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The Apgar Score

The Apgar score, developed in 1952 by an anaesthesiologist called Victoria Apgar, is a quick check designed to determine the physical condition of a newborn baby. The test is taken at one minute after birth, and again at five minutes after birth, by a doctor, midwife or nurse in the delivery room.

A low score can indicate that the baby may be in poor health or has sustained a birth injury, and that medical treatment may be necessary. The test is repeated at five minutes after the birth of the baby to assess whether the child’s condition has improved, and if the score is still low after five minutes, the test may be repeated again at 10 minutes after birth.

Here, the medical negligence solicitors at Potter Rees Dolan explain what the Apgar score measures, what the individual scores mean for the health of your baby, and what to do if negligence has caused an injury to your baby.

How does the Apgar Score test work?

The Apgar score test monitors five different elements that can be used to monitor the overall health of a newborn baby. Each category is named based on a letter from Apgar’s name, to make the test easier for practitioners to remember and administer. The five criteria are:

  • Appearance (skin colouration)
  • Pulse
  • Grimace (responsiveness)
  • Activity (muscle tone)
  • Respiration (breathing rate and effort)

Each of the criteria is given a score of 0, 1 or 2 and then added together to generate a total score out of 10. On average, a healthy baby will score between 7 and 10 on the scale. Below, we have detailed how the scores are calculated and what they indicate about the health of the baby.

What do the Apgar scores mean?

In each category, medical professionals look for specific symptoms before calculating the baby’s score. Below, we have included more information about what each score might indicate about the health of the baby.


2 points - Normal colour all over (hands and feet are pink)
1 point - Normal colour (but hands and feet are blueish)
0 points - Blueish-grey or pale all over


2 points - Normal (above 100 beats per minute)
1 point - Below 100 beats per minute
0 points - Absent (no pulse)


Grimace (responsiveness or reflex irritability)

2 points - Pulls away, sneezes, coughs or cries with stimulation
1 point - Facial movement only (grimace) with stimulation
0 points - Absent (no response to stimulation)


2 points - Active, spontaneous movement
1 point - Arms and legs flexed with little movement
0 points - No movement/floppy muscle tone


2 points - Normal rate and effort, strong cry
1 point - Slow or irregular breathing, weak cry
0 points - Absent (no breathing)

As stated, the majority of newborns are scored between 7 and 10, meaning they do not require any immediate treatment. Scores of 10 are unusual, because most newborns will lose points for having blue hands and feet. However, this is a very common symptom in babies immediately after they are born and does not indicate a problem unless combined with other symptoms.

Babies born prematurely, those who were born via a caesarean section, and those whose deliveries were complicated generally have slightly lower Apgar scores initially which then pick up, but this is to be expected and is not usually a cause for concern.

What does a low Apgar score mean?

An Apgar score of between 4 and 6 is considered moderately abnormal, and the baby may require medical intervention. A low score most often means that a baby is having trouble breathing or has an abnormal heart rate, which may mean that the medical team needs to administer oxygen or clear out airways, or to stimulate the baby’s heart until it beats regularly.

Apgar scores lower than 4 suggest the baby needs urgent medical attention. This can be associated with many different conditions. With the right medical intervention, many babies’ scores will increase at five minutes after birth, but there can still be long-term problems associated with a low Apgar score. Doctors will continue to administer emergency medical care to the baby until their condition improves and symptoms abate.

If the baby’s Apgar score remains low after tests at five and ten minutes after birth, there is a risk that the child will suffer a brain injury or long-term neurological damage, which can result in cerebral palsy and other conditions. 

It is devastating to learn that your baby will have a long-term medical condition, and even more so when that condition arises as the result of clinical negligence on the part of a medical professional. If your child has been the victim of such negligence, you may be entitled to claim compensation. This can help to pay for any lifestyle adjustments you need to make to ensure your child has the happiest and most comfortable life possible.

How can I find more information on birth injuries?

If you are looking for additional information and support on birth injuries and other causes of low Apgar scores, there are a number of organisations and resources that may be useful to you:

  • Birth Trauma Association
  • Scope
  • Action Cerebral Palsy
  • Erb’s Palsy Group (EPG)
  • NHS information on cerebral palsy

If you believe you or your child may be entitled to compensation following a birth injury, you can find out more on our birth injury claims page.

Contact us today

If you or a loved one were the victim of medical negligence that has resulted in a birth injury or cerebral palsy diagnosis, the expert solicitors at Potter Rees Dolan can help. Visit our birth injury claims page or our cerebral palsy claims page to find out more.

If you feel that you may be entitled to compensation because of a birth injury, you can give us a call on 0800 027 2557, or fill in the enquiry form on this page to arrange a call back at your convenience.


