The Ballard Maturational Assessment, Ballard Score, or Ballard Scale is a commonly

used technique of gestational age assessment. It assigns a score to various criteria, the
sum of all of which is then extrapolated to the gestational age of the baby. These criteria
are divided into Physical and Neurological criteria. This scoring allows for the
estimation of age in the range of 26 weeks-44 weeks. The New Ballard Score is an
extension of the above to include extremely pre-term babies i.e. up to 20 weeks.

The scoring relies on the intra-uterine changes that the fetus undergoes during its
maturation. Whereas the neurological criteria depend mainly upon muscle tone, the
physical ones rely on anatomical changes. The neonate (less than 28 days of age) is in a
state of physiological hypertonia. This tone increases throughout the fetal growth period,
meaning a more premature baby would have lesser muscle tone.

It was developed in 1979.[1]

The Physical criteria

These are:

1. Skin
2. Ear/Eye
3. Lanugo Hair
4. Plantar Surface
5. Breast bud
6. Genitals

The Neurological criteria

1. Posture
2. Square Window
3. Arm Recoil
4. Popliteal Angle
5. Scarf sign
6. Heel to Ear

Scoring
Each of the above criteria are scored from 0 through 5, in the original Ballard Score. The
scores were then ranged from 5 to 50, with the corresponding gestational ages being 26
weeks and 44 weeks. An increase in the score by 5, increases the age by 2 weeks. The
New Ballard Score allows scores of -1 for the criteria, hence making negative scores
possible. The possible scores then range from -10 to 50, the gestational range extending
up to 20 weeks. (A simple formula to come directly to the age from the Ballard Score is
Age=(2*score+120) /5)
 SCORE RECORD
NEUROMUSCULAR
SCORE
MATURITY SIGN -1 0 1 2 3 4 5 HERE

POSTURE

SQUARE WINDOW
(Wrist)

ARM RECOIL

POPLITEAL ANGLE

SCARF SIGN

HEEL TO EAR

TOTAL NEUROMUSCULAR
MATURITY SCORE
MATURITY RATING
TOTAL SCORE
WEEKS
(NEUROMUSCULAR + PHYSICAL)
-10 20
-5 22
0 24
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 44
PHYSICAL SCORE RECORD
MATURITY SCORE
SIGN -1 0 1 2 3 4 5 HERE
cracking,
smooth superficial parchment,
gelatinous, pale leathery,
sticky, friable, pink, peeling deep
SKIN red, areas, cracked,
transparent visible &/or rash, cracking,
translucent rare wrinkled
veins few veins no vessels
veins
bald mostly
LANUGO none sparse abundant thinning
areas bald
heel-toe anterior creases
PLANTAR >50 mm faint red creases
40-50 mm: -1 transverse over entire
SURFACE no crease marks ant. 2/3
<40 mm: -2 crease only sole
stippled raised
full areola
barely flat areola areola areola
BREAST imperceptable 5-10 mm
perceptable no bud 1-2 mm 3-4 mm
bud
bud bud
lids open sl. curved well-curved formed
lids fused thick
pinna flat pinna; pinna; soft & firm
EYE / EAR loosely: -1 cartilage
stays soft; slow but ready instant
tightly: -2 ear stiff
folded recoil recoil recoil
testes in testes
scrotum testes testes
GENITALS scrotum flat, upper down,
empty, descending, pendulous,
(Male) smooth canal, good
faint rugae few rugae deep rugae
rare rugae rugae
prominent prominent majora & majora majora
clitoris
GENITALS clitoris & clitoris & minora large, cover
prominent &
(Female) small labia enlarging equally minora clitoris &
labia flat
minora minora prominent small minora
TOTAL PHYSICAL
MATURITY SCORE