Apgar Scores can quickly identify birth injuries, like a brain injury or cerebral palsy

As a Houston, Texas medical malpractice attorney, I invest a lot of time in reading medical and health-related literature. This continuing education helps keep me informed about the standards of care and new developments that can be important to my clients

I am currently reading a great book called “Thinking, Fast and Slow” by Daniel Kahneman. He is a Nobel Prize winning psychologist who, in this book, explains how our minds work.

In a chapter called “Intuitions Vs. Formulas,” Kahneman shares the interesting history about how Apgar Scores—which are still used today by OB/GYNs, pediatricians, and other healthcare providers—were invented back in 1952.

As Kahneman tells it, one day a doctor in training (resident) asked Dr. Virginia Apgar, an anesthesiologist, how she would make a systematic assessment of a newborn. Dr. Apgar wrote down five variables, including heart rate, respiration, reflect, muscle tone, and color. Then she noted three possible scores, 0, 1, or 2, depending on how strong each variable was.

That was the beginning of the Apgar Scores, which are still the standard of care and used at virtually every hospital labor and delivery room in America today.

Apgar Scores

Apgar Scores are a great clinical tool for OB/GYN physicians, neonatologists, pediatricians, and other healthcare providers to quickly assess the healthiness and wellbeing of a newborn.

I believe that it is a good idea for parents and family members to have a basic knowledge of Apgar Scores because, quite often, doctors do not want to immediately share the bad news of a birth injury or suspected brain damage. This is probably out of a remote hope that things may get better. If you ask for the baby’s Apgar Scores, though, it can give a rather objective view of the baby’s condition when there is a problem.

1 minute and 5 minute Apgar Scores

Healthcare providers assess, record, and document in the medical records a newborn’s Apgar Scores at one minute and five minutes after birth.

The 1 minute Apgar Score give doctors instant information about the baby’s health, so an immediate decision can be made about whether further treatments or interventions are needed.

The 5 minute Apgar Score is principally used to measure how well the baby has responded to any treatments triggered by the 1 minute Apgar assessment.

What is measured by Apgar Scores?

An Apgar evaluation measures the newborn’s color, heart rate, reflexes, muscle tone, and respiratory effort. An Apgar score for each factor ranges from zero (0) to two (2). Considering that there are five Apgar factors, the maximum total Apgar Score is 10.

A baby with a total Apgar Score of 7-10 will need only routine care after delivery. For an Apgar Score of 4-6, the newborn may need some assistance with respiration, or breathing. If an Apgar Score is less than 4, it is an emergency situation that requires quick lifesaving measures.

A 5 minute Apgar Score of 7-10 is normal. If a newborn has a 5 minute score of less than seven, though, healthcare providers will continue to monitor and re-assess the baby every 5 minutes for up to 20 minutes.

How is the Apgar Score calculated?

Factor 1: Heart rate

0 – No heart rate

1 – Fewer than 100 beats per minute (baby is not very responsive)

2 – Greater than 100 beats per minute (baby is vigorous)

Factor 2: Respiration

0 – Not breathing

1 – Weak cry, which may sound like whimpering or grunting

2 – Good, strong cry

Factor 3: Muscle tone

0 – Limp

1 – Some flexing or bending of arms and legs

2 – Active motion

Factor 4: Reflex response

0 – No response to airways being stimulated

1 – Grimace during stimulation

2 – Grimace and cough or sneeze during stimulation

Factor 5: Color

0 –Entire body is blue or pale

1 – Good color in body but with blue hands or feet

2 – Completely pink or good color

We are here to help

If you or a loved one has a baby who was seriously injured from a birth-related injury, like cerebral palsy, brain injury, or a disabling nerve injury, call the experienced medical malpractice lawyers at Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation on your potential case. We handle medical negligence and wrongful death cases all over Texas and, in some occasions with local counsel, in other states as well.


Robert Painter is a former hospital administrator and an attorney at Painter Law Firm PLLC, in Houston, Texas. He files medical malpractice and wrongful death lawsuits against doctors, OB/GYNs, hospitals, and other healthcare providers on behalf of patients and family members.

Robert Painter
Article by

Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.