Whooping cough - causes, symptoms and treatment

baby with whooping cough

Whooping cough used to be rare but in recent years the number of cases in the UK has increased. The infection, which lasts for up to three months, is sometimes called the '100 day cough'. Knowing how to tell the difference between a normal cough and whooping cough could make all the difference to your baby's treatment and prognosis.

What is whooping cough?

Whooping cough (pertussis) is a bacterial infection in the respiratory system. The infection causes prolonged coughing bouts that, for the majority, end in a high-pitched sound like a 'whoop'. However as some babies' coughs might not develop the 'whooping' sound, do check for the other symptoms too.

Pertussis is highly contagious and can be very dangerous for babies under one whose immune systems are still developing. The 2012 outbreak in the UK led to a five-fold increase in cases and renewed awareness among parents of young babies.

How do babies get whooping cough?

The bacteria that causes pertussis is very contagious, spreading through coughing, sneezing and personal contact. Airborne bacteria can easily infect young babies who have not yet had their full course of vaccinations and may be susceptible. If older siblings or adult relatives have had the illness or are carrying the bacteria, it can easily put young babies at risk.

What are the symptoms of whooping cough?

Once a baby has been infected by the pertussis bacteria it can take up to 10 days for symptoms to appear. So if your baby has been in contact with another person who has the illness and they seem fine, don't automatically assume that they are out of the woods.

What does whooping cough sound like?

Baby coughing

It starts off very much like a normal cough, with symptoms including a runny nose, sneezing and a mild, dry cough. However, it remains persistent and after a week or two of cough-like symptoms, you'll start to notice the following:

  • The coughing spell will end with a gasp of air like a 'whooping' sound.
  • Your baby's mild cough will develop into persistent coughing spells that last for more than a minute at a time. They tend to occur more at night. On average, someone with pertussis will have about 15 coughing bouts a day, but in severe cases may have up to 30 in 24 hours. Your baby may appear well between these coughing spells.

This is not to be confused with croup – which involves more of a harsh, bark-like cough.

However, some babies may never develop the 'whooping' sound so do not rely on this symptom alone before raising the alarm. Instead, he may have a dry, hacking cough. It's also possible that your baby won't cough at all and instead will struggle to breathe.

Baby having trouble breathing

Other symptoms are:

  • He may vomit or bring up phlegm.
  • His face may turn red or purple during the coughing. During very bad spells of coughing it may seem as though your baby has stopped breathing.
  • The force of the coughing may cause bleeding under the skin around his eyes.
  • Your baby may have a low-grade fever or none at all.

What is the whooping cough vaccine?

Babies cannot be vaccinated against pertussis until they are eight weeks old, meaning they are particularly susceptible to being infected.

As a result, pregnant women are advised to have the pertussis vaccine to help protect their baby during his first few weeks of life. The vaccine is not 'live' meaning you won't get the infection yourself. Instead your body will produce antibodies and some of your immunity will pass to your baby through the placenta.

I had the vaccine at about 37 weeks. I felt a bit ill that night – headache and a sore arm. It was worth it as there were a few cases at my older children's school including a friend whose daughter was quite ill with it.

The vaccine does not guarantee that your baby won't get whooping cough but it has been shown to be over 90% effective at preventing infection in the first eight weeks. The recommended time to get the vaccine is between 16 and 32 weeks of pregnancy. Whilst you can have it after that – indeed any time up until you go into labour – after 38 weeks it may be less effective.

Whooping cough pregnancy vaccine

You may be offered it at your mid-pregnancy 20-week scan, but if you aren't, you can ask your GP. Many pregnant women have it at the same time as the flu jab. Even if you have had the vaccine yourself as a child or had it in another pregnancy, you will be advised to have it again in order to maximise your baby's immunity.

From eight weeks, your baby will be offered his 6-in-1 vaccine, which will protect him from the infection until he has a booster at the age of three.

Public Health England says: "Pertussis is a respiratory disease that is vaccine preventable. It is caused by the Bordetella pertussis bacterium. Pertussis can cause serious and life-threatening complication, including pneumonia, difficulty in breathing (apnoea) and seizures. Severe complications and deaths occur mostly in infants under six months of age.

“Pertussis is a notifiable disease in England and Wales. This means health professionals must inform local health protection teams of suspected cases. PHE collects data on notifiable diseases. This data helps healthcare professionals track outbreaks and trends in disease occurrence over time.

“Immunisation is the most effective way to protect against pertussis.”

Side effects of the vaccine during pregnancy

There are some mild side effects such as swelling, redness or tenderness for a few days where the vaccine is injected in your upper arm – as you might have with any vaccine. Other side effects can include headache, fever, irritation in the injection area, swelling of the vaccinated arm, loss of appetite and irritability.

In terms of the safety of the vaccine during pregnancy, there's no evidence of risks to you or your baby – according to MHRA's study of around 20,000 vaccinated women.

What is the treatment for whooping cough?

If your baby has a cough or trouble breathing, you should always see your doctor. It can be hard to tell the difference between a normal cough and a whooping cough, so you could record one of your baby's coughing spells to play for your doctor. This is a good idea as often your baby will appear fine between coughing bouts and it may be hard for your doctor to assess his symptoms.

If the doctor does suspect that your little one may have the infection, swabs will be taken of your baby's nose, throat and mouth and tested for the pertussis bacteria. The infection can also be diagnosed with a blood test but GPs tend to avoid taking blood from very young babies if possible. Results usually take about five days to come back but if your baby's symptoms are severe, your doctor may diagnose and treat it as whooping cough anyway.

Baby in hospital

Treatment for infants is different than for adults. Babies under six months are often hospitalised, particularly if their symptoms are severe or persistent. This is so they can be monitored in case of complications arising. Severe or untreated cases can lead to pneumonia or inflammation of the brain caused by lack of oxygen during coughing fits.

When the infection is found to be in its early stages, antibiotics are usually prescribed for babies. If antibiotics are started early enough, they can help to shorten the length of the infection. When a baby has had the infection for some time, the doctor will usually prescribe antibiotics in order to stop the spread of the infection to other people. Cough medicine is unlikely to help alleviate such severe symptoms. Even once treatment has been given, it can take up to three months for the coughing to stop so don't expect to see immediate results.

My son had it at 18 months. He coughed, coughed again and coughed again, all without drawing breath. I didn't recognise it initially but our health visitor heard the cough and got us an immediate appointment with GP who prescribed antibiotics that cleared it up instantly.

If your baby is being treated at home, you can help him recover by:

  • Keeping him hydrated and fed. If he is bringing up fluids and food during coughing bouts, he may become dehydrated or risk losing weight. If you breastfeed, offer frequent feeds for shorter amounts of time so that there is not too much milk sitting in his tummy.
  • Let him have plenty of rest where possible. Coughing spells are more common at night so his sleep will be interrupted frequently.
  • Keep your house free of pollutants such as smoke, strong air fresheners and fires that may trigger a coughing spell.
  • Clean away phlegm and sick from your baby's mouth to keep his airways free. Never leave your baby unattended during a coughing fit.
  • Washing your hands and binning used tissues will help to prevent the spread of the infection.

Mumsnetters say

My son caught whooping cough at three weeks old in the 2012 epidemic. He went blue, struggled to breathe and was hospitalised twice. It was horrendous. He also vomited after every feed, lost a lot of weight and the cough went on for six months. I would advise any pregnant woman to have the vaccine.

I myself caught it during my first pregnancy. It was awful for me as an adult and I wouldn’t wish it on my worst enemy, let alone a newborn.

I had my pertussis jab at 24 weeks and had no side effects at all.

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