The Apgar score sums up a newborn’s condition in the first minutes of life as a number from 0 to 10. Five signs are observed at a glance, each worth 0 to 2 points, and the score is taken at one minute and again at five.
Total score
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Total score—
How it is classified—
Range for that class—
Signs scoring full marks—
Signs below two—
The five signs, one by one
Sign
What is observed
Points
How this was worked out
Indicative result. The Apgar score is assigned by whoever attends the birth, with the newborn in front of them. This page is here to explain what each sign measures and how they add up, not to score a baby or to stand in for anyone. A low Apgar score on its own does not predict a child’s development: the American Academy of Pediatrics says so itself.
The formula
Apgar = appearance + pulse + grimace + activity + respiration, 0 to 2 points each
Where it comes from
Virginia Apgar was an obstetric anaesthetist, and she published the score in 1952 because nobody in the delivery room was looking at the newborn systematically: all the attention was on the mother. She wanted five signs that could be observed in seconds, without instruments and without two people disagreeing about the same baby. The APGAR acronym built on her surname came eleven years later, in 1963, and is a mnemonic devised after the fact. The score changed obstetric practice more than any other tool of the last century, and it stands exactly as published.
How to work it out by hand
Look at skin colour: blue, pink with blue extremities, or pink all over
Count the heart rate: absent, below 100, or above 100
Provide a stimulus and watch the response: none, a grimace, or a cry
Check muscle tone: limp, some flexion, or active movement
Assess breathing: absent, weak, or a strong cry, then add the five up
What is worth knowing
The five-minute score is the one that counts, and this is worth saying because the one-minute score alarms people for no reason. Plenty of perfectly healthy newborns score 7 or 8 at one minute — hands and feet take a while to lose their bluish colour, so a 10 is uncommon even after a birth with no complications — and reach 9 or 10 by five minutes. What is watched is not the isolated number but its trend: a score that does not rise between minute one and minute five matters far more than a low score that recovers. The scale also has known limits: premature babies score lower because of neurological immaturity even when they are well, and maternal anaesthesia, a caesarean or a malformation can lower the score without reflecting asphyxia.
Frequently asked questions
What does the Apgar score mean?
It is the sum of five signs observed in the newborn: appearance (colour), pulse, grimace (reflex response), activity (muscle tone) and respiration. Each is worth 0, 1 or 2 points, so the total runs from 0 to 10.
What is a normal Apgar score?
7 to 10 is considered normal. Between 4 and 6 is moderately low and usually calls for assistance; 0 to 3 is low and needs immediate attention. The score that matters is the one at five minutes.
Is an Apgar score of 8 bad?
No. An 8 at one minute is a normal and very common score: typically one point is missing on skin colour and another on muscle tone, because hands and feet take a while to stop looking blue.
Does a low Apgar score cause lasting harm?
A low Apgar score on its own does not predict a child’s development. The American Academy of Pediatrics and the American College of Obstetricians say so explicitly: the score describes the state in that particular minute, not the future. What does raise concern is a score still low at ten minutes.
Why is it taken at one and five minutes?
Because the score measures adaptation, and adaptation is a process. The one-minute score says how the baby arrived; the five-minute score says how they are responding. If it is still below 7, it is repeated every five minutes up to twenty.
Who invented the Apgar score?
Virginia Apgar, an American anaesthetist, in 1952. The acronym on her surname was proposed by the paediatrician Joseph Butterfield in 1963, eleven years after the score was already in use.
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