How to score an Apgar

The Apgar score is a quick, shared way to describe how a newborn is doing right after birth. It does not decide whether to resuscitate; help a baby who needs it right away.

Step by step

1. Resuscitate first if needed

   If the baby is not breathing well or is limp, start newborn resuscitation at once. Do not wait for the 1 minute score. [1]

2. Time the scores

   Score at 1 and 5 minutes after birth. If the 5 minute score is below 7, keep scoring every 5 minutes up to 20 minutes. [2]

3. Appearance (color)

   0 for blue or pale all over, 1 for a pink body with blue hands and feet, 2 for pink all over. [2]

4. Pulse

   Listen to the chest or feel the umbilical cord. 0 if absent, 1 if below 100, 2 if 100 or more. [2]

5. Grimace (reflex response)

   Watch the response to gentle stimulation or suction. 0 for none, 1 for a grimace, 2 for a cry, cough or sneeze. [2]

6. Activity (muscle tone)

   0 for limp, 1 for some bending of the arms and legs, 2 for active movement. [2]

7. Respiration

   0 for no breathing, 1 for slow or weak breathing, 2 for a strong cry. [2]

8. Add and record

   Add the five scores for a total out of 10. Record each total with its time. [3]

Common errors

• Delaying resuscitation to finish the score.
• Scoring blue hands and feet as 0 for color.
• Not repeating the score when the 5 minute total is low.

Apgar totals [2]

Sources

1. AHA Guidelines for CPR and ECC
2. NCCPA PANCE Content Blueprint
3. AAMC Core Entrustable Professional Activities (Core EPAs)

Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.