Severity of Croup Westley Score Calculator

Intercostal indrawing
Stridor
Cyanosis
level of consciousness
Air flow
(or breath sounds)


Score :

What Is the Westley Croup Score?

The Westley Croup Score is a clinical scoring system designed to help evaluate the severity of croup, a respiratory illness that typically affects young children. Croup is characterized by inflammation and swelling of the upper airways, particularly around the larynx (voice box) and trachea (windpipe), which can cause a harsh, barking cough, hoarseness, stridor (a high-pitched wheezing sound), and breathing difficulties.

The Westley Score helps healthcare providers assess a child's condition by assigning points based on five key clinical signs: the presence and severity of intercostal indrawing (the inward pulling of muscles between the ribs), stridor (whether it's present at rest or only with a stethoscope), cyanosis (a bluish color of the skin due to lack of oxygen), level of consciousness (ranging from normal to disoriented), and air flow or breath sounds. Each sign is scored individually, and the total score reflects how severe the croup is.

The resulting score typically ranges from 0 to 17 and is used to classify the illness as mild (0–2), moderate (3–7), or severe (8 or more). In rare and extreme cases, the score may indicate impending respiratory failure. This tool not only helps in determining the urgency of treatment but also in monitoring how the child is responding to interventions over time.

Although the Westley Score is primarily used by medical professionals, this online calculator makes it easier for concerned parents and caregivers to get a general sense of the severity of a child’s symptoms. However, it’s important to remember that the calculator does not replace professional medical advice, diagnosis, or treatment.

Who Should Use This Calculator?

This calculator is intended for parents, caregivers, and healthcare professionals who are concerned about a child's breathing and suspect symptoms of croup. It provides a quick and simple way to evaluate the severity of croup symptoms based on observable signs such as breathing effort, sounds during breathing, skin color, and alertness.

For parents and caregivers, this tool can offer guidance on whether the symptoms appear mild and manageable at home or if they may require urgent medical attention. It can be especially helpful during the night when symptoms often worsen, and it’s not clear whether to visit a doctor or hospital.

For healthcare professionals, particularly those in emergency or pediatric settings, this calculator can serve as a fast reference to assess the child's condition and monitor progress over time.

How to Use the Calculator

Using the Severity of Croup Westley Score Calculator is simple and only takes a few moments. It involves answering a few questions about the child’s current symptoms by selecting the option that best matches what you observe. Each option is linked to a specific score that contributes to the total.

Follow these steps to use the calculator:

  1. Start by reviewing each section of the form, which includes five clinical signs: Intercostal Indrawing, Stridor, Cyanosis, Level of Consciousness, and Air Flow (Breath Sounds).
  2. For each symptom, select the option that most accurately describes the child’s condition. For example, if the child has no intercostal indrawing, you would select “None.”
  3. Repeat this process for all five sections. The options have values ranging from 0 to 5 depending on the severity of the symptom.
  4. Once you have made all your selections, click the “Calculer” button at the bottom of the form.
  5. The calculator will instantly display the total score in the “Score” box, giving you a number between 0 and 17.

The total score reflects the severity of the child’s croup symptoms and can guide you in deciding whether to monitor the child at home or seek medical attention. A score interpretation guide is provided in the next section.

Scoring Criteria Explained

The Westley Croup Score is calculated based on five key clinical signs. Each of these signs reflects how the child is breathing and responding to the illness. Below is an explanation of each criterion and how the scoring works:

1. Intercostal Indrawing

This refers to the inward movement of the muscles between the ribs when a child breathes in. It is a sign that the child is working harder to breathe.

  • 0 points: No indrawing (normal breathing)
  • 1 point: Mild indrawing
  • 2 points: Moderate indrawing
  • 3 points: Severe indrawing

2. Stridor

Stridor is a high-pitched, wheezing sound heard during breathing, often more noticeable when the child inhales.

  • 0 points: No stridor
  • 1 point: Stridor heard only with a stethoscope at rest
  • 2 points: Stridor audible without a stethoscope at rest

3. Cyanosis

Cyanosis is a bluish discoloration of the skin, especially around the lips and face, indicating low oxygen levels in the blood.

  • 0 points: No cyanosis
  • 4 points: Cyanosis when the child is agitated
  • 5 points: Cyanosis even when the child is at rest

4. Level of Consciousness

This measures how alert and responsive the child is.

  • 0 points: Normal and alert
  • 5 points: Disoriented or confused

5. Air Flow (Breath Sounds)

This refers to how easily air moves in and out of the lungs, which can be heard with or without a stethoscope.

  • 0 points: Normal breath sounds
  • 1 point: Diminished breath sounds
  • 2 points: Severely diminished or absent breath sounds

Each of these criteria contributes to the total Westley Score. The higher the score, the more severe the croup symptoms are likely to be.

Understanding the Total Score

After selecting the appropriate responses for each symptom in the calculator, the total Westley Croup Score is automatically calculated. This number helps determine how severe the child’s croup is and guides decisions about care and treatment. The total score can range from 0 to 17, with higher scores indicating more serious symptoms.

Score Interpretation:

  • 0 to 2 – Mild Croup: The child may have a barking cough and minimal breathing difficulty. Symptoms can usually be managed at home with rest, hydration, and comfort measures. Medical treatment is typically not required unless symptoms worsen.
  • 3 to 7 – Moderate Croup: Breathing may be more labored, and stridor might be present even at rest. A healthcare provider may recommend medications such as corticosteroids or a nebulized treatment. Monitoring is important, especially at night when symptoms may intensify.
  • 8 or more – Severe Croup: The child may show signs of distress, such as severe indrawing, cyanosis, or reduced air flow. Immediate medical attention is required. Hospital care, oxygen support, and other interventions may be necessary.

