Whooping cough in children: How to recognize and treat pertussis

recognize whooping cough

What is whooping cough?

Whooping cough is an acute and highly contagious respiratory infection. The trigger is the bacterium Bordetella pertussis, which is why whooping cough is also known as pertussis. When infected, the bacteria infect the nose, throat, trachea and lungs, where they secrete bacterial toxins that weaken the immune system and damage the surrounding tissue. Whooping cough is characterized by spasmodic coughing fits, called staccato cough, followed by sudden, wheezing inhalation, which gives whooping cough its name.

Whooping cough is a very protracted illness that lasts for several weeks, and in a milder form often even for months. After an infection, there is immunity for about 4 to 20 years. Secondary or multiple illnesses are therefore possible. Whooping cough is therefore not one of the “classic” childhood diseases.

The disease is particularly dangerous for infants, as it can lead to life-threatening respiratory arrest. In fact, nowadays it is mainly adults who suffer from whooping cough. About 80 percent of those affected are older than 18 years. This is largely due to the fact that although there is a vaccination coverage rate of around 90 percent in childhood, the necessary booster vaccinations are missed later on.

Routes of transmission of whooping cough

Whooping cough is transmitted by the so-called droplet infection. When speaking, sneezing or coughing, the pathogens are released into the air through saliva droplets. When inhaled, they get into the respiratory tract and settle there on the mucous membranes. The pathogens can also be passed on through kissing, and in rare cases through shared cutlery or crockery.

The incubation period, i.e. the time between infection and the appearance of the first symptoms, is 7 to 20 days for whooping cough. On average, the disease breaks out after about two weeks. Left untreated, whooping cough is contagious for about six weeks from the onset of the disease. The risk of infection is greatest in the first two weeks of the illness, after the sixth week the risk slowly decreases again.

Symptoms of whooping cough

Whooping cough can manifest itself in a number of ways, and often the symptoms in children and adults are very different. The typical whooping cough symptoms in children are:

• spasmodic fits of coughing, especially at night
• audible deep breathing (gasp; in about 50% of children) after the seizures
• Fever
• later: regurgitation of tough, glassy mucus
• Vomiting possible during coughing fits
• red eyes and nosebleeds possible

Babies often do not have the typical coughing fits or they are not as severe. Instead, however, breathing arrests, so-called apneas, can occur in infants, which can be life-threatening.

Even in adults, whooping cough often does not show itself through the characteristic symptoms. There is no paroxysmal coughing, instead the coughing is evenly distributed over a longer period of time. For this reason, whooping cough in adults often goes undetected. Long-lasting cough and, above all, recurring coughing attacks at night should therefore be taken seriously as signs of a possible whooping cough disease.

course of whooping cough

Whooping cough in children usually has three stages: the catarrhal stage, the convulsive stage, and the decremental stage. The rule is: the younger the child, the more difficult the course.

• Catarrhal stage: The first stage of whooping cough begins about two weeks after infection with non-specific symptoms reminiscent of a cold. A mild cold and cough usually occur, and sneezing, sore throat and hoarseness are also common. In some cases conjunctivitis can also occur.
• Stage convulsivum: After about one to two weeks, the typical whooping cough attacks begin with short, dry coughing spurts. Affected children often have up to 40 seizures a day, with these occurring more frequently at night, but also under stress or strain. After the individual attacks, a tough, glassy mucus is often regurgitated or vomited. Fever is also common. After about three weeks, the attacks begin to become less frequent, but they can last up to six weeks.
• Stage decrementi: In the final stage, the body begins to recover from whooping cough and the attacks become less frequent. However, a mild cough often persists for about six to ten weeks, and in some cases it may take several months for full recovery.

Adults usually do not go through the three stages, but have a persistent, strong cough.

Comorbidities in whooping cough

Babies and small children often have complications associated with whooping cough. On average, adults have fewer complications. Common secondary diseases are:

• otitis media
• lung infection
• Inflammation of the brain with seizures possible
• strong weight loss

The severe coughing fits can also lead to rib fractures or hernias. In adults, temporary incontinence can also occur.

treat whooping cough

Whooping cough: when to see a doctor?

Especially since whooping cough manifests itself in the first few weeks through atypical symptoms, it is important to have the exact diagnosis made by a doctor in order to be able to start treatment with antibiotics at an early stage.

In the early stages, the pathogens in infants can usually be easily detected via a swab from the nose. In adolescents and adults, this is often only possible using a very complex and expensive procedure, the so-called polymerase chain reaction (PCR), which is why a throat swab is often analyzed for them, but this rarely provides reliable results.

