Apgar Score Calculator

Score the five Apgar signs — Appearance, Pulse, Grimace, Activity and Respiration — from 0 to 2 each to get the total out of 10 and what it means at 1 and 5 minutes after birth.

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Written and reviewed by the Kinase Medical Team · Last reviewed 30 September 2026

Quick Answer

The Apgar score rates Appearance, Pulse, Grimace, Activity and Respiration from 0 to 2 each (total 0–10) at 1 and 5 minutes after birth. At 5 minutes, 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low. If it is below 7 at 5 minutes, it is repeated every 5 minutes up to 20 minutes.

For learning — not for clinical decisions. This calculator is a study aid for exam preparation. Check every result against your institution's protocols and senior advice before acting on it.

Apgar score calculator

A — Appearance (Skin colour)
P — Pulse (Heart rate)
G — Grimace (Reflex irritability (response to stimulation))
A — Activity (Muscle tone)
R — Respiration (Breathing effort)

Score all five signs to see the total.

How it's calculated

Total
Apgar = A + P + G + A + R (each 0–2, total 0–10)
Appearance (colour)
0 blue or pale all over · 1 body pink, extremities blue · 2 pink all over
Pulse (heart rate)
0 absent · 1 below 100/min · 2 above 100/min
Grimace (reflex irritability)
0 no response · 1 grimace · 2 grimace with cough, sneeze or vigorous cry
Activity (muscle tone)
0 limp · 1 some flexion · 2 active movement
Respiration (effort)
0 absent · 1 slow or irregular, weak cry · 2 good, strong cry

Each sign is observed or elicited at the stated time and scored independently; the five scores are added. The score describes the baby's condition at that moment and how it changes between assessments.

How to interpret the result

Bands for the 5-minute score in term and late-preterm infants (AAP/ACOG, 2015).
5-minute scoreInterpretationWhat happens next
7–10ReassuringRoutine care; no further Apgar scores needed
4–6Moderately abnormalContinue scoring every 5 minutes up to 20 minutes while the baby is assessed and supported
0–3LowContinue scoring every 5 minutes up to 20 minutes, including during resuscitation

Worked example

At 1 minute a baby has blue hands and feet with a pink body, heart rate 120/min, grimaces on suction, has some flexion of the limbs and a weak, irregular cry.

Appearance 1 + Pulse 2 + Grimace 1 + Activity 1 + Respiration 1 = 6.

At 5 minutes the baby is crying vigorously, moving actively and has a heart rate of 140/min, with blue hands and feet: 1 + 2 + 2 + 2 + 2 = 9 → reassuring, so no further scores are required.

Limitations and common pitfalls

  • The Apgar score is not used to decide whether a baby needs resuscitation — that assessment happens straight away at birth, before the 1-minute score is given.
  • It does not predict an individual baby's death or neurological outcome, and a single low score should not be over-interpreted.
  • Gestational age, birth weight, maternal medicines, drug use or anaesthesia, and congenital anomalies all influence the score, so a low score is not the same as asphyxia.
  • Scores given during resuscitation are not directly comparable with those of a spontaneously breathing baby — record what was being done at each time point.
  • Colour is the most subjective item and is hard to judge in babies with darker skin; do not let it dominate the assessment.

Revise the concept behind this tool: Apgar score — concept and exam points →

Sources

  1. StatPearls — APGAR Score (NCBI Bookshelf, NBK470569)
  2. MedlinePlus — Apgar score (U.S. National Library of Medicine)
  3. American Academy of Pediatrics & ACOG — The Apgar Score (Pediatrics 2015;136:819; ACOG Committee Opinion 644)
  4. Five-minute Apgar score and risk of neonatal mortality and morbidity in term infants (PMC10825608)
  5. The Apgar score and race: why healthy babies are supposed to be "pink" (PMC12511204)
  6. From Soranus score to Apgar score (PMC7984437)

For learning — not for clinical decisions. Reference ranges and cut-offs vary between laboratories and guidelines.

Frequently Asked Questions

What does APGAR stand for?▼
It is a mnemonic for the five signs: Appearance (skin colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone) and Respiration (breathing effort). Each is scored 0, 1 or 2, so the total is 0–10. The score is named after Dr Virginia Apgar, who described it in 1952 (published in 1953).
When is the Apgar score done?▼
At 1 minute and 5 minutes after birth. If the 5-minute score is below 7, scoring continues every 5 minutes until 20 minutes, including during resuscitation, so the response to treatment is documented.
What is a normal Apgar score?▼
A 5-minute score of 7–10 is reassuring. A score of 4–6 is moderately abnormal and 0–3 is low. These bands are used for term and late-preterm babies.
Does a low Apgar score mean brain damage?▼
Not on its own. Very low scores that persist beyond 5 minutes are linked with higher rates of death and cerebral palsy, but most babies with a low score do not develop cerebral palsy. The American Academy of Pediatrics states that the Apgar score does not predict individual mortality or neurological outcome.
How is the Apgar score scored in a preterm baby?▼
The same five signs are scored, but the score is influenced by gestational age and birth weight, so a preterm baby can score lower partly because of immaturity. Its value in preterm babies has been questioned, although low 5- and 10-minute scores still carry higher risk.
Why is the skin colour item criticised?▼
Colour is the most subjective sign. The traditional wording 'pink' fits poorly for babies with darker skin, and a recent review argues for more neutral wording. Many babies also have blue hands and feet (acrocyanosis) for some minutes after birth, which scores 1.
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