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Ages & Stages

As soon as your baby is born, a delivery nurse will set one timer for one minute and another for five minutes. When each of these time periods is up, a nurse or physician will give your baby her first “tests,” called Apgars.

This scoring system (named after its creator, Virginia Apgar) helps the physician estimate your baby’s general condition at birth. The test measures your baby’s heart rate, breathing, muscle tone, reflex response, and color. It cannot predict how healthy she will be as she grows up or how she will develop; nor does it indicate how bright she is or what her personality is like. But it does alert the hospital staff if she is sleepier or slower to respond than normal and may need assistance as she adapts to her new world outside the womb.

Each characteristic is given an individual score; two points for each of the five categories if all is completely well; then all scores are totaled. For example, let’s say your baby has a heart rate of more than 100, cries lustily, moves actively, grimaces and coughs in response to the syringe, but is blue; her one minute Apgar score would be 8—two points off because she is blue and not pink. Most newborn infants have Apgar scores greater than 7. Because their hands and feet remain blue until they are quite warm, few score a perfect 10.

If your baby’s Apgar scores are between 5 and 7 at one minute, she may have experienced some problems during birth that lowered the oxygen in her blood. In this case, the hospital nursing staff probably will dry her vigorously with a towel while oxygen is held under her nose. This should start her breathing deeply and improve her oxygen supply so that her five-minute Apgar scores total between 8 and 10.

A small percentage of newborns have Apgar scores of less than 5. For example, babies born prematurely or delivered by emergency C-section are more likely to have low scores than infants with normal births. These scores may reflect difficulties the baby experienced during labor or problems with her heart or respiratory system.

If your baby’s Apgar scores are very low, a mask may be placed over her face to pump oxygen directly into her lungs. If she’s not breathing on her own within a few minutes, a tube can be placed into her windpipe, and fluids and medications may be administered through one of the blood vessels in her umbilical cord to strengthen her heartbeat. If her Apgar scores are still low after these treatments, she will be taken to the special-care nursery for more intensive medical attention.

Apgar Scoring System

 

 Score

0

1

2

Heart Rate

Absent

Less than 100 beats per minute

More than 100 beats per minute

Respiration

Absent

Slow, irregular; weak cry

Good; strong cry

Muscle Tone

Limp

Some flexing of arms and legs

Active motion

Reflex*

Absent

 Grimace

Grimace and cough or sneeze

Color

Blue or pale

Body pink; hands and feet blue

Completely pink

 

*Reflex judged by placing a catheter or bulb syringe in the infant’s nose and watching her response.

 

Last Updated
2/26/2014
Source
Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.