This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
A barking cough in the night
Croup is a viral infection that swells the airway just below the vocal cords. It typically affects children between 6 months and 3 years old and causes a distinctive barking cough, a hoarse voice and sometimes stridor, a harsh, high-pitched sound when breathing in. Symptoms are often worse at night and usually last 3 to 5 days. Most cases are mild, but in a few children the swelling narrows the airway enough to be dangerous.
In 1978 Charles Westley and colleagues created a score to measure croup severity in a study of nebulized epinephrine. The Westley croup score is now the most widely used croup scale in research and in many emergency departments.
The five items
| Sign | Points |
|---|---|
| Level of consciousness: normal (including asleep) / disoriented | 0 / 5 |
| Cyanosis: none / with agitation / at rest | 0 / 4 / 5 |
| Stridor: none / with agitation / at rest | 0 / 1 / 2 |
| Air entry: normal / decreased / markedly decreased | 0 / 1 / 2 |
| Chest wall retractions: none / mild / moderate / severe | 0 / 1 / 2 / 3 |
The total ranges from 0 to 17.
Reading the score
- 0 to 2, mild: occasional barking cough, no stridor at rest, at most mild retractions.
- 3 to 7, moderate: frequent cough, stridor at rest, retractions, but little distress.
- 8 to 11, severe: marked stridor and retractions, the child is distressed or agitated.
- 12 or more, impending respiratory failure: fatigue, decreased consciousness, sometimes cyanosis. This is an emergency.
Worked example
A 2-year-old has stridor at rest (2), decreased air entry (1) and mild retractions (1), is alert and has normal color. The score is 4: moderate croup. Doctors would usually give a corticosteroid and watch the child for a few hours, adding nebulized epinephrine if stridor and retractions persist.
Treatment
- Corticosteroids, usually a single oral dose of dexamethasone, reduce swelling within a few hours and are recommended for all degrees of severity.
- Nebulized epinephrine works within minutes in moderate to severe croup. Its effect wears off after about 2 hours, so children are observed afterward.
- Oxygen is given if saturation is low.
- Cool mist and humidified air are traditional remedies, but studies have not shown that they help.
Keep the child calm: crying makes the narrowing worse. Sitting upright in a parent’s lap often helps.
When to call 911
Call for emergency help if the child has stridor at rest that is getting worse, struggles to breathe or pulls in the skin between the ribs, turns blue or gray around the lips, drools or cannot swallow, or becomes unusually sleepy or confused. Drooling with a high fever and no barking cough can signal epiglottitis, a rarer and more dangerous condition.