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APGAR scores – what do they say about your baby’s health?

Posted: 27/01/2022

This is a new article series which aims to cover a broad range of topics regarding birth injury claims and natal care. The first entry concerns APGAR scores: what they are, how they work, and what they can indicate for a baby’s health.

What are APGAR scores?

The APGAR score is a tool for evaluating the health of a newborn baby immediately after birth, so that they can quickly be treated if there are any problems. The term was coined in 1953 by Virginia Apgar, obstetric anaesthesiologist and medical researcher.

How do they work?

Clinicians perform checks at one minute after birth in order to assess a baby’s APGAR scores. Scores are given between zero and two for each of five criteria: appearance, pulse, grimace, activity and respiration. These scores are added together to produce a score between zero and ten. Checks are repeated at five minutes to see how the baby is progressing.


0 points

1 point

2 points

Appearance (colour)

Blue or pale

Body pink, hands and feet blue

Completely pink

Pulse (heart rate)


Fewer than 100 beats per minute

More than 100 beats per minute

Grimace (reflex response)



Grimace and cough or sneeze

Activity (muscle tone)


Some flexing of arms and legs

Active motion

Respiration (breathing)


Slow, irregular, weak cry

Good, strong cry

Regarding appearance, this is checked to see if blood is circulating as it should. Where skin tones make this less obvious, clinicians may check the palms of hands and soles of feet, as well as nail beds, the mouth and the tongue.

What do they mean?

  • Scores between eight and ten: the newborn is in excellent condition and will need no more than routine care.
  • Scores between five and seven: the newborn is in fair condition, though they may need some help with breathing. This could include vigorously rubbing the baby’s skin, giving them oxygen, or where necessary, suctioning their airways.
  • Scores of below five: a doctor will be needed to provide extra medical assistance.

The NHS Maternity Statistics for England from 2019-2020 show that 98.6% of babies born had a score of at least seven after five minutes. Very few babies are given a score of ten.

In some cases where there has been a difficult birth, a premature birth, or painkillers were given to the mother, scores may be artificially low at first, and then rise to normal levels on the second check. However, consistently low APGAR scores can indicate serious injury. There is evidence that low scores at five minutes are associated with a higher risk of serious medical problems, such as cerebral palsy.[1] If there are concerns over low scores at one and five minutes, scoring may be done for a third time.

What are the causes of a low APGAR score?

Causes of consistently low APGAR scores vary, but they can commonly arise where one or more of the following have occurred:

  • Fetal infection
  • Delay in delivery
  • Fetal monitoring errors
  • Fetal hypoxia/asphyxia
  • Placental abruption
  • Intrauterine growth restriction (IUGR)
  • Umbilical cord prolapse
  • Prematurity

Though low APGAR scores following complications are not always indicative that negligent treatment has been provided, if you do have concerns about the circumstances of your baby’s birth, you may want the reassurance of a specialist birth injury solicitor. Please do not hesitate to contact our specialist birth injury team for a no-obligation discussion.


[1] Lie et al 2010

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