Apgar score | CHAPTER 18 | Pediatric Nursing

Apgar score – Health of the children has been considered as the vital importance to all societies because children are the basic resource for the future of humankind. Nursing care of children is concerned for both the health of the children and for the illnesses that affect their growth and development. The increasing complexity of medical and nursing science has created a need for special area of child care, i.e. pediatric nursing.

Pediatric nursing is the specialized area of nursing practice concerning the care of children during wellness and illness. It includes preventive, promotive, curative and rehabilitative care of children. It emphasizes on all round development of body, mind and spirit of the growing individual. Thus, pediatric nursing involves in giving assistance, care and support to the growing and developing children to achieve their potential for functioning with fullest capacity.

Apgar score

APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb.

• In rare cases, the test will be done 10 minutes after birth.
• Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952.

The five criteria of the Apgar score:

How the Test is performed?

The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby’s:
1. Breathing effort
2. Heart rate
3. Muscle tone
4. Reflexes
5. Skin color

Each category is scored with 0, 1, or 2, depending on the observed condition.

Breathing effort:

• If the infant is not breathing, the respiratory score is 0.
• If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
• If the infant cries well, the respiratory score is 2.

Heart rate is evaluated by stethoscope. This is the most important assessment:

• If there is no heartbeat, the infant scores 0 for heart rate.
• If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
• If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.

Muscle tone:

• If muscles are loose and floppy, the infant scores 0 for muscle tone.
• If there is some muscle tone, the infant scores 1.
• If there is active motion, the infant scores 2 for muscle tone.

Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:

• If there is no reaction, the infant scores 0 for reflex irritability.
• If there is grimacing, the infant scores 1 for reflex irritability.
• If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.

Skin color:

• If the skin color is pale blue, the infant scores 0 for color.
• If the body is pink and the extremities are blue, the infant scores 1 for color.
• If the entire body is pink, the infant scores 2 for color.

Read more:

• Nutritional Anaemia | CHAPTER 15 | Pediatric Nursing