Your Child's First Test: The APGAR

Put away the flash cards and don't expect too much too early; rarely does any baby get a perfect score on this test. Although it is your child's first assessment, it is not a predictor of your their future behavior or intellect. The APGAR was developed in 1952 by obstetric anesthesiologist, Virginia Apgar. This has become a standard tool in assessing newborn babies.

What is the APGAR test?

The APGAR is a quick assessment of overall newborn well being.

When is the APGAR test used?

The APGAR is used immediately following the delivery of the baby. The scores are recorded at one minute and five minutes of life.

Why is the APGAR test necessary?

The one minute APGAR assessment reveals information about the baby's physical health in the first minute after the birth helping the doctor decide if immediate or future medical treatment will be necessary. The five minute APGAR assessment measures how the baby has responded to any resuscitation attempts.

What conditions does the APGAR test evaluate?

The baby's color, heart rate, reflex, muscle tone and respiratory effort.

What do the APGAR scores mean?

The scores given are between zero and two for each condition with a final total of up to ten. At the one minute APGAR, scores between seven and ten indicate the baby will need only routine post delivery care. Scores between four and six may indicate some assistance may be required for breathing. Scores under four may call for prompt lifesaving measures.

At the five minute APGAR, a score of seven to ten is normal. If the score falls below seven the baby will continue to be monitored and retested every five minutes up to twenty minutes. Lower than normal scores do not mean there will be any permanent problems for the baby.

Heart rate:
0 - No heart rate
1 - Fewer than 100 beats per minute - the baby is not very responsive
2 - More than 100 beats per minute - the baby is obviously vigorous

Respiration:
0 - Not breathing
1 - Weak cry; may sound like whimpering or grunting
2 - Good, strong cry

Muscle tone:
0 - Limp
1 - Some flexing (bending) of arms and legs
2 - Active motion

Reflex response:
0 - No response to airways being suctioned
1 - Grimace during suctioning
2 - Grimace and cough or sneeze during suctioning

Color:
0 - The baby's whole body is completely blue or pale
1 - Good color in body with blue hands or feet
2 - Completely pink or good color

Reprinted with permission from American Pregnancy Association.