We start with the letter ‘A’: a neonatology role-playing game about the Apgar score

Materials needed

• Teaching guide (digital version)
• Soft-bodied toy dolls, CE marked and recommended for children aged 2 and over
• Toy stethoscopes
• Printed health record sheets, one per team or child (at the teacher’s discretion)
• Coloured stickers or adhesive dots (red and green)
• Pencil
• Optional: Internet connection and audiovisual equipment for playing audio and video files.

We’re at the hospital, babies have been born, and we have to play the roles of obstetricians (the doctors who help mothers give birth), midwives (the nurses who specialize in pregnancy, childbirth, and postpartum care), and other healthcare professionals specializing in neonatology (the branch of medicine that focuses on the health of babies in the first 28 days of life). Right after birth, the babies need a health check to make sure everything is okay. Afterward, they go straight to their mothers. The check consists of five tests that correspond to the five letters of the last name of the pediatrician who invented it: Virginia Apgar.

When Virginia Apgar became a doctor many years ago, babies sometimes became very ill right after birth, and it wasn’t always clear why. So Virginia studied extensively and invented a way to assess the health of newborns to determine as early as possible whether they were healthy or needed more care. Virginia looked at their appearance (whether they were pink or almost purple); their pulse (the way we know if the heart is functioning properly); their facial expressions (whether they could move their face and hands); their activity (whether they could kick or turn their head); and their respiration (when air enters and leaves the body). We still use the Virginia Apgar score when a baby is born to determine if they are healthy.

Each team of obstetricians, midwives, and pediatricians receives a baby, stethoscopes, a health record, and green and orange stickers. On the record, we will write the baby’s name and date of birth. The goal is to learn how to assess the baby’s health using five key criteria. In teams, we will perform the Apgar score health assessment, which consists of:

A, Appearance

We look at the baby’s skin color. This is important because it indicates whether the baby is breathing well. Is it a pinkish or tan skin tone, or is it slightly blue? It shouldn’t be blue; that means they aren’t breathing well. Since the baby’s skin color is healthy and indicative of good oxygenation, we place a green sticker on the baby’s chart.

P, for Pulse

The organ that moves blood throughout the body is the heart. We need to use the stethoscope to listen to the baby’s heartbeat. At this time, the heartbeat will be played for the whole class (either verbally or using this audio file for tachycardia, or this file for bradycardia). A healthy baby’s heart beats more than 100 times per minute. If we hear a fast heartbeat, we will place a green sticker on their chart. If we hear a slow heartbeat, we will place an orange sticker.

G, for Grimace

If we tickle our baby, touch their nose, feet, hands… they will normally respond by gesturing, moving, making faces, or crying. These are healthy gesticulation responses. At this time, we will show the class a video about the irritability reflex. The team will place a green sticker.

A, for Activity

This is how we will determine the baby’s muscle tone. At this point, we will show either the video of the baby moving (green sticker) or the video of the baby at rest (orange sticker).

R, for Respiration

The baby’s breathing effort is very important, as this is how oxygen reaches the entire body. At this point, we will show the video of the baby crying and breathing and place the green sticker on the card.

We’ve finished assessing the health of the newborns. Did we put on a lot of green stickers? That means the babies are healthy. What have we learned? Living beings have basic physiological needs, like breathing. Our physiology can be assessed using medical techniques such as observation. Prevention is very important for the health of both children and adults. The Apgar test is a preventive measure: we want to identify any health problems in newborns as early as possible so we can address them.

With the collaboration of the Spanish Foundation for Science and Technology (FECYT) – Ministry of Science and Innovation.