A simple five-point scoring system, adapted from human medicine, gives you a structured way to check a newborn puppy’s condition in the first minutes of life — useful both as a triage tool and as something to track over time.
The most important first
- The canine neonatal Apgar score checks five things — heart rate, breathing, muscle tone, reflex response, and color — each scored 0 to 2, for a total out of 10.
- It’s typically assessed within 5 minutes of birth, with a follow-up check around 60 minutes.
- A score of 7–10 suggests normal viability, 4–6 moderate risk needing monitoring, and 0–3 severe distress needing immediate intervention.
- It’s a monitoring and triage tool, not a guaranteed prediction — the score is linked to survival over the first hours to a day, but says much less about the weeks that follow.
- Breeders can use it informally as a structured checklist; vets use it more formally to guide resuscitation decisions.
The five things it checks
Adapted from the human Apgar score, the canine version scores each of five categories from 0 (worst) to 2 (best):
- Heart rate (“Pulse”)
- Respiratory rate and effort (“Respiration”)
- Muscle tone and movement (“Activity”)
- Reflex response, (“Grimace”) — the original study calls this reflex irritability; a gentle squeeze of a paw is a common way to test it
- Mucous membrane color (“Appearance”)
The five scores add up to a total out of 10. In broad terms, each category is scored like this:
- Heart rate: 0 = absent or very slow; 1 = slow; 2 = normal and strong.
- Breathing: 0 = no breathing or crying; 1 = weak, irregular breathing or a faint cry; 2 = regular breathing and a strong cry.
- Activity: 0 = limp; 1 = some movement or flexing; 2 = active, wriggling.
- Reflex response: 0 = none; 1 = weak response; 2 = quick, vigorous response or cry.
- Color of gums and tongue: 0 = blue-gray; 1 = pale; 2 = pink.
Your vet may use precise heart-rate cut-offs; for home use, the descriptions above are enough to tell a vigorous puppy from one that needs help.
When it’s used
The standard timing is an assessment within 5 minutes of birth, with a follow-up check around 60 minutes — this two-point check lets you see whether a puppy that started slow is improving with support, or not, which matters more than either single reading alone.
Puppies born by cesarean section, particularly after a difficult labor, tend to score lower and have higher early losses than puppies born normally. Plan to score and watch them especially closely.
What the score means
A total of 7 to 10 suggests normal viability. A score of 4 to 6 suggests moderate risk — worth continued close monitoring and readiness to intervene. A score of 0 to 3 indicates severe distress and calls for immediate active support, the kind covered in newborn resuscitation.
In practice: a score of 0–3 means the puppy needs help right now. Start the resuscitation steps you’ve agreed with your veterinarian and call them while you work. A score of 4–6 means warming, gentle stimulation, clearing the airway and rescoring. If the puppy isn’t clearly improving by the next check, or gets worse at any point, call your vet. Puppies with low scores are also less likely to find a teat and suckle on their own, so check that each one actually nurses and gets colostrum early — within the first 24 hours at the latest.
In practice
A breeder scores a puppy at 4 out of 10 at the 5-minute mark, and is unsure whether that means the puppy is in serious trouble. Rechecking at 60 minutes and seeing the score rise to 7 or higher, after continued warming and stimulation, shows the puppy is responding well — the follow-up check is what turns a single worrying number into a clearer picture.
(Illustrative, composite scenario.)
A tool, not a guarantee
It’s worth knowing that while lower Apgar scores have been linked to higher mortality in the first couple of hours after birth in research on the scoring system, studies link the score to survival over the first hours to the first day after birth. It tells you much less about the following weeks, when weight gain, warmth and colostrum intake matter more. In practice, this means the score is genuinely useful as an in-the-moment triage tool — flagging which puppies need warming, stimulation, or a vet call right now — without treating a low initial score as a fixed prediction of a puppy’s outcome.
When to call your vet
- Any score of 0–3: start resuscitation and call your vet while you work.
- A score of 4–6 that isn’t clearly better at the next check (and by the 60-minute rescore), or that drops at any point.
- A puppy that doesn’t find a teat and suckle within the first hours — colostrum must go in within the first 24 hours.
- A puppy born by cesarean or after a long labor that stays weak, limp or pale.
- A puppy that feels cool after warming — normal in week one is only about 95–99 °F (35–37.2 °C).
- For the dam: strong straining for 20–30 minutes with no puppy, more than about 2 hours between puppies when more are expected, or green or black discharge before the first puppy (an emergency).
- If in doubt, call — your vet would rather hear from you early.
Work on it
A few minutes here will teach you more than re-reading the article.
Ask yourself
- Could I score a puppy on these five categories without needing to look each one up?
- Do I have a plan to recheck at both 5 and 60 minutes, not just once?
- Would I treat a low score as a call to act, rather than as a fixed prediction?
Find out & check
- Find out whether your vet wants to be informed of low Apgar scores at birth, or only if a puppy doesn’t respond to initial support.
Do one thing
- Print or save a simple version of this five-category checklist to keep with your whelping supplies.
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Sources & further reading
- Veronesi MC, Panzani S, Faustini M, Rota A — An Apgar scoring system for routine assessment of newborn puppy viability and short-term survival prognosis, Theriogenology 2009;72:401–407. air.unimi.it
- Veronesi MC — Assessment of canine neonatal viability — the Apgar score, Reproduction in Domestic Animals 2016;51 Suppl 1:46–50. pubmed.ncbi.nlm.nih.gov
- Merck Veterinary Manual — Management of the Neonate in Dogs and Cats. merckvetmanual.com
- Royal Canin Veterinary Academy (summary of Mila H. et al., Prev Vet Med 2017) — Monitoring of the newborn dog and prediction of neonatal mortality. academy.royalcanin.com
- Fusi J, Faustini M, Bolis B, Veronesi MC — Apgar score or birthweight in Chihuahua dogs born by elective Caesarean section, Acta Veterinaria Scandinavica 2020;62:39. pmc.ncbi.nlm.nih.gov
- Titkova R et al. — Puppy Apgar scores after vaginal delivery and caesarean section, Veterinární Medicína 2017;62:488–492. vetmed.agriculturejournals.cz
- Canadian Kennel Club (Fontaine E., DVM) — Puppy Vitality: Unlocking the Secrets of APGAR Scores. ckc.ca
Where evidence is limited, recommendations rest on established practice and expert judgment, and may be updated as knowledge develops.
Next steps
- Read next: Warmth and the whelping-box microclimate.
- Related: The normal newborn puppy · Newborn resuscitation at birth.
- Return to the area hub: The neonatal period.