What Is the APGAR Score?

Most parents can’t wait to hold their infants post-birth. But something else has to happen before they can enjoy those long-awaited first cuddles. Baby has to take a test! What test are we talking about? The all-important APGAR score. 

You may have overheard doctors discussing it. But do you know what the score means? In this article, we’ll expound on the meaning, methods, and history behind the APGAR score. 

Newborn baby boy shortly after birth.

What is the APGAR Score?

An APGAR score evaluates a baby’s general health after birth. It helps doctors determine whether the baby needs medical intervention or assistance. That way, they can make quick decisions and intervene with medical care when necessary. A baby’s life can depend on quick intervention, so doctors have to know what to look for.

The system focuses on 5 key indicators. They form the acronym APGAR:

  • Appearance
  • Pulse
  • Grimace (response to stimuli)
  • Activity (muscle tone and movement)
  • Respiration

Doctors assign each of the 5 indicators a score of 0,1 or 2. Then they add up the score for each indicator to get the total score. 10 is the highest score a baby can achieve. 

How Doctors Calculate the APGAR Score

Once a baby turns one minute old, doctors perform the first APGAR evaluation. They observe their appearance, movement, and breathing. They also check their pulse. After five minutes, doctors repeat the test to get a new score. 

Here are the specific criteria physicians use to assign points:


  • 0 Points: Bluish-gray or pale 
  • 1 Point: Normal color, bluish hands and feet
  • 2 Points: Normal color all over with pink hands and feet


  • 0: No pulse
  • 1: Pulse below 100 beats per minute (bpm)
  • 2 Points = Pulse over 100 bpm


  • 0: Doesn’t respond to stimuli
  • 1: Only moves the face (grimacing)
  • 2: Coughs, cries, sneezes, or moves 


  • 0: Floppy
  • 1: Little movement, flexed arms and legs
  • 2: Active


  • 0: Not breathing
  • 1: Slow/Irregular breathing, weak crying
  • 2: Normal breathing and crying
Nurses discuss baby's APGAR score.

APGAR Score Meaning

In general, a high score means a baby is in good health. A low score (6 and below) means the baby needs medical attention.

APGAR Score Meaning By Category:

  • 0-3 points: Critical, needs medical intervention
  • 4-6: Abnormal, may need intervention
  • 7 or more: Normal

Premature babies and babies born via C-section have a higher risk of getting a lower score. 

History of the APGAR Score

What is the APGAR score origin story? It’s quite an interesting one. They say it all started with a napkin. 

One day, a medical student approached Dr. Virginia Apgar, an obstetric anesthesiologist, in a hospital cafeteria. The student had a question. Dr. Apgar had always told her students to look at babies after they were born. But what were they supposed to look for? 

With no notebook handy, Apgar reached for a napkin. She jotted down 5 things: heart rate, respiratory effort, muscle tone, reflex irritability, and skin color. 

Later, Apgar reflected on the student’s question. She realized there was no standardized method for assessing newborns. So she developed a quick, objective way for doctors to evaluate a baby’s overall health: the APGAR score. After sharing it with her peers, Apgar published her method in a full manuscript in 1953.  

Today, doctors use the APGAR score in delivery rooms around the world. It may be simple, but it’s practical and useful and has even saved lives. 

Why is the APGAR Score So Important?

Before the invention of the APGAR score, there was no clear protocol for resuscitating newborns. When infants were born blue or had problems breathing, doctors sometimes assumed they wouldn’t make it. Without intervention, many didn’t. But could these struggling babies have survived? It’s possible. 

Nowadays, whether the baby gets extra care isn’t left to the doctor’s subjective opinion. It’s determined by their score. A low APGAR score means doctors are obligated to provide extra medical support. They have to get the score to go up. So they’ll intervene with resuscitation, oxygen support, or warming/cooling therapy.

Baby in distress after birth.

Can Negligence Cause A Low APGAR Score?

When your child’s condition is worrisome, it might be tempting to assume that a low APGAR score means your doctor was negligent. That’s not always the case. 

But it could happen. One possible scenario is that a physician fails to provide adequate care to a mother or infant during delivery. The child develops a birth injury and has a low APGAR score because of it. 

Another scenario is that the baby has a low APGAR score even though doctors provided adequate care. But the doctors don’t attempt to raise the score, and so the child dies or develops a birth injury. 

Both scenarios could give a parent legal grounds to sue. If you believe your child’s injury was preventable, you should contact a birth injury attorney. Call our experts today to find out if you have a viable case.