When your baby is born and you’re soaking in your first moments with them, your health care team is quickly assessing your baby’s overall health and well-being. This very first “test” is called the Apgar score.
If you’ve never heard of an Apgar score or aren’t clear on its purpose, you aren’t alone. Apgar scores have been assigned to newborns for more than half a century, but many parents misunderstand them.
What does the Apgar score mean for your baby, both now and later on? And should you be concerned about the letters and numbers?
Here’s everything you need to know about the Apgar score, what it is, what it measures and what it means for your baby.
What is the Apgar score?
The Apgar score is named after its developer Virginia Apgar, MD, an American anesthesiologist.
“Dr. Apgar devised a scoring system from 1952 to 1958, which provided a standardized way of assessing infants after delivery,” said Peter Stevenson, MD, a neonatologist with Banner Children's.
Your baby’s journey into the world, whether via vaginal birth or caesarean section (C-section), is miraculous and sometimes tough. Going from the comfort of your uterus into the bright, cold world can be an adjustment. The Apgar score provides a way to quickly judge how your baby is doing and what extra medical care they may or may not need, such as help with breathing or a heart problem.
“Apgar scores are often considered a ‘test,’ which is misleading,” Dr. Stevenson said. “It’s better considered a description of an infant's basic condition shortly after birth, which, in most cases, has little correlation with a baby’s long-term future.”
The Apgar is used as an acronym, which evaluates five areas: Appearance, Pulse, Grimace, Activity and Respiration. Here is what health care providers look for in each category:
- Appearance: This refers to your baby’s skin color or skin tone. As your baby takes in their first few breaths, their skin may turn from blue to pink.
- Pulse: Your provider will measure your baby’s heart rate based on the normal level of above 100 beats per minute.
- Grimace response: This refers to your baby’s reflexes. For example, does your baby respond to having their mouth suctioned with a cry, cough or sneeze?
- Activity: This refers to your baby’s movement of their limbs (arms and legs).
- Respiration: The quality of your baby’s respiration is determined by their cry. A good, loud cry is better than a whimper or no cry at all.
How is Apgar scored?
Your baby gets scored for each category, using a scale of 0, 1 and 2, within the first minute they are born for a total score that can range from 0 to 10.
“Apgar scores are assigned at one minute and five minutes routinely,” Dr. Stevenson said.
The score is calculated as follows:
0: Blue or pink
1: Body pink, but hands and feet blue
2: Completely pink
0: Can’t detect heartbeat
1: Less than 100 beats per minute
2: More than 100 beats per minute
0: Doesn’t respond to stimulation
1: Make face movements
2: Make face movements and cry, cough or sneeze
0: Limp, floppy
1: Some flexing of arms and legs
2: Active motion
0: No breathing
1: Slow, irregular breathing; weak cry
2: Good breathing; strong cry
What does my baby’s Apgar score mean?
Your baby’s Apgar score is only meant to look at how they are doing at the moment and whether or not they have immediate medical needs. Most babies receive Apgar scores that indicate good health, though hardly any babies ever receive a maximum score of 10.
According to a study published by the American Academy of Pediatrics, scores are defined as follows:
- Scores higher than 7 are classified as “reassuring”
- Scores between 4 and 6 are classified as “moderately abnormal”
- Scores below 4 are classified as “low”
If your baby has a low Apgar score, your health care team will be on hand to ensure your baby receives all the care and immediate life-saving support required. Very rarely, however, does it predict long-term health, behavior, intelligence or personality issues. There are a number of serious and non-serious reasons that can impact your baby’s score, such as having a C-section, birth trauma/injury or premature birth.
“Apgar scores are mainly a brief description of the condition of your baby in the first minutes after delivery, and are most often used retrospectively or looking back, rather than as a tool to determine treatment and intervention,” Dr. Stevenson said. “This is better determined by continuous evaluation of the baby’s condition and response based on resuscitation algorithms such as NRP, as well as clinical experience.”
Your baby’s Apgar score is only a reflection of how your baby is doing at the moment, and it doesn’t predict your baby’s future. Your baby will receive all the care they need if and when they need it. You can just focus on enjoying those first precious moments snuggling your new little one.