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Apgar score: how to score a newborn
The Apgar score rates a newborn at 1 minute and 5 minutes after birth on five signs (appearance, pulse, grimace, activity and respiration), each scored 0, 1 or 2, for a total of 0 to 10. A 5-minute score of 7 to 10 is reassuring, 4 to 6 is moderately abnormal and 0 to 3 is low.
Apgar scoring chart
| Sign | 0 points | 1 point | 2 points |
|---|---|---|---|
| Appearance (color) | Blue or pale all over | Body pink, hands and feet blue | Pink all over |
| Pulse (heart rate) | Absent | Below 100 beats per minute | 100 or more beats per minute |
| Grimace (reflex irritability) | No response | Grimace | Cry, cough or sneeze |
| Activity (muscle tone) | Limp | Some flexion | Active motion |
| Respiration | Absent | Weak, slow or irregular | Good, strong cry |
How to score it, step by step
- Start a timer at birth. Score at exactly 1 minute and again at 5 minutes.
- Rate each of the five signs 0, 1 or 2 using the chart.
- Add the five numbers for a total from 0 to 10.
- If the 5-minute score is below 7, keep scoring every 5 minutes, up to 20 minutes.
- Record each score with the time.
Worked example
- At 1 minute: hands and feet blue (1), heart rate 130 (2), grimaces to suction (1), some flexion (1), weak cry (1). Apgar 6.
- At 5 minutes: hands and feet still blue (1), heart rate 140 (2), cries (2), active (2), strong cry (2). Apgar 9.
- Blue hands and feet (acrocyanosis) are common in the first minutes, so a 9 at 5 minutes is very common.
Key points
- The Apgar score does not decide whether to start resuscitation. A newborn who is not breathing or has a heart rate below 100 gets help right away, before the 1-minute score.
- Heart rate is the most important sign of how the newborn is responding.
- A low Apgar score alone does not diagnose asphyxia or predict long-term outcome.
NCLEX tip: Neonatal resuscitation starts based on breathing, tone and heart rate, not the Apgar score. If an NCLEX question describes a newborn who is not breathing, act first.
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Frequently asked questions
What is a normal Apgar score?
7 to 10 is reassuring. Most healthy newborns score 8 or 9, because blue hands and feet are common right after birth.
When is the Apgar score done?
At 1 minute and 5 minutes after birth. If the 5-minute score is below 7, it is repeated every 5 minutes for up to 20 minutes.
What does APGAR stand for?
It is named after Dr. Virginia Apgar, and the letters are often used as a memory aid: Appearance, Pulse, Grimace, Activity, Respiration.
What does an Apgar score determine?
It summarizes how a newborn is doing right after birth, at 1 and 5 minutes, using appearance, pulse, grimace, activity and respiration. It does not decide whether to start resuscitation, and a low score alone does not predict long-term outcome.
What does "grimace" mean on an Apgar score?
Grimace means reflex irritability: how the newborn responds to stimulation such as suctioning. No response scores 0, a grimace scores 1, and a cry, cough or sneeze scores 2.
Keep studying
Sources
- The Apgar Score (Committee Opinion No. 644), American College of Obstetricians and Gynecologists
- APGAR Score, StatPearls, NCBI Bookshelf
For study only, not medical advice. Ranges and protocols vary by facility; follow your program, your facility's policies and the provider's orders.