The Apgar Score: Your Child’s First Grade

You don’t have to worry about your baby taking most tests until they are of school age, but there is an important score that he or she will receive at birth and shortly afterward: An Apgar score.

A baby’s Apgar score comes from a quick examination by a nurse, midwife, or doctor that is done at one minute after birth and redone at five minutes after birth.

The exam is fast and effective and gives the healthcare team in the delivery room a rapid assessment of the overall health of your baby. What happens is that a nurse checks your baby for five aspects of his or her health: Breathing or respiration, heart rate, muscle tone, reflexes, and skin color (whether the skin is blue or too red).

Each of these aspects is given a score of 0, 1, or 2, which are added up to create the Apgar score. A high score, which is a score of 7 to 10, means that your baby is in good shape and has come through birth well. It shows that your baby is breathing on their own and has a good heart rate.

Many babies will have a lower Apgar score at one minute after birth and a higher score at 5 minutes after birth. This is because they are not over the shock of going from the warm, dark womb to the cooler outside world and need to get used to taking their first breaths.

The main benefit of the Apgar test is that it can quickly determine if a newborn baby is having any immediate problems or difficulties. It does not require special instruments outside of a stethoscope and can be done very rapidly. The American College of Obstetricians and Gynecologists (ACOG) calls the Apgar an accepted and convenient method for rapidly determining a baby’s status.

However, ACOG also notes that a baby’s Apgar score does not predict an individual baby’s risk of any serious conditions that don’t show up in the first few minutes nor of the baby’s neurologic outcome. The score just tells the healthcare team if the baby needs immediate help, such as some oxygen or stimulation to get their respiration and heart rate going.

For breathing, the healthcare provider will give a score of 0 if the baby is not breathing on his or her own. If your baby is breathing, but breathing slowly or irregularly, the score is 1. If your baby is breathing well or is crying, the score is 2.

The healthcare provider will check your baby’s heart rate with a stethoscope. If there is no heartbeat, the score is 0. If the heart rate is less than 100 beats per minute, the score is 1. If the hear rate is higher than 100 beats per minute, which is normal for a newborn, the score is 2.

Muscle tone is evaluated. If your baby’s muscles are floppy, the score is 0. If there is some movement, the score is 1. If your baby is making active movements, the score is 2.

Reflexes, which are sometimes called a grimace response, tell how well your baby responds to a stimulus, usually to a mild pinch. If your baby doesn’t react, the score is 0. If your baby grimaces or makes a face, the score is 1. If your baby grimaces and cries, coughs, or sneezes, the score is 2.

Last, there is skin color. If your baby is blue, the score is 0. If your baby’s torso and face are pink, but his or her arms and legs are blue, the score is 1. If the baby is pink all over, the score is 2. Even if your baby has dark skin, your healthcare provider can judge whether there is blueness present.

If your baby has an Apgar score of under 7 at five minutes after birth, the assessment may be repeated in another five minutes.

Another way to remember the five parts of an Apgar score is Activity (for muscle tone), Pulse for heart rate), Grimace (for reflexes), Appearance (skin color), and Respiration. This spells out APGAR and serves as a useful mnemonic, but it has become so famous that many people don’t know that the Apgar score is actually named for the woman who created it, Virginia Apgar, MD.

Dr. Apgar was a pioneer in the field of anesthesiology in obstetrics. In 1952, she was asked by a student if there was a way to quickly determine a newborn baby’s condition and whether they needed help to establish breathing. She quickly wrote down the five components of the score. Research later showed that the standardized Apgar score was accurate and helped reduce the mortality rate of babies in the first 24 hours of life. Because of her creation of this useful test, the United States issued a stamp in honor of Dr. Apgar in 1994.

Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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