Apgar score: what your newborn's 1 and 5 minute numbers mean
In this article
The Apgar score is a quick check of your newborn at 1 minute and 5 minutes after birth. Your baby's care team rates five things, skin colour, heart rate, reflexes, movement and breathing, from 0 to 2 each, for a total out of 10. Cleveland Clinic says 7 to 10 is reassuring. The score tells the team whether your baby needs help right now. It does not predict how your child will grow up.
| When | At least twice: 1 minute and 5 minutes after birth |
|---|---|
| What is scored | Skin colour, heart rate, reflexes, movement, breathing |
| Points | 0 to 2 for each sign, 10 in total |
| Reassuring | 7 to 10, Cleveland Clinic says |
| A perfect 10 | Uncommon; circulation takes a few minutes to pick up |
The five signs behind the Apgar score
The name doubles as a memory aid. Cleveland Clinic lists the five signs as Appearance, Pulse, Grimace, Activity and Respiration, and each one scores 0, 1 or 2:
- Appearance: skin colour, as a clue to blood oxygen. Pink skin on the body and limbs scores highest.
- Pulse: the heart rate, which should be above 100 beats a minute.
- Grimace: how strongly your baby reacts when the nose or mouth is suctioned.
- Activity: how much your baby moves. More movement means a higher score.
- Respiration: strong, regular breathing and crying count in your baby's favour.
Cleveland Clinic points out one weakness: the colour score favours pink skin and does not account properly for darker skin. Some doctors look at the lips, tongue and gums instead.
What a normal Apgar score looks like
Cleveland Clinic groups scores into three bands: 7 to 10 is reassuring, 4 to 6 is moderately abnormal, and 0 to 3 is low. It calls 7 or higher ideal.
Do not expect a 10. Cleveland Clinic says a perfect score is not common, because a newborn's circulation can take several minutes to pick up after birth.
If your baby's first score is low
Cleveland Clinic says a score under 7 means your baby might need supportive care, such as extra oxygen or help with breathing. If the 5 minute score is under 7, the team keeps scoring every five minutes, up to 20 minutes after birth. The American College of Obstetricians and Gynecologists (ACOG) says the score is also used to report how a baby responds to resuscitation.
Low scores happen more often after a C-section, a difficult labour, fluid in the baby's airway, a high-risk pregnancy or a premature birth, Cleveland Clinic says. It also says plainly that a low score is not your fault, and that most of the time it just means your baby needs a little extra support while adjusting.
What the Apgar score cannot tell you
The score describes the first minutes after birth. ACOG says the Apgar score does not predict an individual baby's neurological outcome or survival, and should not be used for that. Cleveland Clinic says it cannot predict intelligence, development or future health, and that it is not the only thing your baby's providers rely on.
If you want to know your baby's numbers, ask the delivery team before you leave the ward. Questions about how your baby is feeding or breathing now matter more than the score from their first five minutes.
Frequently asked questions
What is a good Apgar score?
Anything from 7 to 10. Cleveland Clinic calls that range reassuring and says 7 or higher is ideal.
Why did my baby not get 10?
Very few babies do. Cleveland Clinic says a perfect score is not common, because circulation can take several minutes to pick up after birth.
Does a low Apgar score mean brain damage?
Not on its own. ACOG says the score does not predict an individual baby's neurological outcome, and Cleveland Clinic says it does not predict your baby's future.
Who does the Apgar test?
Your baby's healthcare provider at the birth. Cleveland Clinic says they check the score at least twice, at one and five minutes, and keep checking if the 5 minute score is under 7.
Related terms
- Neonate (Newborn): The medical word for a newborn baby in the first 28 days of life.
- C-section (Caesarean Section): An operation to deliver your baby through a cut in your tummy and womb, planned ahead or done in labour.
- Preterm (Premature) Birth: A baby born alive before 37 completed weeks of pregnancy. In Singapore, about 8.5% of babies arrive this early.
- Low Birth Weight: A birth weight under 2.5 kg, from being born early, growing slowly in the womb, or both.
