Apgar Score

Newborn with stethescope
Your newborn baby will go through a number of assessments when he is first born, to make sure that he is in good health. His first assessments, called the Apgar score, occur when he is just one minute and five minutes old.

This assessment, developed by anaesthetist Virginia Apgar in 1952, is a scoring system that assesses newborn babies’ well-being using five different factors: heart rate, breathing, muscle tone, reflexes, and skin colour. The newborn baby is given a score between 0 and 2 for each factor, and the highest possible score is 10. Scores are rarely higher than 9 out of 10. Below is a table of what the doctors look for when assessing the Apgar score.


 Score 0

 Score 1

 Score 2

  Heart rate

 No heart rate

 Below 100 beats/min

 Above 100 beats/min


 No breathing

 Slow and irregular


  Muscle tone

 Limp and loose

 Some flexing of arms and legs

 Actively moving


 No reflex responses

 Grimaces or frowns when 
 reflexes are stimulated

 Vigorously cries when
 reflexes are stimulated


 Blue and pale

 Body is pink but hands and feet
 are blue

 Entire body is pink

The reason the Apgar score is checked at one and five minutes is to give an idea of how well the newborn baby is doing following birth and whether his condition is improving or not. A newborn baby who scores between 4 and 7 needs careful monitoring at regular intervals, and possible treatment. A newborn baby with a score less than 4 would need resuscitation.

Apgar scores are assessments of the newborn baby at the time of the scoring. They are generally not useful predictors for future problems. Initially low Apgar scores do not tell the whole story. At birth, many rapid changes are taking place which need only a few minutes or hours to resolve themselves. A newborn baby who is having some trouble breathing in the first few minutes of life may only need time to clear his lungs of amniotic fluid and might be breathing normally once this natural process has occurred.

Chances are that the Apgar score, physical examination, and other tests will show that your newborn baby is in good health. However, if these tests show that there is a medical problem, he may need to be transferred to a special nursery where a paediatrician will look after your baby. If the problem is more serious, your newborn baby might be transferred to a hospital with a neonatal intensive care unit (NICU) with paediatricians called neonatologists who specialize in the care of newborn babies. They will take care of your newborn baby and do the best they can to improve his health.

Douglas Campbell, MD, FRCPC

Hosanna Au, MD, FRCPC