For healthcare professionals

Westley Croup Score

The Westley croup score rates how severe croup (laryngotracheitis) is from five signs: stridor, chest wall retractions, air entry, cyanosis and level of consciousness. The total runs from 0 to 17. Westley and colleagues introduced it in 1978. This calculator is written for clinicians and is not a diagnosis.

Last reviewed: 2026-11-02 By the uncovermyrisk.com editorial team Educational only, not medical advice.

A child who is struggling to breathe, turning blue or gray, drooling and unable to swallow, or very drowsy: call 911 now.General safety advice (not part of the published score). Do not wait for a score.

Source

Westley CR and colleagues, American Journal of Diseases of Children 1978. Points and severity bands are taken from Table 8 of an open-access (CC BY 4.0) review, Cutrera R and colleagues, Italian Journal of Pediatrics 2017; the same points appear in Table 1 of Hey F and colleagues, Frontiers in Pediatrics 2025 (CC BY). The tests check every item, the band edges and a worked example.

Validated in

Children with croup. It mainly affects children aged 6 months to 3 years, but can occur from 3 months to adolescence (Cutrera 2017). The score has been widely used since 1978 to measure croup severity and the effect of treatment (Yang 2019).

Limits

Scores can differ noticeably between examiners, and a clinician may overestimate or underestimate severity (Yang 2019). The score describes one moment, and respiratory distress in croup may develop slowly or quickly (Cutrera 2017), so repeat the assessment.

Westley croup score table

Add the points for each sign (Cutrera 2017) (Hey 2025).

Stridor

None: 0
With agitation: 1
At rest: 2

Chest wall retractions

None: 0
Mild: 1
Moderate: 2
Severe: 3

Air entry

Normal: 0
Decreased: 1
Markedly decreased: 2

Cyanosis

None: 0
With agitation: 4
At rest: 5

Level of consciousness

Normal: 0
Disoriented: 5

Severity bands

Score	Severity
2 or less	Mild
3 to 5	Moderate
6 to 11	Severe
Over 11	Impending respiratory failure

Bands as printed by Cutrera and colleagues (Cutrera 2017). The score was introduced by Westley and colleagues (Westley 1978).

Worked example: a child with stridor at rest (2), mild retractions (1), normal air entry, no cyanosis and normal consciousness scores 3, moderate croup.

What the bands describe

Mild croup means an occasional barking cough, no audible stridor at rest and no or mild retractions. Moderate croup means a frequent barking cough, easily audible stridor at rest and retractions at rest, but little or no distress. Severe croup adds prominent stridor, marked retractions and significant distress and agitation. Impending respiratory failure brings lethargy or decreased consciousness, often with a dusky appearance without supplemental oxygen (Cutrera 2017).

In a prehospital study of 226 children treated for croup, the average score was 4.1, and the score fell by 21.2% on average for each extra year of age (Hey 2025).

Related calculators

To score level of consciousness in a preverbal child, see the Pediatric Glasgow Coma Scale. For a child with a minor head injury, see the PECARN head injury rule. Other bedside scores are listed under For healthcare professionals.

Sources

Cutrera R, Baraldi E, Indinnimeo L, et al. Management of acute respiratory diseases in the pediatric population: the role of oral corticosteroids. Ital J Pediatr. 2017;43(1):31. doi:10.1186/s13052-017-0348-x. PMID 28335827. Open access (CC BY 4.0). Laryngotracheitis section and Table 8 (Westley croup score points and severity bands). pmc.ncbi.nlm.nih.gov/articles/PMC5364577/
Hey F, Lieftuchter V, Olivieri M, Zimatschek S, Hoffmann F, Pfeiffer D. Treatment pathways and rebound-rate of prehospital viral croup attacks: data from a prehospital pediatric physician led emergency service. Front Pediatr. 2025;13:1544480. doi:10.3389/fped.2025.1544480. PMID 40421306. Open access (CC BY). Table 1 (Westley score) and Results (226 patients, average score 4.1). pmc.ncbi.nlm.nih.gov/articles/PMC12104051/
Yang WC, Hsu YL, Chen CY, et al. Initial radiographic tracheal ratio in predicting clinical outcomes in croup in children. Sci Rep. 2019;9(1):17893. doi:10.1038/s41598-019-54140-y. PMID 31784540. Open access (CC BY). Introduction and Methods (use of the Westley score since 1978, variation between examiners). pmc.ncbi.nlm.nih.gov/articles/PMC6884517/
Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child. 1978;132(5):484-487. doi:10.1001/archpedi.1978.02120300044008. PMID 347921. pubmed.ncbi.nlm.nih.gov/347921/

Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-02. Spotted an error? See About.