Apgar Score: Chart, Definition, Normal, Baby, and More (2024)

The Apgar score is a scoring system doctors and nurses use to assess newborns after they’re born. A score of 7 to 10 five minutes after birth is reassuring, 4 to 7 is moderately abnormal, and 0 to 3 is concerning.

Dr. Virginia Apgar created the Apgar scoring system in 1952. She used her name as a mnemonic for each of the five categories that a person will score. Since that time, medical professionals across the world have used her scoring system to assess newborns in their first moments of life.

Medical professionals use this assessment to quickly relay the status of a newborn’s overall condition. Low Apgar scores may indicate the baby needs special care, such as extra help with their breathing.

Sometimes after birth, a nurse or doctor may announce the Apgar scores to the labor room. This lets all present medical personnel know how a baby is doing, even if some of the medical personnel are tending to the mom.

When a parent hears these numbers, they should know they’re one of many different assessments medical providers will use.

Other examples include heart rate monitoring and umbilical artery blood gases. However, assigning an Apgar score is a quick way to help others understand the baby’s condition immediately after birth.

The Apgar scoring system is divided into five categories. Each category receives a score of 0 to 2 points. At most, a child will receive an overall score of 10. However, a baby rarely scores a 10 in the first few moments of life. This is because most babies have blue hands or feet immediately after birth.

A: Activity/muscle tone

  • 0 points: limp or floppy
  • 1 point: limbs flexed
  • 2 points: active movement

P: Pulse/heart rate

  • 0 points: absent
  • 1 point: less than 100 beats per minute
  • 2 points: greater than 100 beats per minute

G: Grimace (response to stimulation, such as suctioning the baby’s nose)

  • 0 points: absent
  • 1 point: facial movement/grimace with stimulation
  • 2 points: cough or sneeze, cry and withdrawal of foot with stimulation

A: Appearance (color)

  • 0 points: blue, bluish-gray, or pale all over
  • 1 point: body pink but extremities blue
  • 2 points: pink all over

R: Respiration/breathing

  • 0 points: absent
  • 1 point: irregular, weak crying
  • 2 points: good, strong cry

The Apgar scores are recorded at one and five minutes. This is because if a baby’s scores are low at one minute, a medical staff will likely intervene, or increased interventions already started.

At five minutes, the baby has ideally improved. If the score is very low after five minutes, the medical staff may reassess the score after 10 minutes. Doctors expect that some babies may have lower Apgar scores. These include:

  • premature babies
  • babies born via cesarean delivery
  • babies who had complicated deliveries

A score of 7 to 10 after five minutes is “reassuring.” A score of 4 to 6 is “moderately abnormal.”

A score of 0 to 3 is concerning. It indicates a need for increased intervention, usually in assistance for breathing. A parent may see nurses drying off a child vigorously or delivering oxygen via a mask.

Sometimes a doctor, midwife, or nurse practitioner may recommend transferring a patient to a neonatal intensive care nursery for further assistance.

The Apgar score has received serious criticism in recent years for characterizing healthy skin as “pink,” which does not adequately address the health of newborns with darker skin.

A 2023 report found that using skin color to detect cyanosis, jaundice, or other disorders in newborns led to both false positive and false negative results. The report stated that more accurate ways to assess an infant’s health by appearance included:

  • color of lips
  • color of tongue
  • pulse oximetry

Other considerations that can affect an Apgar score include sedation or anesthesia of the birthing parent, congenital malformations, gestational age, or trauma. A healthy preterm infant may also score low without actually having oxygen problems.

Many doctors don’t consider the Apgar scoring system to be perfect. There are modifications to this scoring system, such as the Combined-Apgar score. This scoring system describes not only the baby’s Apgar score, but also the interventions an infant has received.

The maximum score of the Combined-Apgar score is 17, which indicates a baby who hasn’t received any interventions and receives all points. A score of 0 indicates the baby didn’t respond to interventions.

While the Apgar score has value in helping medical providers understand how a baby is doing immediately after birth, the score doesn’t usually have any bearing on how healthy a baby is long term.

Also, because a person is assigning the number, some parts of the Apgar score can be subjective. One person could score a baby a “7” while another could score the baby a “6.”

