The components (each scored 0, 1 or 2).

• A — Appearance (skin colour). 0 blue or pale all over · 1 body pink with blue extremities (acrocyanosis) · 2 completely pink.
• P — Pulse (heart rate). 0 absent · 1 under 100 bpm · 2 100 bpm or above. This is the single most important component: the heart rate drives every resuscitation decision.
• G — Grimace (reflex irritability). 0 no response to stimulation · 1 grimace or feeble cry · 2 vigorous cry, cough, sneeze or pulling away.
• A — Activity (muscle tone). 0 limp · 1 some flexion of the limbs · 2 active movement, well-flexed.
• R — Respiration. 0 absent · 1 slow or irregular, weak cry · 2 good, vigorous cry.

Timing. Assigned at 1 minute and at 5 minutes after birth, and — if the 5-minute score is below 7 — repeated at 10, 15 and 20 minutes. The 1-minute score describes how the baby arrived and whether resuscitation is needed now; the 5-minute score describes the response and is the more prognostic of the two. This tool holds three time points so the trend can be seen, because a score that moves from 4 to 7 is a different clinical situation from one that stays at 4.

Bands. 7–10 reassuring. 4–6 moderately abnormal — the baby may need stimulation, airway support and oxygen. 0–3 low — immediate resuscitation. These bands guide attention, not action: resuscitation is started on the assessment, not after the score has been tallied, and a baby who is apnoeic or has a heart rate under 100 at 1 minute needs positive-pressure ventilation immediately regardless of what the total turns out to be.

Worked example. Heart rate 120 bpm (2), respiratory effort weak and irregular (1), grimace on suctioning (1), some flexion of the limbs (1), body pink with blue hands and feet (1) = 6 at 1 minute. At 5 minutes the same baby has a vigorous cry (2), pulls away (2), active movement (2) and is still acrocyanosed (1), with a heart rate of 140 (2) = 9. That trajectory — 6 then 9 — is reassuring in a way that neither number alone is.

Limits, and these matter. The American Academy of Pediatrics and the American Heart Association are explicit that an APGAR score alone does not predict individual neurological outcome, and a low score is not by itself evidence of intrapartum hypoxia. Preterm infants score lower for reasons that have nothing to do with asphyxia — immature tone, a weaker respiratory drive and less reflex response all cost points, so the score has to be read against gestation. Maternal sedation, opioids, general anaesthesia and magnesium all depress the score transiently. Congenital anomaly, infection, trauma and airway obstruction affect it too. The colour component is the least reliable: pulse oximetry shows that almost no newborn is fully pink at one minute, and acrocyanosis at 1 minute is normal. The score is also observer-dependent, and in a real resuscitation it is often assigned retrospectively. It has never been validated as a decision tool for starting or stopping resuscitation.

Privacy. Scores are held in this page's memory and are cleared when you reload or close it. Nothing is written to the browser's storage and nothing is sent anywhere — deliberate, because this is patient data and ward computers are shared.

Disclaimer. A scoring aid for qualified clinicians — not medical advice. Sources: Apgar, Current Researches in Anesthesia & Analgesia 1953 · American Academy of Pediatrics / American Heart Association, The Apgar Score policy statement · Neonatal Resuscitation Program 8th edition. Last reviewed: 2026-09-21.