From the second stage, a diagnosis in children is often possible based on the typical symptoms. In case of doubt, a blood test is also used, which can detect whooping cough antibodies in the blood.

When whooping cough is diagnosed, the doctor usually prescribes antibiotics. Although these usually do not help against the cough itself, they do mean that the patient is no longer contagious after five days. Taking antibiotics early can also significantly weaken and shorten the course of the disease.

What can you do about whooping cough?

Because whooping cough lasts for so long, the condition is often particularly debilitating. In order to support your child’s recovery as much as possible, you can, for example, observe the following:

• Bed rest: Your child’s immune system is very weakened by the infection with whooping cough. In addition, the nocturnal fits of coughing often deprive him of sleep. It is therefore important that he rests as much as possible and avoids exertion and stress as much as possible so that he can recover quickly.
• Inform community institutions: Although there is no obligation to report whooping cough in most German federal states, it still makes sense to inform your child’s school or kindergarten if you are infected. Those responsible can then pass on the information and any other affected persons can be treated with antibiotics at an early stage.
• Lots of fluids: If you have whooping cough, make sure your child drinks enough. If they have a fever and vomit, their body loses an above-average amount of fluid. In order to keep the fluid balance stable, it should drink plenty of water or mild herbal teas.
• Good room climate: The respiratory tract is severely strained when you have whooping cough. In order to make it easier for your child to breathe and to keep the mucous membranes moist, cool and humid room air is particularly suitable. If you don’t have a humidifier, you can simply hang damp towels in your child’s room. Regular airing also ensures the right temperature and sufficient oxygen.
• A lot of affection: For your child, the spasmodic coughing fits with whooping cough are not only physically but also very exhausting. So give your child lots of affection and love and, if possible, help them with coughing attacks. This way, your child does not feel left alone and does not panic in the event of severe coughing fits or shortness of breath.

Home remedies for whooping cough

In addition to treatment with antibiotics, you can also use some home remedies to relieve your child’s symptoms of whooping cough.

What to do if you have a fever

• Calf wraps: You can use calf wraps to lower your child’s body temperature if you have a fever. The cool envelopes that are wrapped around the shins dissipate excess body heat to the outside. For the calf wraps, simply soak a thin cloth in cold water and wrap them around your child’s calves. Secure the wraps with another dry cloth. You can find detailed instructions in our article ” calf wraps against fever “.
• Vinegar socks: Vinegar socks have the same effect as calf wraps, because they are also intended to dissipate body heat to the outside when you have a fever. For the vinegar socks, prepare a solution of five tablespoons of vinegar essence and one liter of cold water. Then you dip a pair of thin cotton stockings into the liquid and wring out the socks slightly. Now put the damp socks on your child. You can put a pair of dry stockings on top of that. If you put a towel underneath, your child’s bed will stay dry. Now let the vinegar socks work until they are dry.

What to do about cramps?

• Warm chest wraps: With whooping cough, the entire chest muscles and lungs cramp during the coughing attacks. You can use warm potato compresses to relieve these symptoms and relax your upper body. Boil a few large potatoes until soft and place them in a clean tea towel with their skins on. Then wrap the potatoes in the towel and mash them in the towel into a layer about 1/2 inch thick. Now let the potatoes cool down until you can place the package on the inside of your forearm for about thirty seconds without getting too hot in this sensitive area. Now place the wrap on your child’s upper body. If it is too warm for him, you can also put a terry towel between the upper body and the wrap.

Prevent whooping cough

The Standing Committee on Vaccination (STIKO) of the Robert Koch Institute (RKI) recommends vaccination to prevent whooping cough. Up to 80 percent of unvaccinated people contract whooping cough when they come into contact with the pathogen. Since any existing antibodies against whooping cough are not passed from the mother to the baby at birth, there is no immune protection against an infection in infants either. However, since whooping cough usually takes a very severe course, especially in infants, vaccination is recommended from the 2nd month of life. Adults who were not vaccinated as children can catch up with a combination vaccine against tetanus, diphtheria and whooping cough. Since the vaccination protection only lasts about four to twelve years, regular booster vaccinations against whooping cough are necessary. You can find out more about this in our article “Sixfold Vaccination ”.

If there is a concrete risk of infection, your family doctor can prescribe you preventive medication. This so-called chemoprophylaxis is primarily intended for people who are in close contact with those who are ill, so that they do not become infected with whooping cough themselves.