The assessment of respiratory distress in a newborn consists of looking for signs of distress like tachypnea, chest recession, grunting and cyanosis. Silverman-Anderson retraction and Downe’s scoring system is helpful in evaluating the degree of distress and impending respiratory failure. The chapter illustrates components of these scoring systems. It is imperative for a clinician to use this scoring system in assessment of respiratory distress and monitor the need for CPAP or mechanical ventilation.