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APGAR Test Title Image

The APGAR test is used to rapidly perform a newborn assessment by healthcare workers. The test is performed at one and five minutes after a baby is born. The one minute APGAR score indicates how well the baby tolerated the birthing process and can be a quick indicator for resuscitation. The five minute score shows EMS how well the newborn is adjusting to life outside the womb.


The baby is assigned an APGAR score based on five categories and the score can help EMS workers decide what interventions must be done immediately.


What is the APGAR Score?

The APGAR test is a rapid head to toe newborn assessment tool. EMTs and other healthcare workers use the APGAR scale to assign newborns a score at both one minutes and five minutes after birth.

The APGAR score can help EMTs and paramedics quickly determine if any interventions need to be taken. 

APGAR reassessments may need to be done every 5 minutes for 20 minutes on newborns with an APGAR score less than 7, unless resuscitation measures are started.


APGAR Meaning

APGAR is a mnemonic which stands for each of the five categories newborns are tested on, these are listed below.

→ Appearance
→ Pulse
→  Grimace
→ Activity
→ Respirations


APGAR Test Scores

This section will go over what test score results mean for EMS personnel. Scroll down to see how each category of the test is scored below. The APGAR test is made up of five categories that are each scored on a scale from 0-2.

See the APGAR score chart pictured below for more details.


APGAR Score Chart

APGAR Score Chart
A score below 3 requires immediate ALS. 4-6 may need some assistance. 7-10 only needs normal care.


The APGAR test checks the baby’s:

  • color
  • heart rate
  • muscle tone
  • reflexes
  • respirations


The APGAR test score can range from 0-10 points. Scoring will help determine what actions you take as a first responder.

Ten is the highest APGAR score available, but most newborns won’t score a 10 at 1 minute.


Scoring the APGAR Categories


Checking appearance during an APGAR test is a quick evaluation of the overall appearance of the newborn while quickly evaluating the infant’s color.

Acrocyanosis is when a baby has blue extremities. It’s commonly seen in newborns, especially at one minute after birth.


→ Extremities and body are pink: 2 Points 

→ Blue extremities with a pink body: 1 Point

→ Entire baby is cyanotic: 0 Points



Heart rate is a reliable indicator of a newborn’s distress level. You can check for a pulse by palpating the brachial pulse or palpating a pulse near the base of the umbilical cord, at the newborn’s abdomen.

A normal newborn pulse is about 120-160 beats per minute.


→ Heart rate is greater than 100: 2 Points 

→ Heart rate is less than 100: 1 Point 

→ Pulse is absent: 0 Points (Initiate CPR)



Grimace is checking the newborn’s reflex irritability. Healthy newborns will cry, especially with stimulation.


EMTs will need to immediately dry the newborn in order to prevent hypothermia. This is a great opportunity to apply stimulation and check the reflex irritability.

If the newborn doesn’t respond to normal drying efforts, apply stimulus by drying the bottom of the feet or rubbing the back to elicit a response.


Normal newborns will cry, especially when stimulated by drying.  

Normal and vigorous crying would score a 2. If the newborn is making faces or grimacing but not crying, the score is a 1. If there is no response, the score is a zero.


→ Stimulation causes the baby to cough, sneeze or cry: 2 Points

→ Stimulus results in facial grimace: 1 Point

→ No response to tactile stimulation: 0 Points



Checking activity is a quick assessment of the newborn’s muscle tone. When you see a newborn that is moving slowly with decreased muscle tone, you will be able to tell.


→ Spontaneous movements, arms and legs flex, active:  2 Points 

→ Slow movements, some flexing of arms and legs: 1 Point

→ Newborn is flaccid or limp, no movements: 0 Points



The respiratory APGAR test is checking for both the respiratory rate and effort it takes the newborn to breathe. If the newborn has a good strong cry, it’s an indicator they are breathing well. 


→ Normal rate and effort, strong cry: 2 Points 

→ Breathing is slow or irregular, gasping: 1 Point 

→ Respirations are absent: 0 Points


What Does the Baby’s Score Mean?

