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Writer's pictureZoo Knudsen

Pediatric Experts Recommend Apgar Score Update, More Focus on Infant Bonding

Itasca, IL - A group of pediatric philosophers and psychologists with the American Academy of Pediatrics (AAP) Section on Breastfeeding (SOBr) are recommending an update to the Apgar score system used to assess the health of newborns immediately after birth, with the hope of increasing focus on infant bonding.


A newborn human, shown here screaming into the void of a seemingly meaningless existence even as he yearns desperately for the slightest sense of connection to something greater than himself

"Historically the Apgar score has been used to provide a snapshot of how a newborn tolerated the birthing process and how they responded to any required resuscitation from a physical perspective," Jasmine Viator, an infant bonding expert and breastfeeding philosopher, explained. "But we have learned a lot about the newborn experience since the 1950s, so an update that takes into account the fundamental nature of their knowledge, reality, and existence is long overdue."


First developed by Dr. Virginia Apgar in 1952, the scoring system that still carries her name as a helpful backronym inspired mnemonic involves the assessment of five key clinical components:


Appearance - an infant's color as a surrogate marker of oxygen delivery to the tissues

Pulse - an infant's heart rate

Grimace - an infant's response to stimulation

Activity - an infant's muscle tone

Respiration - an infant's ability to breathe spontaneously


Since the development of the scoring system, the science of newborn health has expanded significantly. According to Mort Fishman, MD, a pioneer in the field of neonatal psychiatry, the development of the infant psyche is intimately bound to health outcomes such as the risk of early-onset sepsis and hyperbilirubinemia. "Infant bonding, both to the mother and to the society into which the child is born, is an incredibly important foundational step in the process."


"Feelings of dread and anxiety directly oppose the development of infant bonding," Fishman revealed. "Unlike non-human animals that rely on pure instinct to navigate their existence, the newborn human is faced with a profound and unique freedom of choice. It is the awareness of undefined possibilities and the heavy responsibility of choice that results in anxiety to varying degrees, though debilitating angst is still usually the mother's fault."


In order to increase the early detection of newborn angst, and to respond effectively with measures aimed at building a sense of confidence and trust, Fishman and his colleagues are recommending adding a second "A" to the Apgar scoring system mnemonic. "We haven't decided yet if a determination of newborn angst should take place before or after assessing for the possibility of lung disease or a heart defect. They are both so important."

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