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Baby’s First Test: Apgar Scoring Explained

Baby’s First Test: Apgar Scoring Explained

  • Health professionals will do the Apgar assessment to check how your baby is doing outside the womb & see if they need to give more medical attention them.
  • The scoring will not tell you the overall health of your baby or their future health.
  • You can't practice for this test, but it's a good thing to know before you give birth!
Apgar Score

Giving birth is a challenging experience for moms, and it can also be physically challenging on the baby. Healthcare providers use a quick test called the Apgar score to measure how newborn babies are doing immediately after birth.


What Is Apgar?

Apgar stands for “Appearance, Pulse, Grimace, Activity, and Respiration.” These are the five factors that healthcare providers use to get an overall score.

  • Appearance: skin color
  • Pulse: heart rate
  • Grimace response: reflexes
  • Activity: muscle tone
  • Respiration: breathing effort


How Is It Scored?

Healthcare providers will look at your baby’s color, movement & breathing, use a stethoscope to check their pulse, and check reflexes with a light pinch or nose suction. Each of the five factors is scored on a scale of 0 to 2, with 2 being the best score. They are then added together to get an overall score between 0-10. Most newborn infants have Apgar scores of 7 or higher, but few score a perfect 10. That’s because most babies’ hands & feet are blue until they warm up. When it comes to checking skin color for Asian or African American babies, they will check the color of their mouth, palms of their hands, and soles of their feet since their body’s will not be pink. Check out this summary table below.

Apgar Sign




(skin color)

Normal color all over (hands and feet are pink)

Normal body color (but hands and feet are bluish) Bluish-gray or pale all over

(heart rate)

Normal (above 100 beats per minute)

Below 100 beats per minute

No pulse

(reflex irritability)

Pulls away, sneezes, coughs, or cries with stimulation (a light pinch or nose suction)

Facial movement only (grimace) with stimulation

No response to stimulation

(muscle tone)

Active, spontaneous movement

Arms and legs flexed with little movement

No movement, “floppy”

(breathing rate and effort)

Normal breathing, good cry Slow or irregular breathing, weak cry

No breathing

Table Reference: Kids Health

Healthcare providers typically measure two Apgar scores at different times, the first at 1-minute after birth & the second at 5-minutes after birth. The 1-minute score can show how well the baby tolerated the birthing process. The 5-minute score can show how well the baby is doing on its own, outside the mom’s body. Some babies may need to be checked again if their first two scores are low.


What Does a Low Score Mean?

A lower score doesn’t mean that your baby is unhealthy or at risk. It might just mean that they need some special immediate care to help them adjust to the new environment. If your provider is worried about your baby’s score, they will let you know and will explain how your baby is doing, what might be causing problems (if any), and what care is being given. Providers may suction the airways or give your baby oxygen to help him or her breathe. If your baby needs more assistance, they may be transferred to the neonatal intensive care nursery.

Some babies are expected to have lower Apgar scores after birth. These include:

  • premature babies
  • babies born via C-section delivery
  • babies who had complicated deliveries

It’s important to understand that while the Apgar score helps providers understand how a baby is doing immediately after birth, the test was not designed to predict a baby’s long-term health.

It does not indicate how healthy your baby will be as they grow up or how they will develop. It simply alerts your providers if your baby is sleepier or slower to respond than normal & may need a little more assistance adjusting to the outside world. Most babies with low scores are healthy and do well with medical care and just need some time to get used to their new environment.


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