The APGAR test score helps determine whether the newborn needs any immediate treatment interventions. Babies are tested at one minute after birth and then the APGAR test is given again at five minutes after birth. Stable newborns won’t need anymore follow up APGAR testing.


APGAR Test one min and five


APGAR reassessments may need to be done every 5 minutes for 20 minutes on newborns with an APGAR score less than 7, unless resuscitation measures are started.


APGAR Score 7 or Higher

If a newborn has an APGAR test score that is 7 or more points, EMS will provide routine care and then perform another APGAR five minutes later. Examples of routine newborn care are drying off the baby and then wrapping the newborn for warmth. 


APGAR Score of 4 – 6

If the newborn has an APGAR test score of 4, 5 or 6 points they will need assistance from the emergency medical technician (EMT). This can include interventions like suctioning the mouth, stimulation, etc. An APGAR retest at 5 minutes after birth will check for improvement. 


APGAR Score of 3 or Less

An Apgar score of 3 indicates that the baby is not perfusing adequately. If the newborn has an APGAR score of 3 or less they need immediate Advanced Life Support initiated.


Overview APGAR Interventions

Your APGAR score interpretation will determine what interventions you take. A baby with APGAR test results that are 7-10 will only need routine post delivery care.

This can include interventions like drying the baby, wrapping it for warmth, positioning the baby with it’s neck in a neutral position and suctioning the newborn with a bulb suction if the baby is gasping.


A newborn with an APGAR test score of 4 – 6 will need interventions. The newborn may need additional stimulation, oxygen, and suction along with some resuscitation efforts.


An APGAR score of 3 or less means the newborn needs immediate Advanced Life Support initiated. Begin Basic Life Support until ALS is available.

For example, if the newborn’s pulse is absent, chest compressions need to be started immediately. If there are no respirations, oxygen and ventilation therapy needs to be started until ALS is available.


Low APGAR Scores and Development

A low APGAR score at birth doesn’t mean the baby will have chronic health issues. It’s common for a newborn to score less than 10 on their first APGAR test and then go on to be a healthy, happy baby. 

In fact, most babies with a low APGAR score at birth recover quickly and are fine.


The APGAR test was designed as an assessment tool for healthcare workers, not as a longterm predictor of health. However, there has been research showing an increased risk of disability for a small percentage of babies with a low APGAR score at 5 minutes. (Source)

Keep in mind for most babies, having a low APGAR score at birth or 5 minutes will not cause any problems later in life.


APGAR Practice


APGAR Practice #1

You are performing a one minute APGAR test on a newborn female in the field. The baby has a strong cry and is pink with cyanotic hands and feet. You assess a pulse of 122 beats per minute and the baby has some flexion of both the arms and legs. While drying the newborn is responsive and cries while you dry it. What is the APGAR score?



APGAR Score Explanation:

A: 1 Baby is pink with blue hands and feet.

P: 2 Pulse is 122 (Greater than 100).

G: 2 Responsive and cries when baby is dried.

A: 1 Some flexion of arms and legs.

R: 2 Baby has a strong cry.

Answer: APGAR Score is 8


APGAR Practice #2

You’re performing a one minute APGAR test on a newborn. Your quick  assessment finds the newborn has a strong cry, a heart rate of 104 and  cyanotic body and extremities. The baby is limp and has no response to stimulation. What is the APGAR score?



APGAR Explanation

A: 0 Baby is cyanotic all over.

P: 2 Pulse is 104 (Greater than 100).

G: 0 No response to stimulation.

A: 0 Baby is limp.

R: 2 Baby has a strong cry.

Answer: APGAR Score is 4



APGAR Practice #3

While performing the APGAR test at five minutes on a newborn you find the baby has a pulse of 125, a weak cry and pale skin all over. The baby is active with flexing of the arms and legs and the newborn cries with stimulation.  What is the APGAR score?


APGAR Explanation

A: 2 Baby is pale all over. (No cyanosis)

P: 2 Pulse is 125 (Greater than 100).

G: 2 Cries with stimulation.

A: 2 Active flexing arms and legs.

R: 1 Baby has a weak cry.

Answer: APGAR Score is 9




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