What is the APGAR Score?

Newborn baby

What is the APGAR Score?

Virginia Apgar, an obstetric anesthesiologist in New York, developed the APGAR scoring system in 1952 to determine how anesthesia affected the babies in her care. This assessment is done at 1 minute of life and 5 minutes of life, and can be repeated after that as needed as the condition of the baby warrants.

What Does the APGAR Test Evaluate?

There are 5 categories that are scored with a maximum of 2 points per category. The categories scored include the baby’s color, heart rate, reflexes, muscle tone, and respiratory effort.

When the APGAR test is being administrated, doctors are checking your baby in five specific areas:


0 = Blue or pale
1 = Blue hands or feet
2 = Completely pink

A score of 0 would indicate that the baby’s skin color is blue or pale all over, while a score of 2 indicates that the baby’s skin color is healthy. A score of 1 denotes that the baby's skin color is slightly pale or slightly blue in the extremities or around the mouth only.

Pulse/Heart rate

0 = No heart rate
1 = Heart rate less than 100 beats per minute
2 = Heart rate over 100 beats per minute

Measuring pulse rate (heart rate) is an important aspect of determining an infant's health. An absent pulse would receive a score of 0, a pulse less than 100 beats per minute would receive a score of 1, and a pulse over 100 beats per minute would receive a score of 2.

Grimace or Reflex Irritability

0 = No response to stimulation
1 = Grimace or weak cry with stimulation
2 = Cry with stimulation

A score of 2 would mean the baby sneezes, coughs, gags or vigorously cries with little or no stimulation. A score of 0 indicates no response, while a score of 1 means the baby grimaces with stimulation.

Activity/Muscle Tone

0 = Limp, floppy
1 = Some flexion of extremities
2 = Active motion

When scoring for activity, healthcare providers are checking the baby’s muscle tone and their ability to have active, spontaneous movement. 0 means the baby has no movement or is flaccid or floppy, 1 means limited flexion, and 2 means active motion.

Respiratory Effort

0 = Absent
1 = Slow, irregular breathing
2 = Strong cry

If a baby is able to breathe easily and cry, his score would be a 2. A baby who has slow or irregular breathing would receive a score of 1. A baby who is showing no respiratory (breathing) effort would receive a 0 score.

What Does Your Baby’s Score Mean?

The APGAR test is generally done twice. The doctors score at one minute and five minutes after birth. Medical personnel may repeat the test later if the baby’s score remains low. A total score of 7 and above is considered generally healthy. A score between 4 and 6 is considered low. A score below 3 is hazardously low and requires significant and immediate medical care.

As new parents, it can be easy to become overwhelmed by the idea of your child not scoring well. Although the APGAR tests several important aspects of your child's first few minutes of life, a baby’s initial APGAR score is not necessarily predictive of long-term outcomes. According to the American Academy of Pediatrics, “Population studies have uniformly reassured us that most infants with low Apgar scores will not develop cerebral palsy. However, a low 5-minute Apgar score clearly confers an increased relative risk of cerebral palsy, reported to be as high as 20- to 100-fold over that of infants with a 5-minute Apgar score of 7 to 10.”

While the initial score may not predict long-term outcomes, the AAP does indicate that a low 5-minute APGAR score may denote an increased risk of cerebral palsy.

How We Can Help

If you believe your baby’s low APGAR score was the result of a serious birth injury, The Law Firm of Michael H. Bereston can assist you. We specialize in serving clients with catastrophic injuries as a result of medical negligence. Major injuries during birth can include lack of oxygen, improper delivery technique, hemorrhage, surgical malpractice, the use of forceps, or delivery trauma. Negligent management in pregnancy and childbirth can include uterine rupture, untreated gestational diabetes, untreated pre-eclampsia or eclampsia, fetal distress, and the use of potentially dangerous medications, among others.

The Law Firm of Michael H. Bereston represents birth injury, medical malpractice, and personal injury cases. As a nationwide birth injury attorney, we offer free, confidential consultations to clients seeking assistance.

If your child is experiencing the signs of cerebral palsy, contact a nationwide birth injury attorney to discuss your options for financial compensation so your family can rebuild.

The Law Firm of Michael H. Bereston, Inc. is devoted to seeking justice and a hopeful future for you and your family, contact us today at (410) 220-6581 to learn more.