Moderate Croup (Westley Score 2–7) with Oxygen Saturations Above 94%: How to Manage
Children presenting with croup at a Westley score between 2 and 7 — with oxygen saturations above 94% and mild recession — occupy a clinically important mid-range that requires prompt, structured management distinct from mild or severe presentations.
Clinical Scenario
Moderate severity croup defined by a Westley croup score of 2–7, oxygen saturations greater than 94%, and mild recession. These children are symptomatic enough to require active intervention and a period of observation, but maintain adequate oxygenation at presentation.
Approach Overview (Partial)
Initial priorities include minimising distress in the child. The pharmacological mainstay is a corticosteroid, with a nebulised alternative available when the preferred agent cannot be used. An additional nebulised agent may be considered in selected cases. The full protocol specifies the agents, sequencing, observation period, and criteria that guide the next step.
Complete regimen, dosing, and decision pathway available below ↓
Goals at 2–3 Hours
- No stridor at rest
- Normal oxygen saturations
- Good air entry
- Normal colour
- Normal level of consciousness
- Able to tolerate oral fluids
References
- Moderate- Score 2 – 7
- Oxygen saturations > 94%
- Mild recession
- Keep child calm
- Observe for 2-3 hours
- No stridor at rest & normal oxygen saturations
- Good air entry
- Normal colour
- Normal level of conscious
- Able to tolerate oral fluids
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