What happens during an Apgar test?


During the APGAR test five characteristics are assessed to evaluate the newborns transition to extrauterine life. These five characteristics are: activity, heart rate, reflex irritability, appearance, and respiration. Each characteristic is scored on a scale of 0 to 2 as follows:

Activity is evaluated by observing the infant

  • Score 0:  Muscles are loose and floppy
  • Score 1: There is some muscle tone
  • Score 2: There is active motion

Heart rate is evaluated by stethoscope. This is the most important assessment:

  • Score 0:  There is no heartbeat
  • Score 1:  The heart rate is less than 100 beats per minute
  • Score 2:  The heart rate is greater than 100 beats per minute

Reflex irritability is a term describing response to stimulation such as a mild pinch:

  • Score 0:  There is no reaction
  • Score 1:  There is grimacing
  • Score 2:  There is grimacing and a cough, sneeze, or vigorous cry.

Appearance is evaluated by observing the infant;s skin color:

  • Score 0:  The skin color is pale blue
  • Score 1:  The body is pink and the extremities are blue.
  • Score 2:  The entire body is pink

Respirations are evaluated by observing chest movement:

  • Score 0:  The infant is not breathing
  • Score 1:  The respirations are slow or irregular
  • Score 2: The infant cries
Deborah Mulligan
Deborah Mulligan on behalf of MDLIVE
No, this is not another test to study for!  Your baby is carefully checked at birth and soon after by a pediatrician.  The Apgar score (named after Dr. Virginia Apgar, who first described it) is assessed in the delivery room.  At one minute and again at five minutes from the moment of birth the APGAR test is completed by the delivery nurse or your doctor. When each of these time periods is up, a nurse or physician will give your baby the results of his/her first “tests,” called Apgars.

Although the Apgar score cannot predict how healthy a child will be when s/he grows up, it can help the physician estimate your baby’s general condition at birth. The test measures your baby’s color (A – appearance) heart rate (P – pulse), reflex response (G – grimace), muscle tone (A – activity) and breathing (R – respiration rate). It cannot predict how healthy she will be as she grows up or how she will develop; nor does it indicate how bright she is or what her personality is like. But it does alert the nurse and physician when there is a baby born who may need assistance as he adapts to his new world outside the mommy’s womb.

Each characteristic is given an individual score; two points for each of the five categories if all is completely well; then all scores are totaled. Most newborn infants have Apgar scores greater than 7. Because their hands and feet remain blue until they are quite warm, few score a perfect 10.