Apgar score: what it is and how to interpret it

Devised by Dr. Virginia Apgar in 1952, the Apgar score is a number from 1-10 that indicates how healthy a newborn is at birth, based on five categories; Appearance, Pulse rate, Grimace (reflex), Activity, and Respiratory effort. A score of 7 or above is considered normal, while 4 to 6 is low, and 3 or below is critically low. The test is most frequently done at one and five minutes after birth, but may be performed again if the score is below 7 at the one or five minute intervals. A low score may mean that the baby requires medical attention, but does not necessarily indicate long-term problems.

Each of the five categories of the Apgar test is graded from 0-2, with 0 the lowest and 2 the highest. The scores from each of the five categories are added together to come up with the overall Apgar score.


The “Appearance” portion measures oxygen flow across the body – a baby who is not getting enough may have a blue tint. A score of ‘0’ will be given to those who are blue in the body and extremities, while a ‘1’ will be given to those who are blue just in the extremities. Babies whose bodies and extremities are totally pink and healthy will be given a ‘2’.

“P”ulse rate

The “Pulse” section measures the heart rate to make sure that a newborn’s heart is functioning as it should. Babies with absent pulse rates get a score of ‘0’, while those whose pulse rates exist but are below 100 are given a ‘1’, and those with a pulse of over 100 get a ‘2’.

“G”rimace (reflex)

This measures the baby’s reflexes – how they respond to stimulation. A baby geting a ‘0’ will not respond to stimulation. A baby who gets a ‘1’ will make some slight reaction, and a baby getting a ‘2’ will cry or pull away when stimulated.


The “Activity” portion scores baby on how well they are moving around. A baby who displays little activity will get a ‘0’. A baby with a ‘1’ will show some flexion, while a baby who gets a ‘2’ will display flexed arms and legs, and resist extension.

“R”espiratory effort

This section measures the amount of effort a baby is able to put toward breathing. A baby who displays no signs of breathing will get a ‘0’. Weak or inconsistent gasping gets a ‘1’, and a strong cry will get a ‘2’.

What happens if the score is low?

Oftentimes, a baby with a total score below ‘7’ may be in need of some extra medical attention, but this is not always the case – your healthcare provider will be able to give you a clear assessment of your baby’s health regardless of the Apgar score. The Apgar score is among the best-known neonatal tests in the United States, but it is not universal. Your healthcare provider may have a different rubric that they use to score Baby‘s health, even if you are in the US.

Reviewed by Dr. Jamie Lo
Read more
  • “Apgar score.” U.S National Library of Medicine. MedlinePlus, 11/20/2014. Web.
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