APGAR test

APGAR test is administered one and five minutes after a child is born. The purpose of the Apgar test is to determine initial health and quickly determine whether a newborn needs immediate medical care; it was not designed to make long-term predictions on a child's health or IQ.

Each letter stands for what is tested.

  • A – Appearance – Does the child have good color (pinkish indicating the blood is circulating through the body) including extremities.
  • P – Pulse – Is there a pulse? Indicates the circulatory system is working properly. The heart is beating and pumping blood. HR > 100 =score of 2, < 100 score = score of 1.
  • G – Grimace – Dr. touches bottom of foot with her finger to determine if babies foot curls. This is a neurological test to test for reflexes indicating whether the brain is working, neurons are firing, reflexes are intact. Reactions to other stimuli – smell, light, sound?
  • A – Activity – Child has good muscle tone – active child, moving and squirming, the arms and legs are moving and kicking about – not placid/floppy.
  • R – Respiration – Is the child breathing on her/his own? Indicates lungs are clear and fully developed. Some children may need to be aspirated upon birth, especially if born through C – section without the proper stimulus needed to clear the lungs and stimulate the circulatory system. Many premature babies are born without fully developed lungs. They are at higher risk for breathing disorders such as asthma because of lack of development and exposure to pure oxygen in incubators. Looking for strong not weak and irregular breathing.

Scale for test is 0 – 2 on individual Items - Medical Personal administer the test - usually Drs. but it can be nurses. See for more precise scale.

  • 0 is the lowest score on each item think of a “still birth” – child born dead,blue, not moving, not breathing, no muscle tone, does not react to stimulus.
  • Level 2’s are scores used when a child is fully and completely doing the criteria on his or her own – pink and rosy appearance and active baby, not placid in the muscles, strong beating pulse, breathing on own, active on own, grimace with stimulation to bottom of the foot.
  • Level 1’s are in between scores where a baby may need to be stimulated or aspirated to breath on own or CPR induced. This is cause for concern, but if the second test produces higher scores there is less concern. What we don’t want to see is deterioration with time. This is cause for grave concern. Blue in extremities can be normal for hours.
  • Today, scores between 7 & 10 are considered normal. Originally, Dr. Apgar concluded that the prognosis for an infant was excellent if the child received a score of 8-10. However, some say scores below 8 are cause for concerns for developmental delays (Mental delays, Mental Retardation, Learning Difficulties). Children born behind tend to stay behind and not catch up, although there are always exceptions to the general rules. Few children score perfect 10’s. The original purpose of the test was to determine if a baby needed medical help transitioning from fetus to neonate. We must keep this in mind.