What Is the Apgar Score And What Does It Tell Us About a Newborn Baby's Health?

One of the most complex parts about being a tween or a teen is dealing with the feeling that other people are constantly judging you. Not that this goes away as you age: The uncomfortable feeling can rear its ugly head at your job and basically anytime you interact with new people. Then there are moms, who — both during pregnancy and after giving birth — likely experience far more judgment and unsolicited advice in one year than most men do in a lifetime. Sometimes, assessments come with a numerical value, like grades in school or marks on a performance review at work. But for most of us, the first time it happened was literally one minute after we were born. How? In the form of the Apgar test, for which we received an Apgar score.

If you’re about to become a new parent, you’ve probably seen the term in one of your baby books. And, naturally, it could be causing you a bit of new parent panic. So, here’s what to know about the Apgar scale and what it tells us about a newborn’s health.

What is the Apgar test?

The Apgar test was created in 1952 by Dr. Virginia Apgar to quickly assess a newborn’s condition immediately following birth. According to the American Academy of Pediatrics, it checks a baby’s heart rate, muscle tone, and other signs to see if emergency care is needed. While the Apgar scale got its name from its creator, it also is used as a mnemonic device to help remember the five aspects of the test:

1. Appearance (skin color)
2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration (breathing rate and effort)

A doctor, nurse, or midwife administers the Apgar test one minute after a baby is born to determine how well the baby tolerated the birthing process. Healthcare professionals perform the test again five minutes after a baby enters the world to establish how it is functioning on its own.

How do you calculate an Apgar score?

The Apgar score chart consists of five categories, each of which is scored from zero (being the lowest) to two (the highest), depending on the conditions the healthcare provider observes. After the assessment, the scores for all categories are added together to calculate an Apgar score ranging from one to 10.

Here’s how each category is assessed, per MedlinePlus:

Breathing Effort:

• If the infant is not breathing, the respiratory score is zero.
• If the respirations are slow or irregular, the infant scores one for respiratory effort.
• If the infant cries well, the respiratory score is two.

Heart Rate:

• If there is no heartbeat, the infant scores zero for heart rate.
• If the heart rate is less than 100 beats per minute, the infant scores one for heart rate.
• If the heart rate is greater than 100 beats per minute, the infant scores two for heart rate.

Muscle Tone:

• If muscles are loose and floppy, the infant scores zero for muscle tone.
• If there is some muscle tone, the infant scores one.
• If there is active motion, the infant scores two for muscle tone.

Grimace response or reflex irritability describes the baby’s response to stimulation, such as a mild pinch:

• If there is no reaction, the infant scores zero for reflex irritability.
• If there is grimacing, the infant scores one for reflex irritability.
• If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores two for reflex irritability.

Skin Color:

• If the skin color is pale blue, the infant scores zero for color.
• If the body is pink and the extremities are blue, the infant scores one for color.
• If the entire body is pink, the infant scores two for color.

Here’s an example of an Apgar scoring table below from the ABC Law Center:

What is a normal Apgar score?

Apgar scores range from one (the lowest) to 10 (the highest). A typical Apgar score is between seven and nine, indicating that the baby is in good health. There are very few perfect 10s because newborns usually have blue hands and feet (which is perfectly normal and nothing to worry about).

What does an Apgar score of 6 mean?

When it comes to scoring, anything between a four and a six is considered abnormal. This means the child may need medical treatment to address any issues that may come up. It is a poor score and should be managed as soon as possible by the child’s pediatrician, but it isn’t as urgent as a score less than four. A rate between four and six could mean the newborn is having difficultly adjusting to living outside of the womb. A score of seven and above is good, as it shows that your baby is healthy and has warmed up to life well. However, anything three or lower is deemed a low and concerning score.

What causes a low Apgar score?

An Apgar score lower than seven means that the baby is still getting adjusted to life outside the comforts of the womb. Most of the time, low Apgar scores result from a difficult birth (including via C-section) and/or fluid remaining in the baby’s airway. In these cases, the treatment typically consists of providing the baby with oxygen and assistance clearing out their airway, plus physical stimulation to get their heart beating at a healthy rate.

The good news is that, in most cases, babies with a low Apgar score at one minute have one that’s close to normal at the five-minute test. And while it may be alarming and distressing when a medical professional assigns your new, tiny, precious baby a low numerical value, keep in mind that the Apgar score doesn’t predict the child’s future health. Likewise, it isn’t an indicator that they’ll develop severe or long-term health problems as they age. So, go ahead and take a deep breath, mama.

Management of Baby with Low Apgar Score

An infant with a low Apgar score might have trouble breathing. Newborns with a score below seven may suffer from neonatal asphyxia, so doctors will provide oxygen and clear the child’s airway. Physicians may also provide resuscitation and lung stimulation to help the baby breathe.

Does meconium aspiration affect APGAR score?

Meconium is an infant’s first poop, and when a child experiences meconium aspiration, they ingest a mix of amniotic fluid and meconium during delivery. A newborn who experiences this condition usually has an Apgar score of seven or less after about one to five minutes after birth. This is because the baby’s body is under a large amount of stress.