Every parent will tell you that giving birth can be a whirlwind of activity. No matter how prepared you are — birth plans made, hospital bags packed, and car keys in hand — nothing can quite prepare you for welcoming a child into the world.

Birth is also a whirlwind of activity for your new baby. They have to leave the home they’ve had for the last nine months and emerge into a world filled with loud sounds, bright lights, and doctors and nurses performing tests.

After one minute in the world, your baby will get its first Apgar score. The second Apgar score is given five minutes after birth. In this blog, Nicolette Marak, MD, of Ross Bridge Medical Center Pediatrics in Hoover, Alabama, discusses what an Apgar score is, how it’s calculated, what can impact a score, and what your baby’s score means for the future.

At Ross Bridge Medical Center Pediatrics, we know that caring for a newborn is both exciting and stressful, especially for first-time parents. To help with this, we offer newborn care and prenatal and lactation care. We’ll help you keep track of your baby’s health for those important first weeks and beyond.

What is an Apgar score?

Dr. Virginia Apgar developed her namesake score in 1952 as a rapid method of assessing the clinical status of a newborn infant and, in particular, to determine if intervention is needed to establish breathing.

Today, it serves as a standardized way to assess a baby’s health after delivery. All infants receive a score after one minute and five minutes. Scores of eight and higher are considered normal, and further scoring at 5- or 10-minute intervals may be done if the initial scores are low.

What does an Apgar score address?

An Apgar score contains five measures of a newborn’s health:

  • Breathing effort
  • Heart rate
  • Muscle tone
  • Reflexes
  • Skin color

Each category is scored from 0-2, with two being the highest score. The scores, which are added up at the end, are made up of the following categories:

Breathing effort

  • 2: Normal breathing effort and good crying
  • 1: Slow or irregular breathing, weak cry
  • 0: No breathing

Heart rate

  • 2: More than 100 beats per minute
  • 1: Less than 100 beats per minute
  • 0: No pulse

Muscle tone

  • 2: Active, spontaneous movement
  • 1: Flexing with little movement
  • 0: No movement


  • 2: Pulls away, sneezes, or cries with stimulation
  • 1: Only facial movement with stimulation
  • 0: No response to stimulation

Skin color

  • 2: Color all over, hands and feet are pink
  • 1: Normal color, hands and feet are bluish
  • 0: Blue or pale all over

A baby with a score of 8-10 is considered healthy. A low score does not mean your baby is unhealthy. It may just mean that your baby needs extra medical attention, like having their airway cleared. Perfectly healthy babies can have low scores, especially in the first test.

When lower scores may be common

The one minute Apgar score assesses how well a baby tolerated the birthing process. The five minute score is a more accurate reflection of how well the baby is doing outside the mother’s womb. With this in mind, the one minute score may be lower for babies born under certain circumstances, including:

  • After a high-risk pregnancy
  • After a complicated labor and delivery
  • C-section birth
  • Premature birth

Babies with a low one minute score may have a much higher five minute score. Many babies with low one minute scores are perfectly healthy and just need time to adjust to life outside the womb.

On future health

The Apgar score is only a measure of a newborn’s overall physical condition directly after birth and is used to determine if they need medical care right away. The score is not at all predictive of your baby’s long-term health, behavior, intelligence, personality, or outcome.

To learn more about Apgar scores and newborn health, call (205) 494-7337 to book an appointment with Ross Bridge Medical Center Pediatrics today.


Our goal is for you to leave our office with a memorable and enjoyable experience, which is why our welcoming and compassionate staff will do everything they can to make you feel right at home.

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