Chapter 4: The Apgar

The introductory text reads, Just moments after birth, babies are administered their very first test. The APGAR score is an assessment tool used by doctors and nurses to determine whether a newborn requires any medical intervention. It tests five specific criteria of health, and the medical professional assigns a score of 0, 1, or 2 for each category. A perfect score of 10 is rare—most babies will show some minor deficits at the 1-minute mark, and many will still lose points at the 5-minute mark.
A chart shows a photo of a newborn baby in the center and the checkpoints along with the scores. The criterion Grimace Response/ Reflexes points to the baby’s mouth, and the text reads, Score (2), A healthy baby will indicate his displeasure when his airways are suctioned—he or she will grimace, pull away, cough, or sneeze. Score (1), Baby will grimace during suctioning. Score (0), Baby shows no response to being suctioned and requires immediate medical attention.
The criterion Respiration points to the baby’s nose, and the text reads, Score (2), A good strong cry indicates a normal breathing rate. Score (1), Baby has a weak cry or whimper, or slow/irregular breathing. Score (0), Baby is not breathing and requires immediate medical intervention.
The criterion Pulse points to the baby’s wrist, and the text reads, Score (2), A pulse of 100 or more beats per minute is healthy for a newborn. Score (1), Baby's pulse is less than 100 beats per minute. Score (0), A baby with no heartbeat requires immediate medical attention.
The criterion Appearance/ Color points to the baby’s skin, and the text reads, Score (2), Body and extremities should show good color, with pink undertones indicating good circulation. Score (1), Baby has some blueness in the palms and soles of the feet. Many babies exhibit some blueness at both the 1- and 5-minute marks; most warm up soon after. Score (0), A baby whose entire body is blue, grey, or very pale requires immediate medical intervention.
The criterion Activity and Muscle Tone points to the baby’s legs, and the text reads, Score (2), Baby exhibits active motion of arms, legs, and body. Score (1), Baby shows some movement of arms and legs. Score (0), A baby who is limp and motionless requires immediate medical attention.
A subheading reads, Reflexes in Infants. The following text reads, Never underestimate the power of a reflex. For developmentalists, newborn reflexes are mechanisms for survival, indicators of brain maturation, and vestiges of evolutionary history. For parents, they are mostly delightful and sometimes amazing.
A photo of a newborn sucking on a doctor’s finger accompanies the text that reads, The Sucking Reflex: A newborn, just a few minutes old, demonstrates that he is ready to nurse by sucking on a doctor’s finger.
A photo of a newborn grasping a doctor’s thumbs and dangling in air accompanies the text that reads, The Grasping Reflex: When the doctor places a finger on the palm of a healthy infant, he or she will grasp so tightly that the baby’s legs can dangle in space.
A photo of a nurse helping a newborn taking her first steps accompanies the text that reads, The Step Reflex: A 1-day-old girl steps eagerly forward on legs too tiny to support her body.