APGAR Score Calculator
Newborn Health Assessment at 1 and 5 Minutes — Standard Since 1952
Understanding the APGAR Score
The APGAR score was developed in 1952 by Dr. Virginia Apgar, an American anesthesiologist at Columbia University. It was the first standardized method for evaluating the health of a newborn immediately after birth and has been in continuous clinical use for over 70 years.
The name APGAR conveniently serves as a mnemonic for the five criteria assessed:
- A — Appearance (skin color)
- P — Pulse (heart rate)
- G — Grimace (reflex irritability)
- A — Activity (muscle tone)
- R — Respiration (breathing effort)
The assessment is routinely performed at 1 minute and 5 minutes after birth. The 1-minute score reflects how well the newborn tolerated the birthing process, while the 5-minute score indicates how well the newborn is adapting to life outside the womb. If the 5-minute score is below 7, additional assessments may be done at 10, 15, and 20 minutes.
The APGAR score provides a rapid, systematic assessment that allows healthcare providers to quickly identify newborns who may need immediate medical attention, such as respiratory support or resuscitation.
The 5 APGAR Components in Detail
Each of the five components is scored from 0 to 2, giving a total possible score of 0 to 10.
Appearance (Skin Color)
Assesses oxygenation by observing skin color. A score of 2 indicates fully pink skin (well-oxygenated), a score of 1 means the body is pink but the extremities are blue (acrocyanosis, which is common in the first few minutes), and a score of 0 indicates the baby is blue or pale all over, suggesting poor oxygenation. Note that skin color assessment may be less reliable in newborns with darker skin pigmentation; providers may examine the palms, soles, and mucous membranes instead.
Pulse (Heart Rate)
Heart rate is the most important indicator of newborn well-being. A rate of 100 beats per minute or above (score of 2) is considered normal. A rate below 100 bpm (score of 1) may indicate the need for intervention. An absent heartbeat (score of 0) is the most critical finding and requires immediate resuscitation.
Grimace (Reflex Irritability)
Tests the newborn's reflex response to stimulation, typically a gentle nasal suction or flick of the foot. A vigorous cry or active withdrawal (score of 2) indicates good neurological function. A grimace or feeble cry (score of 1) suggests a diminished response. No response (score of 0) indicates depressed reflexes.
Activity (Muscle Tone)
Evaluates muscle tone by observing the newborn's posture and movement. Active flexion of the arms and legs with spontaneous movement (score of 2) is normal. Some flexion (score of 1) may indicate mild depression. A completely limp or floppy baby (score of 0) suggests significant neurological or metabolic compromise.
Respiration (Breathing Effort)
Assesses the quality and strength of the newborn's breathing. A strong, lusty cry with regular respirations (score of 2) is optimal. Slow, irregular breathing or a weak cry (score of 1) may indicate respiratory difficulty. Absent respirations (score of 0) require immediate airway management.
What APGAR Scores Mean
Score 7–10: Reassuring — Normal
A score of 7 or above is considered reassuring. The newborn is in good to excellent condition and typically requires only routine postnatal care. Most healthy newborns score 7 to 9 at 1 minute and 8 to 10 at 5 minutes. A perfect score of 10 is uncommon at 1 minute because almost all newborns have some degree of acrocyanosis (blue extremities) immediately after birth.
Score 4–6: Moderately Abnormal
A moderately low score indicates the baby may need some medical assistance, such as suctioning the airway, supplemental oxygen, or stimulation. The 5-minute score is particularly important — if it has improved from the 1-minute score, it suggests the baby is responding well to any interventions provided.
Score 0–3: Low — Requires Immediate Attention
A very low score indicates the newborn requires immediate medical intervention, potentially including resuscitation, intubation, and advanced neonatal care. This is most often seen in premature infants, babies who experienced a difficult delivery, or those with congenital conditions.
Why the 5-Minute Score Matters More
The 5-minute APGAR score is generally considered more clinically significant than the 1-minute score. A low 1-minute score that improves by 5 minutes is a reassuring sign that the baby is adapting well. A persistently low score at 5 minutes may prompt further assessment and continued intervention.
Important Limitations
The APGAR score is NOT designed to predict long-term neurological outcome or future health. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists emphasize that a low APGAR score alone does not diagnose birth asphyxia, and should not be used as evidence of brain injury. The score is a clinical snapshot at a single point in time and must be interpreted in the context of the entire clinical picture.
