# What is the Apgar score?

Adds up the five Apgar signs of a newborn (color, heart rate, reflex irritability, muscle tone, and breathing), each scored 0 to 2, to a score of 0 to 10, and reads a 5-minute score with the ACOG and AAP bands.

- Page: https://www.acalculator.org/health/apgar-score-calculator
- JSON spec: https://www.acalculator.org/health/apgar-score-calculator.json
- Version: 67fab224dea0

## Default answer

Example with the default inputs (Color (appearance) 1: Acrocyanotic (blue hands and feet), Heart rate (pulse) 2: Over 100 per minute, Reflex irritability (grimace) 2: Cry or active withdrawal, Muscle tone (activity) 2: Active motion, Respiration 2: Good, crying, Minutes after birth 5 minutes): The Apgar score at 5 minutes is 9 out of 10: Reassuring (7 to 10).

## Inputs

| Key | Label | Description |
| --- | --- | --- |
| c | Color (appearance) | Skin color: completely pink, pink with blue hands and feet (acrocyanotic), or blue or pale. |
| hr | Heart rate (pulse) | Heart rate: over 100 per minute, under 100 per minute, or absent. |
| r | Reflex irritability (grimace) | Response to stimulation: cry or active withdrawal, a grimace, or no response. |
| t | Muscle tone (activity) | Muscle tone: active motion, some flexion, or limp. |
| b | Respiration | Breathing: good, crying; a weak cry or slow, irregular breathing; or absent. |
| min | Minutes after birth | When the score was taken: at 1 and 5 minutes, then every 5 minutes up to 20. |

## Outputs

| Key | Label | Description |
| --- | --- | --- |
| score | Apgar score | Color + heart rate + reflex irritability + muscle tone + respiration, 0 to 10. |
| reading | Reading | For a 5-minute score: 7 to 10 reassuring, 4 to 6 moderately abnormal, 0 to 3 low (ACOG 644). |

## Method

Apgar score = color + heart rate + reflex irritability + muscle tone + respiration, each 0, 1, or 2 (ACOG 644, Fig. 1). A 5-minute score of 7 to 10 is reassuring, 4 to 6 moderately abnormal, and 0 to 3 low.

## Assumptions

- Each sign is scored as seen at that minute, on the levels of the ACOG and AAP expanded Apgar score form.
- The bands apply to the 5-minute score of babies born at term or late preterm; scores at other times are not graded.
- The score describes the baby at one moment; it does not decide resuscitation and does not predict one baby’s outcome.

## Worked examples

1. c = 1, hr = 2, r = 2, t = 2, b = 2, min = 5 gives score = 9, reading = Reassuring (7 to 10). Source: ACOG Committee Opinion 644: 1 + 2 + 2 + 2 + 2 = 9 at 5 minutes, reassuring (7 to 10) ().
2. c = 2, hr = 2, r = 2, t = 2, b = 2, min = 5 gives score = 10, reading = Reassuring (7 to 10). Source: ACOG Committee Opinion 644, Fig. 1: every sign 2 gives the highest score, 10.
3. c = 1, hr = 2, r = 1, t = 1, b = 2, min = 5 gives score = 7, reading = Reassuring (7 to 10). Source: ACOG Committee Opinion 644: 7 is the lowest reassuring 5-minute score.
4. c = 1, hr = 2, r = 1, t = 1, b = 1, min = 5 gives score = 6, reading = Moderately abnormal (4 to 6). Source: ACOG Committee Opinion 644: a 5-minute score of 4 to 6 is moderately abnormal.
5. c = 0, hr = 1, r = 1, t = 1, b = 1, min = 5 gives score = 4, reading = Moderately abnormal (4 to 6). Source: ACOG Committee Opinion 644: 4 is the lowest moderately abnormal score.
6. c = 0, hr = 1, r = 1, t = 0, b = 1, min = 5 gives score = 3, reading = Low (0 to 3). Source: ACOG Committee Opinion 644: a 5-minute score of 0 to 3 is low.
7. c = 0, hr = 0, r = 0, t = 0, b = 0, min = 5 gives score = 0, reading = Low (0 to 3). Source: ACOG Committee Opinion 644, Fig. 1: every sign 0 gives 0.
8. c = 0, hr = 1, r = 1, t = 1, b = 1, min = 1 gives score = 4, reading = Not graded (the bands are for the 5-minute score). Source: ACOG Committee Opinion 644 grades the 5-minute score only.

## FAQ

### What is the Apgar score?

A quick, standard check of a newborn right after birth, devised by Dr. Virginia Apgar in 1952. Five signs (color, heart rate, reflex irritability, muscle tone, and breathing) each get 0, 1, or 2 points, for a total of 0 to 10.

### When is the Apgar score taken?

At 1 minute and at 5 minutes after birth, for every baby. If the 5-minute score is under 7, the Neonatal Resuscitation Program guidelines repeat it every 5 minutes for up to 20 minutes (ACOG Committee Opinion 644).

### What do the scores mean?

ACOG and the AAP call a 5-minute score of 7 to 10 reassuring, 4 to 6 moderately abnormal, and 0 to 3 low, in babies born at term or late preterm. The bands are for the 5-minute score, so this page does not grade the score at other times.

### Does a low Apgar score mean a baby will have problems?

Not on its own. The score does not predict one baby’s death or brain outcome, and the score alone is not evidence of a lack of oxygen at birth (asphyxia). A 1-minute score of 0 to 3 does not predict any one baby’s outcome. In large groups a low 5-minute score goes with a higher risk of cerebral palsy, but most babies with low scores do not develop it.

### Why do so few babies score 10?

Color often scores 1, because blue hands and feet are common in healthy newborns, even at 5 minutes (StatPearls). A score of 7 to 10 at 5 minutes is reassuring.

### Is the Apgar score used to decide on resuscitation?

No. Resuscitation starts before the 1-minute score is given, so the score is not used to decide whether to start it, which steps to take, or when. A score given during resuscitation is not the same as a score given to a baby who breathes on its own (ACOG Committee Opinion 644).

### Why can a preterm baby score lower?

Tone, color, and reflexes depend partly on how mature the baby is. ACOG notes that a healthy preterm baby may get a low score only because of immaturity.

## Sources

- American College of Obstetricians and Gynecologists Committee on Obstetric Practice and American Academy of Pediatrics Committee on Fetus and Newborn. Committee Opinion No. 644: The Apgar Score. Obstet Gynecol. 2015;126(4):e52-e55, reaffirmed 2025 (five signs scored 0, 1, or 2; Fig. 1, the expanded Apgar score form; 5-minute bands; timing; limits). https://doi.org/10.1097/AOG.0000000000001108 (free full text; ACOG page: https://www.acog.org/clinical/guidance/committee-opinion/2015/10/the-apgar-score, retrieved 2026-10-18)
- Simon LV, Shah M, Bragg BN. APGAR Score. StatPearls, last update January 31, 2026 (each sign’s levels in words; color often scores 1 at 5 minutes). https://www.ncbi.nlm.nih.gov/books/NBK470569/ (retrieved 2026-10-18)