WHAT’S AN APGAR SCORE (and why is it important to my baby)?

by John McKiggan

What does a 65 year old test have to do with the health of your baby?

Although you may not have heard of her, Dr. Virginia Apgar has played a role in the assessment of the well-being of virtually every newborn baby born in Canada, the United States and elsewhere in the world for the last 65 years.

The so-called “APGAR score” was developed by Dr. Virginia Apgar over 65 years ago to provide a means by which doctors and nurses could quickly assess the health of a newborn baby and the need for resuscitation. The test has now become a standard part of the labour and delivery process and your child was almost certainly given an APGAR score when he or she was born.

Five criteria

There are five categories, or criteria, that the nurse or physician must consider and assign a value. Within each criteria the nurse or physician must assign a value of 0, 1 or 2.

The sum of the scores from the 5 criteria equals the APGAR score. Thus, the APGAR score can be anywhere from 0 to 10. The lower the score; the more likely the need that the child requires resuscitation.

The APGAR score is usually assessed at 1, 5 and 10 minutes after birth.

How is the APGAR scored?

The five criteria are scored as follows:


Blue or Pale = 0

Blue at Extremities = 1

Completely Pink = 2

Heart Rate

Absent = 0

Less than 100 beats per minute = 1

More than 100 beats per minute = 2

Reflex Irritability

No Response = 0

Grimace = 1

Cry or Active Withdrawal = 2

Muscle Tone

Limp = 0

Some Flexion = 1

Active Motion = 2


Absent = 0

Weak cry or Hypoventilation = 1

Good crying = 2

So a baby that is born pink, with a heart rate of more than 100 beats/minute, that withdraws from stimulus, actively moves and has a strong cry will receive a perfect APGAR score of 10.

Low APGAR means resuscitation needed

As indicated, the APGAR is first scored at 1 minute of age. If the 1 minute APGAR is low, for example at 3 or below, the baby likely requires medical attention and resuscitation. APGAR scores generally increase at 5 and 10 minutes as the baby’s condition improves.

APGAR scores don’t predict outcome!

It is important to remember that the purpose of the APGAR scoring is to assess the health

of the newborn at the time of birth. The APGAR score has a very poor predictive value for determining the long term health of a child and APGAR scores should not be used for any purpose other than the quick, non-invasive assessment of newborn babies.

In other words, if your baby was born with a low APGAR score it does not necessarily mean that your baby is injured. Most children born with low APGAR scores have no long term or permanent deficits or problems.

On the other hand, just because your baby had a normal APGAR score does not mean that your baby wasn’t injured during labour and delivery. If your baby has been diagnosed with cerebral palsy and you suspect it may have been caused by medical negligence, a careful examination of the neuroimaging, the neonatal records and the electronic fetal monitor tracing can indicate whether your child likely suffered a birth injury during labour and delivery.

Want more information?

If you want more information about newborn birth injuries, or have questions about a possible birth injury claim, you may want to read a copy of our book: Birth Injury Lawsuits: A Parent’s Guide. 

The members of the Birth Injury Lawyers Alliance wrote this consumer education guide to help parents understand their rights and their child’s rights when faced with an injury caused by medical negligence.  This is the only legal guide in Canada written specifically for parents of children injured during child birth.

 The book is available to download on our website for free.  If you would like a print copy, the book is for sale on Amazon (all proceeds go to charity), but we will send you a copy at no charge, if you call us, toll-free at 1-800-300-BILA (2452).

*image courtesy of emsworld.com

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