What are the common causes of a low Apgar Score?

If the baby has a low Apgar score, it is usually cased by a difficult birth, a C-section or fluid in the baby's airway.

If this occurs then the baby would receive oxygen and have its airways cleared to help the baby breathe, or receive physical stimulation to get the heart beating at a healthy rate.

Unfortunately, if these problems arise, then the baby may have sustained a serious injury, such as Cerebral Palsy or Erb's Palsy.

Further reading

Useful Information

Emergency Caesarean Section

This procedure is usually carried out when a normal vaginal delivery would put the mother or the baby at risk.

However, an emergency caesarean is performed when circumstances before or during labour call for an unplanned procedure.

A caesarean section is usually carried out under an epidural or a spinal anaesthetic causing the lower part of the body to be numbed. The procedure usually takes 40-45 minutes but, during an emergency, can be performed quicker.

The risks to the mother in a caesarean section can include an infection of the wound or the womb lining, a blood clot (thrombosis) in the legs or excess bleeding.

Doctors now give the mother a dose of antibiotics before the operation to reduce the likelihood of any infections.

Risks to the baby during a caesarean, according to the NHS, are no greater than a normal vaginal delivery but the most common problem of babies delivered by caesarean is difficulty breathing, although this usually affects babies born prematurely.


This is a condition where tissue which behaves like the lining of the womb (endometrium) is found outside the womb. This is a common condition which is said to affect around 2 million women in the UK. [source]

The symptoms of endometriosis varies from woman to woman but the most common include; painful or heavy periods, pain in the lower abdomen, pelvis or lower back, pain during and after sex, bleeding between periods and difficulty getting pregnant.

The exact cause of endometriosis is unclear and there are many different theories. One theory is that endometriosis is hereditary where it has been passed down through the genes.

Another theory is that it is caused by retrograde menstruation which is when the womb lining flows backwards through the fallopian tubes into the abdomen instead of leaving the body as a period. The tissue then embeds itself into the pelvic organs and grows.

There is no cure for endometriosis but treatments are available to help ease the symptoms including; pain relief and hormone injections. Alternatively, surgery may be performed to remove the endometriosis tissue through laparoscopy or even hysterectomy.

Endometriosis can sometimes cause fertility problems through damaging the ovaries or fallopian tubes but it is said that up to 70% of women with mild-mid endometriosis have no problems getting pregnant after treatment.

Erb's Palsy

This condition is usually caused by a traumatic childbirth where the baby's arm is paralysed when the upper group of the arm's main nerves is injured.

Erb's Palsy, or otherwise known as brachial plexus paralysis, can occur if the infant's head and neck are pulled toward the side at the same time as the shoulders pass through the birth canal.

The condition can also be caused by excessive pulling on the shoulders during a cephalic presentation (head first delivery), or by pressure on the raised arms during a breech (feet first) delivery.

Other causes can include a raised BMI of the mother at time of baby's birth, a high weight at birth and a long second stage of labour.

The child is usually unable to abduct the arm from the shoulder, rotate the arm externally from the shoulder or supinate the forearm giving them a 'waiter's tip' appearance.

Hand grasp in children with Erb's Palsy is usually normal unless the lower part of the plexus is also damaged.

Some babies recover on their own but some need specialist treatment.

Gestational Diabetes

Diabetes is condition where there is too much glucose in the blood which is controlled by a hormone called insulin.

The illness is caused by either insufficient insulin being produced or the body is becoming resistant to insulin.

Gestational diabetes is when, during pregnancy, the woman's body produces a number of hormones which make her body insulin-resistant. The purpose of this hormonal effect is to allow the extra glucose and nutrients in your blood to pass to the foetus so it can grow.

Her body should produce more insulin in order to cope with the increased amount of glucose in the blood. However, some women cannot produce enough insulin in pregnancy to transport the glucose to the cells or their body is becoming more resistant to insulin.

Pregnant women may be more likely to have gestational diabetes if her body mass index is high, if they have previously had a baby weighing more than 10lbs at birth or if they have a family history of diabetes.

Some women may need medication to control their glucose levels but most can control the gestational diabetes through diet and exercise.

Gestational diabetes is usually developed after 28 weeks and usually disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life.

If the gestational diabetes is not detected it can cause problems during and after birth.

These include; a risk of the child becoming obese or have diabetes later in life, trauma during birth and placental abruption whereby the placenta starts to come away from the wall of the womb which can cause vaginal bleeding and abdominal pain.

Other complications which can occur include; needing to induce labour, premature labour and even perinatal death, where the baby dies around the time of the birth.

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