This is why the Apgar score is just one of several assessments used to evaluate a newborn’s general condition.

Apgar Score: Chart, Definition, Normal, Baby, and More (2024)

FAQs

Apgar Score: Chart, Definition, Normal, Baby, and More? ›

The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth. A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health.

What is the normal and good Apgar score for newborn infants? ›

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.

What is the difference between normal and abnormal Apgar score? ›

Neonatal Encephalopathy and Neurologic Outcome, Second Edition, published in 2014 by the College in collaboration with the AAP, defines a 5-minute Apgar score of 7–10 as reassuring, a score of 4–6 as moderately abnormal, and a score of 0–3 as low in the term infant and late-preterm infant 6.

What are the five components of the Apgar score describe? ›

Elements of the Apgar score include color, heart rate, reflexes, muscle tone, and respiration. Apgar scoring is designed to assess for signs of hemodynamic compromise, including cyanosis, hypoperfusion, bradycardia, hypotonia, respiratory depression, or apnea. Each element is scored 0, 1, or 2.

What Apgar score indicates developmental difficulties? ›

The 5 min Apgar score is inversely associated with a risk of developmental vulnerability in early childhood across its entire range. There is an increased risk of developmental vulnerability among children with an Apgar score of 9, compared with children with a score of 10.

What does an Apgar score of 3 indicates that the baby is? ›

The Apgar score is measured at 1 and 5 minutes and then at 10 and 20 minutes as resuscitative efforts are continued. A score of 0 to 3 indicates a severely depressed neonate, whereas a score of 7 to 10 is considered normal.

How rare is a perfect Apgar score? ›

Very few babies get a perfect Apgar score – in fact at our hospital, fewer than 1 in 100 get that perfect 10.

What is considered to be a normal Apgar score quizlet? ›

Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low.

What is the normal head circumference of a newborn? ›

The average head circumference at birth is about 34.5 cm (13.5 in.). By the end of the first month, it increases to about 37.6 cm (15 in.).

What is a low Apgar score associated with? ›

A recent study showed that Apgar scores of less than 7 at five minutes after birth were associated with low cognitive function, neurologic disability and even subtle cognitive impairment as measured by academic performance at 16 years of age11,12.

Does the Apgar score predict the future health of a baby? ›

Most of the time, a low score at 1 minute is near-normal by 5 minutes. Apgar scores are not usually measured after 5 minutes. A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.

What does APGAR stand for? ›

Apgar stands for Appearance, Pulse, Grimace, Activity and Respiration: A — Appearance: Your baby's healthcare provider will look at your baby's skin tone or color. Newborns don't start circulating oxygen-rich blood until after they're born and have taken their first breath.

What Apgar score is considered to be an emergency? ›

Medical professionals consider a score of 7 or higher to be a sign of good health, while a baby who scores under a 7 may require immediate medical care.

What is a good or bad Apgar score? ›

The higher the score, the better the baby is doing after birth. A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.

What is a normal Apgar score for cerebral palsy? ›

Children with a low Apgar score of 0-3 at one minute and a normal score of 7-10 at five minutes have substantially higher risks of cerebral palsy and epilepsy compared with those who have normal Apgar scores (between 7 and 10) at both one and five minutes.

What does it mean when a newborn receives an Apgar score of 8? ›

Your baby's Apgar score will range from 0 to 10. The higher your baby's Apgar score, the better they're doing after birth. Most newborns score 7, 8 or 9 on the Apgar test. A score of 7 or higher is considered a good Apgar score.

What if a baby has a low Apgar score of 5 or 6? ›

A doctor, nurse, or midwife will evaluate the baby based on 5 categories and assign a score of between 0 and 2 for each category. The highest possible APGAR score is 10. An infant with an APGAR score of 6 or below typically requires immediate medical attention.

What does it mean if the Apgar score is between 5 and 7 at one minute? ›

Most newborn infants have Apgar scores greater than 7.

Because their hands and feet remain blue until they are quite warm, few score a perfect 10. If your baby's Apgar scores are between 5 and 7 at one minute, she may have experienced some problems during birth that lowered the oxygen in her blood.

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