Westley Croup Score Calculator (Croup Severity in Children)
Calculate the Westley croup score from level of consciousness, cyanosis, stridor, air entry and chest wall retractions — mild, moderate, severe croup or impending respiratory failure.
How it works
Westley = consciousness (normal 0, disoriented 5) + cyanosis (none 0, with agitation 4, at rest 5) + stridor (none 0, with agitation 1, at rest 2) + air entry (normal 0, decreased 1, markedly decreased 2) + retractions (none 0, mild 1, moderate 2, severe 3). Range 0–17: ≤ 2 mild · 3–7 moderate · 8–11 severe · ≥ 12 impending respiratory failure.
The Westley croup score (Westley et al., American Journal of Diseases of Children 1978) is the most widely used measure of croup severity in children and is used in guidelines such as the Alberta clinical practice guideline. Mild croup is usually treated with a single dose of oral dexamethasone at home; moderate and severe croup need dexamethasone and observation, with nebulised epinephrine for severe distress; a score of 12 or more signals impending respiratory failure needing urgent airway expertise.
Worked example
A toddler has a normal level of consciousness (0), no cyanosis (0), stridor only when agitated (1), decreased air entry (1) and mild retractions (1): Westley score = 0 + 0 + 1 + 1 + 1 = 3 / 17 — moderate croup (3–7).
Sources: Westley CR et al. Nebulized racemic epinephrine by IPPB for the treatment of croup. Am J Dis Child 1978 · Bjornson CL, Johnson DW. Croup in children. CMAJ 2013
Frequently asked questions
What is a mild Westley croup score?
0–2: a barking cough with no stridor at rest and no or mild retractions. Most children are treated with a single dose of dexamethasone and go home.
When is croup severe?
A score of 8–11 means severe croup with stridor at rest and marked retractions, usually needing nebulised epinephrine and hospital care. 12 or more indicates impending respiratory failure.
Does a sleeping child score as normal consciousness?
Yes — normal includes a child who is asleep and rousable. Disorientation scores 5 because it suggests hypoxia or exhaustion.
Should I calm the child before scoring?
Yes, ideally score while the child is calm, since crying and agitation increase stridor and retractions. Never upset a child with severe croup to examine the throat.
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Clinical decision tool for education and for use by trained clinicians alongside clinical judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.