What Is Baby’s Apgar Score? What Does It Mean?

What does baby's Apgar score mean? Does it predict baby's health later on? Here’s everything parents need to know about the Apgar score.

Shortly after your baby is born, doctors will run an Apgar test and give baby an Apgar score. But what does the Apgar score mean for your baby, both now and later on? Here’s everything parents need to know about the Apgar score. 

What is the Apgar score?

The Apgar score shows the results of baby’s first health tests, which gauge their heart rate, breathing activity, appearance, and other factors. 

Doctors and nurses use these tests to gauge how your baby is doing immediately after birth, and see if baby needs help breathing or has problems with their heart rate.

Usually, doctors or nurses will perform the Apgar tests one minute after baby is born, and then again, around five minutes after baby is born. 

The first test sees how baby is doing after labor and delivery, and the second checks on them again after they’ve had some time outside the womb.

What does Apgar stand for?

The Apgar test got its name from Dr. Virginia Apgar, who created the test in 1952. 

Dr. Apgar’s test was originally meant to determine whether a baby would need to be resuscitated (whether they’d need breathing or heart rate assistance) after their mother received anesthesia during the delivery.

The test’s exact purpose has changed through the years. Nowadays, it’s meant to see how baby is doing right after birth, and is used for all babies. 

But just as when Dr. Apgar coined it, the score still involves checking baby’s breathing and heart rate, as well as three other factors (color, muscle tone and reflexes). 

The name “Apgar” is used as an acronym, which stands for the five areas doctors check during the test:

A: Appearance (color of skin)

P: Pulse (heart rate)

G: Grimace (reflex, or how baby reacts to the stimulus of being pinched lightly)

A: Activity (muscle tone and movement)

R: Respiration (breathing)

How are babies scored?

In each of the 5 areas of the Apgar test, babies receive a score of 0 to 2. (2 is the best possible score in a category.)

A: Appearance (color of skin):

Babies with light skin will usually be checked for a pink body all over. Babies with darker skin will have their palms of hands, soles of feet, mouth, and tongue closely checked for their “appearance” score, because these areas are the least pigmented and are usually pink. 

2– Palms of hands and soles of feet are pink; skin color looks healthy

1– Palms of hands and soles of feet are bluish; skin color still looks healthy

0– Palms of hands and soles of feet are blue; mouth and tongue are blue; skin color is pale, gray-blue, or otherwise looks unhealthy

 

P: Pulse (heart rate):

Baby’s heart rate will be checked with a stethoscope.

2– 100 or more beats per minute (BPM)

1– Fewer than 100 beats per minute (BPM)

0– The doctor or nurse can’t detect baby’s heartbeat


G: Grimace (reflex):

A doctor or nurse will lightly pinch baby’s skin, or provide another form of stimulation, and see how baby reacts. (Don’t worry, the stimulation won’t hurt baby!)

2– Baby makes face movements (grimaces) and reacts to the stimulation in a “strong” way. They might cry, pull away, cough, or sneeze. 

1– Baby only makes face movements (grimaces) as a reaction to the stimulation

0– Baby doesn’t respond to the stimulation at all


A: Activity (muscle tone and movement):

The doctor or nurse will check baby’s muscle tone, as well as how active they are. 

2– Very active and has good muscle tone

1– Arms and legs are flexed; some movement of arms and legs

0– Muscles are inactive, loose or “floppy;” no movement


R: Respiration (breathing):

The doctor or nurse will check baby’s breathing and the strength of their cry. 

2– Good breathing; strong cry

1–  Irregular or slow breathing; weak cry

0– No breathing


Together, these 5 areas make up the total Apgar score, with a maximum of 10 points available.

  • A score of 7-10 means baby is in good or excellent health, and only needs routine immediate care. 
    • They shouldn’t need breathing assistance or help getting their heart rate up. 
    •  (This is considered the “normal” Apgar score.) 
  • A score of 4-6 means baby is in fair health, but may need some breathing or heart rate assistance.
  • A score lower than 4 means baby is currently in poor health. 
    • They require immediate medical attention (usually, breathing assistance or heart rate assistance).
    •  This could include oxygen, clearing of the airway (suction), or stimulation to get baby’s heart rate up.  

Hardly any babies receive the maximum score of 10, because babies’ feet and hands are usually blue right after birth – they haven’t warmed up yet.

What does baby’s Apgar score mean?

Baby’s Apgar score is only meant to gauge how they are doing in the moment, to see if they have certain immediate care needs. 

It’s not meant to tell you anything about how healthy baby will be in the long term.

  • Most babies receive Apgar scores that indicate good health. 
  • If baby doesn’t “pass” the Apgar test the first time, don’t worry. 
    • Doctors will closely monitor them and give them the care they need. 
    • Most babies receive good health scores during their second test, even if they had a lower score on the first. 
  • And if baby receives a low score both times, that’s not a cause for concern, either.
    • A low Apgar score doesn’t predict poor health later on – most babies with low scores still end up being perfectly healthy.  
    • What’s important is that their immediate care needs were identified and met.

What else should I keep in mind if baby’s Apgar scores are low?

As Johns Hopkins All Children’s Hospital shares, if your doctor has concerns about baby’s Apgar scores, they’ll keep you in the loop. 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.” 

They might also run a third Apgar test (at the 10-minute mark) to see how well baby is responding to the care.

Keep in mind that slightly lower Apgar scores (especially on the first test) are often a result of:

  • A C-Section
  • A difficult labor/delivery 
  • A higher-risk pregnancy
  • Premature birth
  • Fluid in baby’’s airway

Remember: the score only shows how baby is doing in the moment – it doesn’t predict baby’s future health! Baby will get the care they need if they need it. Instead of dwelling on the Apgar score, focus on enjoying these first precious moments with your new little one. 

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