluish or blue all over
Pulse (heart rate)Higher than 100 beats per minuteLower than 100 beats per minuteNo pulse
Grimace (reflexes)Grimaces, coughs, sneezes or pulls away when stimulatedGrimaces or cries weakly when stimulatedDoes not react to being stimulated
Activity (muscle tone)Active movementSome movementNo movement
Respiration (breathing effort)Strong cryWeak, slow or irregular breathingNo breathing

 

As an example, if your newborn...

  • has a normal body colour with bluish feet

  • has a heart rate of 97 beats per minute

  • grimaces and sneezes when stimulated

  • wriggles a lot

  • cries out strongly

...then your baby would score

  • 1 for Appearance

  • 1 for Pulse

  • 2 for Grimace

  • 2 for Activity

  • 2 for Respiration.

This would give your little one a total APGAR score of eight.

In Summary

The APGAR score is based on your midwife’s assessment of skin colour (Appearance), heartbeat (Pulse), reflexes (Grimace), muscle tone (Activity) and breathing (Respiration) at 1 minute, 5 minutes and sometimes also 10 minutes after birth. It’s based on a simple scoring system with zero, one or two points awarded for each factor. The APGAR score helps your child’s midwife or doctor see if your baby needs any immediate medical care.

 

What Do the Results of the APGAR Test Mean?

Most babies get an APGAR score of seven or above. However, even a perfectly healthy baby can sometimes get a lower score, especially for the 1-minute test. It’s rare for babies to score a ‘perfect 10’ in the APGAR test, because – for example – a little blueness of extremities like the hands or feet is so common it’s considered normal. Remember, the APGAR score is an assessment of your newborn baby’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 APGAR score doesn’t improve in the second test, your midwife, doctor and the rest of the care team will continue to give medical care and keep a close eye on your baby. A lower score may be more common if

In Summary

Most babies have an APGAR score of seven or more (at five minutes), and even healthy babies sometimes have a lower score than that. A maximum score of 10 is very rare. The APGAR score is not reflective of your baby’s long-term health prospects.

 

What If Your Baby Has a Low APGAR Score

Intervention may only be necessary if the APGAR score is lower than seven at the five-minute test or below five during the one-minute assessment, or if there is a specific issue like a lack of pulse. If your baby gets a low score overall or in one specific area, your midwife or obstetrician will assess what may be the problem. Try to remember that your baby will be receiving expert care from highly trained professionals who know what steps are needed to help resolve any issues. For example, the care team may begin giving oxygen to help your little one breathe better. If your baby still needs a little extra support, your newborn may be given closer monitoring or extra treatment. As you can see, the APGAR score helps your healthcare provider decide what, if any, 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.

In Summary

Your baby may need a little extra support if the five-minute APGAR score is less than seven, or if your baby has a specific issue like your baby doesn’t have a pulse or he or she isn’t breathing. Generally speaking, though, try not to worry about the result – your baby is in expert hands and the APGAR score is a tool your child’s midwife or doctor uses to ensure your baby gets any care needed as quickly as possible.

 

FAQs at a Glance

  • The APGAR score is based on assessments of five factors:
    Appearance (skin colour)
    Pulse (heart rate)
    Grimace response (reflexes)
    Activity (muscle tone)
    Respiration (breathing rate and effort).

  • The APGAR score helps your midwife make a quick assessment of your baby’s overall physical condition immediately after birth. If the test results indicate additional care is needed, this can be given straight away.

The Bottom Line

The APGAR score is a useful tool for your midwife to make a quick assessment of your baby’s overall physical condition in the minutes immediately after birth. Although most babies score seven or above, no matter what your baby’s score is, your midwife 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 getting to know your little one.

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 National Health Service (NHS). 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.