The first test most babies are given — and which most pass with good scores — is the Apgar test. It was developed in 1952 by Dr. Virginia Apgar, who wanted a quick, simple way to check how newborns were adjusting right after delivery.
Here’s what you need to know about your baby's Apgar test.
What is the Apgar score?
The Apgar score is a simple test, given just moments after birth. It’s a quick way for doctors and nurses to assess how your newborn is adjusting to life outside the womb — and whether they might need a little extra help breathing or getting their heart rate up.
APGAR is an acronym that stands for what will be assessed:
- Appearance (skin color)
- Pulse (heart rate)
- Grimace (reflexes)
- Activity (muscle tone)
- Respiration (breathing effort)
What’s a normal Apgar score?
“An Apgar score of 7, 8, or 9 is normal and is a sign that newborn is in good health,” says the National Institutes of Health (NIH). “A score of 10 is very unusual since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.”
- An Apgar score of 7 to 10: The newborn is in good to excellent health and usually only needs routine newborn care.
- An Apgar score of 4 to 6: The newborn is in fair condition and may need a little extra help (like oxygen or gentle stimulation).
- An Apgar score under 4: The newborn needs immediate medical attention and close monitoring.
Remember, these scores aren’t grades — they’re just a quick check of how your baby’s body is working in the very first minutes after birth.
How does the Apgar score work?
A pediatrician, OB/GYN, midwife, or nurse will assign your newborn an Apgar score of 0, 1, or 2 on each of the five criteria, for a total of up to 10 points. The higher the Apgar score, the more smoothly your baby is adjusting.
The American College of Obstetricians and Gynecologists (ACOG) notes that there are many factors that can influence a baby’s score, including mom’s anesthesia (for an epidural or a C-section), birth trauma, and gestational age. In addition, some elements of the score, such as skin color, can be subjective and even biased against babies of color.
Here’s how your baby’s practitioner will come up with the numbers:
Appearance/Skin Color
Healthy babies are pink all over, but some may have bluish hands and feet at first, until their circulation gets going. It’s their oxygen-rich blood that makes their skin turn pink after they take their first breath, explains Cleveland Clinic.
- Pale blue: 0
- Pink body, blue extremities: 1
- Pink all over: 2
Pulse/Heart Rate
Using a stethoscope, the doctor or nurse will listen to your baby’s heart.
- Heartbeat is not detectable: 0
- Heartbeat of fewer than 100 beats per minute: 1
- Heartbeat of 100 beats per minute or more: 2
Grimace/Reflexes
This category notes how your baby reacts to gentle stimulation, like a light pinch (don’t worry, it doesn’t hurt).
- No response to stimulation: 0
- Grimacing: 1
- Grimacing with a cough, sneeze, or lusty cry: 2
Activity/Muscle Tone
This category measures how much your baby is moving.
- Loose, floppy or inactive muscles: 0
- Some movement of arms and legs: 1
- A lot of activity: 2
Respiration/Breathing Effort
This is an assessment of how well your baby is breathing.
- No breathing: 0
- Slow or irregular breathing: 1
- Good breathing (crying): 2
“The heart rate and respiratory effort are the most important aspects of the test,” says Kyle Monk, M.D., board-certified pediatrician at Cedars-Sinai Medical Centerin Los Angeles and a member of the What to Expect Medical Review Board.
Depending on how your baby is doing, he may be given oxygen or medications and may need to be taken to the neonatal ICU for further monitoring, explains Dr. Monk.
When and how often is the test done?
All babies get at least two Apgar scores in the delivery room. The first test will be done one minute after birth to see how well your newborn made it through the labor and delivery process.
At five minutes after birth, the test will be repeated to see how your baby is adjusting now that he’s breathing on his own. Most low scores at one minute are normal five minutes later.
Once in a while, a baby with a low score at five minutes may get tested again at the 10-minute mark. “Some babies take a little longer to transition from the womb and into the world,” says Dr. Monk. “Most are breathing comfortably and pink all over by 10 minutes.”
Want to feel more prepared for your little one's grand entrance? The What to Expect app has expert-backed info on everything from Apgar scores to your first snuggle. Get the lowdown on what those first precious minutes after birth really mean — for your baby and for you.
Does a low Apgar score mean my baby won't be healthy?
Not at all. While the Apgar test can tell a lot about your baby’s condition in the few minutes after birth, it doesn’t tell you much about anything long-term.
“My first had a low apgar at first because of his cord being wrapped twice, but bounced back and has been completely healthy his entire life,” says What to Expect Community mom BH182021.
The Apgar score really just lets us know if baby needs any extra assistance, notes Dr. Monk. In fact, even babies whose scores remain low at five minutes usually turn out to be completely healthy.
“My daughter’s scores were 3 and 8,” says What to Expect Community member baby2sixyearslater. “She was on oxygen for a while and a cpap. She recovered quickly and seems fine and perfect now.”
As Dr. Monk sums up, “The Apgar score is an assessment of a moment in time — not a predictor of your baby’s future.”
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