A friend of mine was anxious about her three-year-old granddaughter. Though she could not say for sure what it was, she felt something was not right. I casually asked her if she remembered the child’s “Apgar score” at birth. She gave me a blank look — the same look that most parents have when I am taking down details of their school-going child, who is not performing at the appropriate level in class. So, what is Apgar score and why should I, a remedial teacher, be bothered about it?

Evaluates vital functions

The Apgar score is a rating system that evaluates a newborn’s vital functions at one minute and again after five minutes. The baby’s heart rate, respiratory effort, muscle tone, reflex response and colour are recorded with a number between zero and 2 [2 being the strongest rating]. The numbers are totalled and 10 is considered a perfect score, though it is rarely achieved. Babies with a score of 7 to 10 are given routine newborn care. Infants with a score of 6 or under are likely to have some serious problem that needs immediate medical intervention. A score of 3 or below is considered critically low. The babies with such low scores are taken to the neonatal intensive care unit for more testing.

‘Apgar’ was developed by Dr. Virginia Apgar in 1952 and now is used in modern hospitals worldwide.

Some children with a low Apgar score eventually catch up with developmental milestones, while others do not. Those who do not, may end up with subtle deficits in cognitive functions that are only detectable as the child grows older. However, it was Dr. Andrea Stuart of Sweden who said “it is not the Apgar score in itself that leads to lower cognitive abilities. It is the reasons leading to a low Apgar score that might have an impact on future brain function”. Several prenatal factors can impact on infant’s health and physical condition. For example, pre-term delivery, low birth weight, asphyxiation, maternal drug use and infections. These can all lead to a low Apgar score, which can then impact the baby’s cognitive development.

The first six years of a child’s life are very important. The intellectual development of the child is most rapid during this period than at any other stage in life. It is between ages five and six that thinking skills progress in a more predictable sequence. The developing sensory and motor systems are the foundations for development of verbal and abstract thought. Skills such as reading and writing require complete co-ordination of these systems, and children who have not achieved sufficient sensory motor integration, will experience learning difficulties leading to academic challenges.

Awareness helps

Many factors influence the way the brain develops and we have little control over it. If there is enough awareness about the Apgar score then it will be possible to identify children who are likely to be at “risk”. Such children should be followed very closely and carefully assessed as they grow older. When the parent is alert to the significance of Apgar score, then he will not waste precious time in “wait and see” adage. He can seek professional help. Intervention in the form of stimulation and therapy may be started at the earliest and later one may think about remedial education so that the child benefits the most.

Remember, delayed acquisition of motor skills, language difficulties, perceptual problems and poor social skills are early markers that are suggestive of the possibility of later problems.

The writer is a Remedial Educator