Westley croup score calculator
Use this croup score calculator to assess pediatric croup severity and document mild, moderate, severe, or impending respiratory failure from the standard five Westley exam domains.
Last reviewed: February 26, 2026
Clinical disclaimer
Westley croup score quick read
- The Westley croup score grades croup severity on a 0-17 scale using stridor, retractions, air entry, cyanosis, and level of consciousness.
- Use the Westley croup score to document mild, moderate, severe, or impending respiratory failure in the standard viral croup exam.
- Re-score after dexamethasone or nebulized epinephrine and before disposition or escalation decisions.
- Local croup pathways still determine observation length, epinephrine use, and airway escalation.
Select the option that best matches the child's current exam in each domain.
How the Westley croup score works
The Westley Croup Score assigns points to five clinical findings: level of consciousness, cyanosis, stridor, air entry, and chest wall retractions. Each item has weighted options (for example, 0 points for normal mental status versus 5 points for disorientation), and the total score reflects overall croup severity.
- Items and weights: Level of consciousness (0 or 5), Cyanosis (0, 4, or 5), Stridor (0, 1, or 2), Air entry (0, 1, or 2), Retractions (0, 1, 2, or 3).
- Severity bands: 0–2 points = mild; 3–5 = moderate; 6–11 = severe; ≥12 = impending respiratory failure.
- This calculator sums the selected item scores, displays the total and severity category, and provides a deep‑link you can share with colleagues for handoff.
How to interpret the Westley croup score
The score is most useful for structuring your exam and communication, not as an absolute rule. Children with the same numeric score may look very different depending on their baseline health, age, and trajectory. Use the score to complement, not replace, bedside assessment and vital signs.
- Mild (0–2): barky cough with few or no audible stridor at rest, normal air entry, and minimal retractions.
- Moderate (3–5): stridor at rest or with agitation and mild–moderate retractions but preserved mental status and reasonable air entry.
- Severe (6–11): marked stridor, prominent retractions, decreased air entry, and fatigue; these children warrant close observation and aggressive therapy.
- Impending respiratory failure (≥12): lethargy or disorientation, cyanosis at rest, poor air entry, and severe retractions or paradoxical breathing.
In any child with severe or impending respiratory failure scores, the score should trigger escalation—calling for senior help, preparing airway equipment, and following your croup or upper airway obstruction pathway urgently.
Westley croup management notes
Evidence‑based croup management centers on corticosteroids for most children and nebulized epinephrine for those with moderate–severe symptoms. The Westley score can help determine which group a child falls into and how long they should be observed after treatment.
- Mild: single‑dose dexamethasone with home care, clear return precautions, and instructions on when to seek urgent care.
- Moderate: dexamethasone plus nebulized epinephrine and observation until symptoms improve and a safe home plan is clear.
- Severe/Impending failure: immediate senior and airway support, repeated nebulized epinephrine and steroids as per pathway, and consideration of higher level of care or intubation if the child does not respond.
Always consider alternative diagnoses when the course is atypical, the child appears toxic, or symptoms fail to improve as expected after appropriate therapy.
Westley croup reassessment cadence
- After dexamethasone or nebulized epinephrine: repeat score and focused airway exam in the same care block.
- If improving and stable: continue observation at protocol intervals before discharge decisions.
- If worsening work of breathing or mental status change: immediate re-score and escalation.
Westley croup escalation triggers
- Resting stridor with escalating retractions despite initial therapy.
- Cyanosis, poor air entry, fatigue, or altered level of consciousness.
- Atypical course or poor response suggesting alternative diagnosis (e.g., bacterial tracheitis, epiglottitis, foreign body).
- Need for repeated epinephrine without sustained improvement.
Westley croup handoff checklist
- Latest total score and component findings (stridor, air entry, retractions, consciousness, cyanosis).
- Interventions given with timing and observed response window.
- Current trajectory versus prior reassessment.
- Escalation threshold and next reassessment time.
Related croup and respiratory tools
- Wang score bronchiolitis calculator for lower-airway bronchiolitis severity when wheeze and retractions are the main question.
- RDAI bronchiolitis score calculator when your pathway uses wheeze-and-retraction scoring instead of the Wang score.
- Bronchiolitis severity bands for a quick mild, moderate, or severe bronchiolitis handoff.
- Pediatric Asthma Score (PAS) calculator when the respiratory presentation is wheeze/asthma rather than classic croup.
- Dexamethasone pediatric dose calculator and steroid dosing calculator when croup treatment dosing is needed.
- Pediatric ED and acute care calculators for the broader respiratory distress and escalation toolkit.
Frequently asked questions
The Westley Croup Score sums five findings—level of consciousness, cyanosis, stridor, air entry, and chest wall retractions—to estimate croup severity. Higher scores reflect more severe airway obstruction and respiratory distress.
Use the score alongside your clinical assessment to categorize croup as mild, moderate, severe, or impending respiratory failure. It can help standardize communication and guide decisions about steroids, nebulized epinephrine, observation, and escalation, but it should never replace judgment.
Pulse oximetry is recommended when hypoxia is suspected, but the Westley score itself is based on physical exam findings. Use pulse oximetry to complement the score, particularly in children with moderate, severe, or atypical presentations.
Reassess and re‑score after key interventions (such as dexamethasone or nebulized epinephrine), with any change in clinical status, and before decisions about discharge, continued observation, or escalation.
No. The Westley score was developed for viral croup. Children with atypical features, poor response to therapy, or concern for alternative diagnoses (e.g., epiglottitis, bacterial tracheitis, foreign body) require broader evaluation beyond this scoring system.
Document serial scores, treatment timing, trend direction, and return precautions. Clear documentation is important when symptoms improve after epinephrine but may recur.
References
- Westley CR et al. Nebulized racemic epinephrine by IPPB for the treatment of croup. Am J Dis Child. 1978.
- Canadian Paediatric Society — Acute management of croup.