Newborn Care in the First Hours
The first hours after birth are a critical period for both the newborn and the parents. Here is what to expect:
Immediate Skin-to-Skin Contact
Placing the newborn directly on the mother's bare chest immediately after delivery is recommended by the World Health Organization and the AAP. Skin-to-skin contact helps regulate the baby's temperature, heart rate, and breathing; promotes colonization with beneficial bacteria; facilitates bonding; and supports early breastfeeding. It also reduces stress hormones in both mother and baby.
Breastfeeding Initiation
Most healthy newborns are ready to breastfeed within the first hour of life. Early initiation of breastfeeding provides the baby with colostrum — the nutrient-rich first milk that is packed with antibodies and immune factors. The AAP recommends exclusive breastfeeding for the first 6 months of life.
Routine Newborn Procedures
In the first hours, healthcare providers typically perform vitamin K injection (to prevent bleeding disorders), erythromycin eye ointment (to prevent infection), a full physical examination, newborn metabolic screening, and hearing screening. The timing of these procedures can be coordinated to minimize disruption to skin-to-skin contact and breastfeeding.
When to Be Concerned
Contact your healthcare provider immediately if you notice any of the following in your newborn:
- Difficulty breathing, grunting, or persistent blue color
- Temperature instability (feeling too hot or too cold)
- Poor feeding, refusing to latch, or excessive sleepiness
- Jaundice (yellowing of the skin) that appears within the first 24 hours
- Unusual irritability or high-pitched crying
- Fewer than expected wet or dirty diapers
Frequently Asked Questions
The APGAR score is a quick assessment performed on newborns at 1 minute and 5 minutes after birth to evaluate their overall physical condition. It was developed in 1952 by Dr. Virginia Apgar and measures five criteria — Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (breathing effort). Each criterion is scored from 0 to 2, giving a total score of 0 to 10. It is used worldwide as the standard initial assessment of newborn health.
The APGAR assessment is performed by the healthcare provider attending the delivery, which may be a physician, midwife, or nurse. The assessment is done quickly and does not interfere with immediate care or resuscitation if needed. In most hospital settings, a nurse or neonatal specialist will observe and score the newborn at the designated time points while the attending physician or midwife focuses on the delivery and immediate postpartum care.
A score of 7 or above (out of 10) is generally considered reassuring and indicates the newborn is in good condition. Most healthy newborns receive scores of 7 to 9 at 1 minute. A perfect score of 10 is relatively uncommon at 1 minute because many newborns have some acrocyanosis (blue hands and feet), which is normal in the first few minutes of life. By 5 minutes, scores of 8 to 10 are typical for healthy newborns. The 5-minute score is considered more significant for overall assessment.
Not necessarily. A low 1-minute APGAR score can occur for many reasons, including prematurity, the effects of anesthesia given to the mother during delivery, or a difficult birth process. Many babies with low 1-minute scores improve significantly by the 5-minute assessment as they adapt to breathing on their own and receive any needed stimulation or intervention. A low score simply signals that the baby may need some extra attention in the moments after birth. It does not diagnose any specific condition or predict future health.
The APGAR score is performed at 1 minute and 5 minutes to assess both the baby's immediate condition and their response to any interventions. The 1-minute score provides a snapshot of how the baby tolerated labor and delivery. The 5-minute score shows how well the baby is adapting to the outside environment. The change between the two scores (the trend) is clinically valuable — improvement from 1-minute to 5-minute scores is a positive sign, even if the initial score was low. If the 5-minute score remains below 7, additional assessments at 10, 15, and 20 minutes may be performed.
No. The APGAR score is explicitly not a predictor of long-term health, development, or neurological outcome. This is an important and common misconception. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have clearly stated that the APGAR score should not be used to predict individual neonatal outcome. A 2001 study published in the New England Journal of Medicine (Casey et al.) confirmed that while very low scores at 5 minutes are associated with increased short-term risks, the APGAR score alone has limited value in predicting long-term outcomes. It is a useful clinical tool for the immediate assessment period only.
Medical Disclaimer
This APGAR Score Calculator is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The APGAR score is a clinical tool designed to be performed by trained healthcare professionals in a delivery setting. This online calculator is intended for educational reference and training purposes only. Actual APGAR scoring should always be performed by a qualified healthcare provider at the bedside. All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.
References
- Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267.
- American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 8th ed. Elk Grove Village, IL: AAP; Washington, DC: ACOG; 2017.
- Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001;344(7):467-471.
- American Academy of Pediatrics, Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. The Apgar Score. Pediatrics. 2015;136(4):819-822.