While this scoring system helps indicate the severity of croup, it should not replace a clinical judgment. If your child is having difficulty breathing, becomes lethargic, or shows signs of bluish skin or lips, seek emergency medical help immediately.

What Do the Results Mean?

The result from the Westley Croup Score Calculator gives you a number that reflects the severity of your child's croup symptoms. This number is based on your responses to five key clinical signs. Understanding what the score means can help you decide what steps to take next and whether medical attention is needed.

Score Breakdown:

  • 0 to 2 – Mild Croup: Your child likely has a mild case of croup. Symptoms may include a barking cough and hoarseness, but there should be no major signs of breathing difficulty. In most cases, mild croup can be managed at home. Make sure your child stays calm, hydrated, and comfortable. If symptoms worsen, contact your healthcare provider.
  • 3 to 7 – Moderate Croup: This score suggests a moderate case of croup. The child may be experiencing stridor (a high-pitched breathing sound) and increased effort to breathe. Treatment with corticosteroids or other medications may be needed. It’s important to monitor the child closely and consult a healthcare provider, especially if symptoms appear to get worse.
  • 8 or higher – Severe Croup: This indicates a severe case of croup. Your child may have significant breathing difficulty, bluish skin (cyanosis), disorientation, or very limited air movement. These are signs of a medical emergency. You should seek immediate medical attention or call emergency services right away.

Always remember that this calculator is a helpful guide, but it does not replace professional medical advice. If you're unsure or worried about your child's condition at any time, it's best to speak with a doctor or seek urgent care.

When to Seek Medical Help

While many cases of croup are mild and can be treated at home, it’s important to recognize when a child needs professional medical care. Croup can sometimes progress quickly, and early intervention can prevent serious complications.

You should seek medical help immediately if your child shows any of the following warning signs:

  • Stridor at rest: A loud, high-pitched sound while breathing in, even when the child is calm and not crying.
  • Labored breathing: Noticeable chest retractions (inward pulling of the skin between the ribs), flaring nostrils, or rapid breathing.
  • Cyanosis: A bluish tint to the lips, face, or fingernails, which can indicate low oxygen levels.
  • Lethargy or disorientation: If the child is excessively sleepy, difficult to wake, confused, or not responding normally.
  • Very weak or absent breath sounds: If you can barely hear the child breathing or if the chest movement becomes minimal.
  • Symptoms worsen suddenly: If there is a sudden increase in breathing difficulty or other concerning symptoms.

Trust your instincts — if something doesn’t feel right or you’re unsure about your child’s condition, don’t wait. It’s better to be cautious and have your child evaluated by a healthcare professional.

In case of severe symptoms, call emergency services or go to the nearest hospital immediately.

Frequently Asked Questions (FAQs)

What is croup?

Croup is a common respiratory illness in young children caused by a viral infection. It leads to swelling in the upper airway, resulting in a barking cough, hoarseness, and sometimes difficulty breathing or stridor (a high-pitched sound during breathing).

What age group is most affected by croup?

Croup most commonly affects children between 6 months and 3 years old, although it can occur in older children as well. It is more frequent during the fall and winter months.

Is the Westley Croup Score only for doctors?

No. While the score was originally developed for clinical use by healthcare professionals, this online calculator allows parents and caregivers to estimate symptom severity. However, it should not replace medical advice or diagnosis.

What should I do if my child scores high?

A high score (8 or more) may indicate severe croup and should be treated as a medical emergency. You should seek immediate medical attention or call emergency services. Even with moderate scores (3–7), it is wise to consult a healthcare provider.

Can I use the calculator more than once?

Yes, you can use the calculator as often as needed, especially if you're monitoring a child over time. It’s helpful to track changes in symptoms and share results with your healthcare provider.

Does this calculator provide a diagnosis?

No. This tool is for informational purposes only and does not provide a medical diagnosis. Always consult a healthcare provider if you are concerned about your child’s health or symptoms.

Can croup be treated at home?

Mild cases of croup can often be managed at home with rest, fluids, and comfort. A cool mist humidifier or taking the child into a steamy bathroom may help ease symptoms. However, if symptoms worsen or do not improve, contact a doctor.

Disclaimer

This calculator is intended for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. While the Westley Croup Score can help assess the severity of symptoms, it should not be used to make medical decisions without consulting a qualified healthcare provider.

If your child is experiencing difficulty breathing, shows signs of cyanosis (bluish skin), is unusually drowsy or unresponsive, or if you are otherwise concerned about their health, seek immediate medical attention.

References

  • Westley, C. R. (1978). Assessment of croup: A scoring system. American Journal of Diseases of Children, 132(6), 614–616.
  • Nelson, W. E., Kliegman, R. M., & St. Geme, J. W. (Eds.). (2020). Nelson Textbook of Pediatrics (21st ed.). Elsevier.
  • Rudolph, C. D., Rudolph, A. M., Hostetter, M. K., Lister, G. E., & Siegel, N. J. (2003). Rudolph's Pediatrics (21st ed.). McGraw-Hill.
  • Fleisher, G. R., Ludwig, S., & Henretig, F. M. (2010). Textbook of Pediatric Emergency Medicine (6th ed.). Lippincott Williams & Wilkins.
  • Berkow, R., & Fletcher, A. J. (Eds.). (2000). The Merck Manual of Diagnosis and Therapy (17th ed.). Merck Research Laboratories.