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Did you know all newborns are scored two numbers at birth?

{at 1 minute & 5 minutes of life}

“APGAR Scoring System” is a method to quickly summarize the health of a newborn. The score is given checking muscle tone, heart rate, reflexes, etc. to assess if extra medical care is needed. Developed in 1952 by Dr. Virgina Apgar at NewYork-Presbyterian Hospital. Criteria listed below:

Every baby gets an APGAR score, but as a parent, it can be a completely foreign topic that leaves you worried and confused, especially if your infant ends up getting a low score. To help you better understand the APGAR scoring method and what it does, here are some quick answers to the most common questions.

Why Was The Test Created?

The APGAR score is used to check some key signs of your newborn baby, but keep in mind that most babies rarely gets a perfect score and it should not cause alarm if your baby does get a low score. A low score just indicates to doctors that they need to look for potential issues so that your infant can be cared for the best.

Generally, the APGAR score is a baby's first assessment. Its purpose is to check their basic health, like heart rate, but it's not an indicator (in any way) of your baby's future behavior or intellect. The test is only a basic assessment to help doctors provide your baby with the highest level of care.

The test itself was developed all the way back in 1952 by Virginia APGAR, an obstetric anesthesiologist. It is a standard tool by which all newborn babies are assessed.

What Is APGAR Used For?

In short, the APGAR test is a quick assessment of your newborn's physical wellness. It will help medical staff determine if present or future medical care may be required for your baby in addition to the standard care that infants receive.

When Is The APGAR Test Performed?

It is standard procedure for every doctor to perform the APGAR test on a newborn baby. The test is actually performed twice. First, the APGAR test is performed right after your baby is delivered. The test scores will be recorded, and then the test will be completed again five minutes after your baby’s birth. Both scores will be used.

Completing the test twice helps ensure accuracy and it also helps the doctors detect any discrepancies that may have occurred from the first test to the second test. Changes between the scores or two low scores could mean issues, and so the APGAR test helps doctors get your baby assessed right away so that they can deliver appropriate care to your infant.

What Does An APGAR Score Mean?

A score between 7 and 10 is considered normal. A score between 4 and 6 indicates that breathing assistance may be required. A score under 4 means that prompt, life-saving measures may be called for.

To get the overall score for an infant, a score of 0 to 2 will be assigned for each of the 5 aspects medical staff will check.

Heart rate:

0 means there is no heart rate,

1 means there are fewer than 100 beats per minute (not very responsive),

2 means there are more than 100 beats per minute (baby is vigorous)


0 means there is no breathing,

1 means there is a weak cry,

2 means there is a strong cry

Muscle tone:

0 means the baby is limp,

1 means the baby has some flexion,

2 means the baby has active motion

Reflex Response:

0 means no response to their airways being stimulated,

1 means there is a grimace during stimulation, and

2 means there is a grimace and cough/sneeze during stimulation


0 means the baby's entire body is blue/pale,

1 means the baby has good color except on their hands/feet,

2 means the baby is completely pink and has good color

It's important to keep in mind that an infant rarely has a perfect score. Medical staff will communicate with you if both APGAR tests come back with a low score or if they have a reason for concern.


A- Appearance (skin color pink or blue) P -Pulse (rate or beats per minute) G -Grimace (did he/she cry to stimulation) A -Activity (appropriate reflex of flexion) R - Respiration (breathing pattern assessed) APGAR range 0-10, 10 being best. After the baby is born (if higher level of care is needed) these scores help us understand the newborns health status in the NICU setting.

What Happens If My Baby Has A Low APGAR Score?

If your baby has a low APGAR score, medical staff will first focus on getting your baby into a stable condition and then they will seek to find answers to the questions that will be weighing on your mind, like what has caused your baby’s low score.

As medical staff works to discover if there is an underlying condition or another cause of your baby's low score, they will keep you updated throughout the process. More importantly, they will keep you informed about your baby's current state of health and what to expect in the coming days.

NICU Nurse Essential Resources

March of Dimes! Resources for parents & providers

Tori's Tips on NICU NURSE 101: See Blog Post Tori Meskin BSN RNC-NIC. Nurse. Blogger. Podcaster. Tori has been a clinician since 2012, works in acute care/inpatient NICU & Pediatric settings in southern California. She is a blogger, podcaster, NICU & Pediatric Critical Care RN, Sponsored Capella University MSN student, a Barco Uniforms Ambassador & Brave beginnings Ambassador. She has obtained her National NICU Nurse Certification (RNC-NIC) & has previously worked as a travel nurse, pursuing bedside experiences in several NICU settings. Follow her as she shares her NICU journey married life & juggles work, school, content creation, & brings you top notch Tips & Tricks along the way. Find her at or

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