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This story is part of a series on parenting—from surveilling our teens to helping our kids navigate fake news and misinformation.
Twice last year I thought my children were about to die. The first episode took place one night in February. My 2-year-old daughter had been a little fussy before bed, but she wasn’t sick. In the early hours of the morning, though, she jerked awake with an awful sound—a wretched, desperate, wheezing inhalation that seemed to leave her nearly breathless. She couldn’t talk or answer questions; she only stared at us in panic. Within minutes we’d pulled on heavy coats and boots over our pajamas and rushed outside into the freezing rain. There’s an emergency department a few blocks from our house in New York City. I carried her there, gasping in my arms.
Nine months later, the same thing happened, more or less, on the night of Halloween. Our baby son—then just shy of 6 months old—woke up coughing in an eerie and unnatural way, as if he were blurting out a high-pitched syllable. I tried to be more calm this time, and fumbled with my phone for WebMD, to better understand whether our baby was in danger and if so to what degree. But it was very late. I was tired and confused. Again, we rushed to the hospital.
Both nights the diagnosis was the same: Our kids had croup—that blight on children under 5 (and almost no one else). The word itself can be a shibboleth for parents. If you’d mentioned croup to me not long ago, before my kids were born, I’d have thought it was an antiquated term, one of those conditions that has either been renamed by modern medicine or vaccinated into history—an exhibit in the same museum as pleurisy or dropsy or catarrh. But now that I’m a grown-up, and looking after a pair of tiny tracheas, I know croup to be a very modern, terrifying syndrome: A seizing of a child’s respiratory tract, often coming on at night, and manifesting as a queer distress. Your kid with croup may start coughing like a wounded seal; she may wheeze or make a grating sound while breathing in; and the skin around her ribs and chest could well retract with every breath. In short, it will appear as though your baby’s throat is closing up. It will seem to you that she’s on the verge of suffocation.
In fact, she’s not. Croup is mostly harmless. No one has made a careful tally of its mortal cost (in part because the victims are so few), but we have some expert guesswork. One official writeup in the journals pegs the rate of death from croup at 0.0001 percent, which is to say: 1 case in a million. Perhaps more realistic (but still not that dire) is an estimate from the University of Calgary professor and noted croup scholar David W. Johnson: He and his colleagues have presumed, through what he told me was a process of “smoking a cigar and waving it” and “an extrapolation from an extrapolation,” that 1 in 30,000 child-patients dies from the condition. (That’s about one-half the rate of death among infants and toddlers who get the flu.)
The rest, broadly speaking, are just fine.
These numbers make me wonder at the choices that I made on those scary nights last year. Did we really need to rush our children to the hospital? Both times the doctors told us it was “good” that we’d come in; both times our kids were given treatment, the steroid dexamethasone. (My daughter also got an epinephrine spray.) Then both times a heavy dose of billing followed: Several thousand dollars for each visit. The cost was a major insult to our budget and our bank account; and I gather the dangers we staved off were rather shrimpy.
Croup hasn’t always taken such a meager toll, of course. In the old days, when the illness was still described with the (as in “this child has the croup”), its course was understood to be quite grave. Francis Home, a Scottish doctor, was the first to make a careful study of this disease that “had entirely escaped all regular examination;” his inquiry, from 1765, warned readers that the croup “is silent in its progress, and gives no visible alarm, till death is near at hand.” Victorian physicians concurred with Home on the perils of the croup’s “stealth invasion,” and traced its march from what seemed to be a common cold to a deadly culmination: “The lips and nails become blue, every respiratory muscle seems to exert its utmost power to obtain the required air, … the veins of the face and neck become prominent, and a profuse perspiration bursts from every pore.” British records from the 1860s blame
