Your Child’s First Test: The APGAR

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 generally a baby’s first assessment, it is not a predictor of his or her future behavior or intellect. The APGAR was developed in 1952 by obstetric anesthesiologist, Virginia Apgar, and has become a standard tool in assessing newborn babies.

What is the APGAR test?

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

When is the APGAR test used?

The APGAR is used immediately following the delivery of a baby. Test scores are recorded at one minute and five minutes from the time of birth.

Why is the APGAR test necessary?

The one minute APGAR assessment provides information about the baby’s physical health that helps the physician determine if immediate or future medical treatment will be required. The five minute assessment measures how the baby has responded to previous resuscitation attempts.

What conditions does the APGAR test evaluate?

APGAR measures the baby’s color, heart rate, reflexes, muscle tone and respiratory effort.

What do the APGAR scores mean?

APGAR scores range from zero to two for each condition with a maximum final total score of ten. At the one minute APGAR, scores between seven and ten indicate that the baby will need only routine post delivery care. Scores between four and six indicate that some assistance for breathing might be required. Scores under four can 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 for up to twenty minutes. Lower than normal scores do not mean that there will be permanent health problems with the child.

Heart rate:

0 – No heart rate

1 – Fewer than 100 beats per minute indcates that the baby is not very responsive.

2 – More than 100 beats per minute indicates that the baby is 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 stimulated

1 – Grimace during stimulation

2 – Grimace and cough or sneeze during stimulation

Color:

0 – The baby’s entire body is blue or pale

1 – Good color in body but with blue hands or feet

2 – Completely pink or good color

Last Updated: 05/2006

Compiled using information from the following sources:

Nemours Foundation, http://www.kidshealth.org

William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 28.