The Apgar score is a quick assessment of a newborn’s health performed at 1 minute and 5 minutes after birth. It rates five physical signs on a scale of 0 to 2, giving a total score between 0 and 10. Each letter in “APGAR” stands for one of the five categories: Appearance, Pulse, Grimace, Activity, and Respiration.
The Five Categories and How Each Is Scored
Each category is scored 0, 1, or 2, with 2 being the healthiest response. Here’s what the medical team is looking for in each one.
Appearance (Skin Color)
This measures blood circulation by looking at the baby’s skin color. A score of 0 means the baby’s entire body appears blue or pale. A score of 1 means the body is pink but the hands and feet are still bluish, a common condition called acrocyanosis. A score of 2 means the baby is pink all over. It’s worth noting that many healthy newborns score only a 1 here because bluish hands and feet are extremely common in the first few minutes of life.
Pulse (Heart Rate)
Heart rate is the single most important indicator of how a newborn is doing. If no heartbeat is detected, the score is 0. A heart rate below 100 beats per minute scores 1. A heart rate above 100 beats per minute scores 2. The medical team typically checks this with a stethoscope or by feeling the pulse at the base of the umbilical cord.
Grimace (Reflex Irritability)
This tests the baby’s response to stimulation, such as gentle suctioning of the nose or a light flick on the sole of the foot. No response at all scores 0. A facial grimace or slight frown scores 1. A strong cry, cough, or sneeze in response scores 2.
Activity (Muscle Tone)
The team observes how the baby moves. A completely limp, floppy baby scores 0. Some flexion of the arms and legs but limited movement scores 1. Active, spontaneous movement with well-flexed limbs scores 2.
Respiration (Breathing Effort)
If the baby is not breathing, the score is 0. Slow, irregular, or weak breathing (or a weak cry) scores 1. A strong, vigorous cry with regular breathing scores 2.
When the Score Is Taken
Every newborn receives an Apgar score at 1 minute and again at 5 minutes after birth. The 1-minute score reflects how the baby tolerated the birthing process. The 5-minute score shows how the baby is adapting to life outside the womb.
If the 5-minute score is below 7, the assessment continues every 5 minutes, up to 20 minutes after birth. This extended monitoring helps the care team track whether the baby is responding to any support being provided.
What the Total Score Means
The five individual scores are simply added together for a total between 0 and 10.
- 7 to 10: The baby is in good condition. Most healthy newborns fall in this range. A perfect 10 is actually uncommon because so many babies have slightly blue hands and feet in the first minutes.
- 4 to 6: The baby may need some assistance, such as gentle stimulation, suctioning of the airway, or supplemental oxygen. Many babies in this range improve quickly with basic support.
- 0 to 3: The baby needs immediate medical attention. The care team will begin active interventions right away.
What matters most is the trend between the 1-minute and 5-minute scores. A baby who scores a 4 at 1 minute but improves to an 8 at 5 minutes is responding well. A low 1-minute score on its own is not a cause for alarm if the baby recovers quickly.
A Quick Example Calculation
Imagine a baby born with a pink body but blue hands and feet, a heart rate of 120, a grimace when stimulated, some arm and leg flexion but not much active movement, and a weak cry. That baby would score:
- Appearance: 1 (pink body, blue extremities)
- Pulse: 2 (heart rate above 100)
- Grimace: 1 (facial grimace only)
- Activity: 1 (some flexion)
- Respiration: 1 (weak cry)
Total: 6 out of 10. This baby would likely receive some gentle support and be reassessed at 5 minutes.
What the Apgar Score Does Not Tell You
The Apgar score is a snapshot of the first few minutes of life, not a prediction of your child’s future health. A 2024 study in JAMA Network Open found that low 5-minute Apgar scores in extremely preterm infants were not associated with impaired thinking or movement abilities at age 5. Even an Apgar score of 0 at 10 minutes is a poor predictor of long-term disability: at least half of surviving children with that score had no disability or only a mild one.
The American Academy of Pediatrics has stated clearly that the Apgar score was never intended to predict neurological outcomes. It is a useful tool for quickly summarizing a newborn’s condition in the delivery room and guiding immediate care, but it says very little about what comes after those first critical minutes.