Category: Special Populations

Topic: Neonatal Care

Level: EMR

Next Unit: Neonatal Emergencies

6 minute read

APGAR Test and Scoring


The APGAR test is used for assessing newborns.
You should assess a newborn at 1 minute and 5 minutes after delivery.


Judge each of the following categories on a scale of 0-2. If your total is above 7, it's considered normal; below 3 is critically low.

Appearance (skin color)
Pulse (heart rate)
Grimace (irritability)
Activity (muscle tone)
Respiration (work of breathing)


The Scoring System!

Assign the following points based on your finding:

Appearance (skin color) 
2 - Pink
1 - Chest and abdomen pink, extremities blue
0 - Blue all over

Pulse (heart rate) 
2 - HR greater than 100
1 - HR between 60 and 100
0 - HR less than 60

Grimace (irritability)
2 - Coughs, cries and jerks away when stimulated
1 - Weak cries, irritated face, not very angry when poked
0 - No response to stimulation

Activity (muscle tone)
2 - Lots of active movement
1 - Some flexion of the extremities
0 - No movement

Respiration (breathing)
2 - Strong and regular respiration (strong cry is a good indicator of strong respiration.)
1 - Weak or irregular respiration
0 - Not breathing


So, you just assisted in a home delivery. You are doing your 1 minute APGAR assessment. The baby is pink all over, HR 95, is highly irritated when you mess with him, moved around actively with good muscle tone, and is crying his heart out and breathing well. What do you document your APGAR score to be here?

Lets break it down by section:

  • Appearance - 2 ( pink color) 
  • Pulse - 1 (HR is between 60 and 100)
  • Grimace- 2 (very irritated)
  • Activity -2 (good tone)
  • Respiration -2 (strong cry)

The total APGAR score for this newborn would probably be 9!


The APGAR score doesn't hold a lot of correlation for the long term health of the child, but its a decent tool for measuring the degree of success of your resuscitation efforts. If my 1 minute APGAR was 3, and I started an adjunct airway, performed positive pressure ventilation with oxygen... my 5 minute APGAR could be really useful in letting me know how my resuscitation efforts are doing.

Remember that you're going to be wound up when assisting in the delivery of a newborn. Just remember to suction, dry, stimulate and assess. That's mostly it for a normal pregnancy. Always document your 1 and 5 minute APGAR scoring in your patient reports.

Some people learn best with silly videos. This one takes 5 minutes and explains it well.