The APGAR score is a quick test performed at 1 and 5 minutes after birth to determine the physical condition of the newborn. The rating is based on a scale of 1 to 10. Ten suggests the healthiest infant, and scores below 5 indicate that the infant needs immediate assistance in adjusting to his or her new environment.

The test was designed in 1952 by Dr. Virginia Apgar at Columbia University's Babies Hospital.

• Heart rate
• Respiratory effort
• Muscle tone
• Reflex irritability
• Color

• Heart rate is evaluated by stethoscope. This is the most important assessment:
  • If there is no heartbeat, the infant scores 0 for heart rate.
  • If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
  • If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.
• Respiratory effort:
  • If there are no respirations, the infant scores 0 for respiratory effort.
  • If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
  • If there is good crying, the infant scores 2 for respiratory effort.
• Muscle tone:
  • If the muscle tone is flaccid, the infant scores 0 for muscle tone.
  • If there is some flexion of the extremities, the infant scores 1 for muscle tone.
  • If there is active motion, the infant score 2 for muscle tone.
• Reflex irritability is a term describing the level of newborn irritation in response to stimuli (such as a mild pinch):
  • If there is no reaction, the infant scores 0 for reflex irritability.
  • If there is grimacing, the infant scores 1 for reflex irritability.
  • If there is grimacing and a cough, sneeze or a vigorous cry, the infant scores 2 for reflex irritability.
• Color:
  • If the color is pale blue, the infant scores 0 for color.
  • If the body is pink and the extremities are blue, the infant scores 1 for color.
  • If the entire body is pink, the infant scores 2 for color.

The 1-minute APGAR score assesses how well the infant tolerated the birthing process. The 5-minute APGAR score assesses how well the newborn is adapting to the environment.

This test is a screening tool for health care providers to determine what assistance is immediately necessary to help your newborn stabilize.

A score of 8 or 9 is normal and indicates your newborn is in good condition. A score of 10 is very unusual -- almost all newborns lose one point for blue hands and feet.

Any score lower than 8 indicates your child needs assistance stabilizing. A low score at 1 minute that normalizes by 5 minutes has not been associated with any long-term negative effects.