Signs and symptoms

In a child who has not been immunized, whooping cough begins with a runny nose, low-grade fever (37.8°C to 38.3°C), and a cough that gradually worsens over the next two to three weeks. Then, the cough becomes characteristic: it is worse at night than during the day and paroxysmal (several coughs occur at once without inhaling in between). At the end of a spasm the child makes a “whoop” or strangling sound as air is sucked into the lungs; vomiting of thick mucus follows. The severe, strangling cough persists for another two to three weeks and gradually subsides in three to six more weeks. But the cough may return with new respiratory infections.

In an unimmunized child, the diagnosis is unmistakable. The diagnosis may not be obvious, however, in infants who never develop a “whoop,” and in an immunized child the diagnosis may be impossible. The child who has been immunized may have full or partial immunity, but without boosters the immunity declines over the years. A child who is partially immune may have a mild case of whooping cough that produces none of whooping cough’s identifiable characteristics. In the absence of characteristic symptoms, laboratory tests don’t help. All the organisms that cause whooping cough are difficult to grow on cultures and more modern techniques for the isolation of these organisms are not readily available. Because it may be difficult to diagnose and because both doctors and parents mistakenly believe the disease is rare, over 90 percent of cases of whooping cough are never detected, or even suspected.

Home care

A child who has whooping cough should be isolated from young brothers and sisters. If the vomiting is severe, feed the child several small meals a day.

Precautions

• Infants should be immunized against whooping cough. Risks from the disease far outweigh the risks from the immunization. Infants are not naturally immune to the disease, and the mortality (death) rate among infants who contract whooping cough is high.

• A child who has a mild cough may have a mild form of whooping cough, in which case he or she could spread the disease. Avoid unnecessary exposure to others.

• If your child has been exposed to whooping cough, take the child to a doctor.

• Report to a doctor any cough that is getting progressively worse at the end of two weeks.

Medical treatment

Your doctor will try to establish a diagnosis with the help of a complete blood count and cultures of the secretions from the nose and throat. Most often, however, the child’s medical history and the doctor’s clinical judgment are all that you can depend on. All infants with whooping cough are hospitalized, while older children may or may not be, depending on the child’s condition.

Your doctor may prescribe the antibiotic erythromycin for ten to 14 days to make the disease less contagious. If given early enough, the medication may shorten the course of the illness. If your child has been exposed to whooping cough, he or she can be given erythromycin by mouth, a booster shot of vaccine, or a large dose of human antipertussis serum.

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Coming home

When you come home from the hospital with a new baby, a brand-new period of your life begins. It may take several weeks, or even several months, for the mother to recover from the physical stress of labor and delivery. At the same time, the new baby is completely dependent on the parents for food, shelter, and comfort. To accommodate the mother’s physical tiredness and the baby’s constant needs, you may have to review what is most important to you as a family. For example, keeping the house spotless may have to take second place to caring for the baby and allowing the mother to get the extra rest she needs. Household jobs may have to be reassigned so that the mother can devote more time to the baby. Your social schedule may have to change as well. You may find that your preferences have changed, and you would rather stay home with the baby than go to a party or a movie. This certainly does not mean you must—or should—give up going out or never do the things you enjoy. It only means that your priorities will probably change when you have an infant in your household.

Feeding

In the first months of life, eating is a major concern of your baby. This activity will take up a lot of your time and a lot of your energy. But whether you breast-feed or bottle-feed your baby, feeding time is a time of closeness. You are giving the baby nourishment and thus meeting the child’s most basic need. At the same time you are holding and cuddling the baby, and he or she is getting to know your touch and your voice.

Burping the baby

As the baby nurses, from the bottle or the breast, air is swallowed along with the milk. Burping the baby helps to expel excess air and prevent discomfort. Interrupt the feeding once in the middle for a burp, and also burp the baby after a feeding. Expelling extra air in the middle of the meal ensures that the baby’s stomach will fill up with food, not air.

To burp an infant, put the baby over your shoulder, sit the baby up on your lap, or place face down across your lap. Pat or rub the baby’s back gently until you hear a good, solid burp. Some babies prefer one position while others need to be moved around until they burp. If burping is difficult, experiment with different positions and combinations of patting and rubbing. Some babies will protest the interruption of the meal, but burp them anyway at mid-meal. They will get more nourishment and your life will be easier.

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Why did I get diabetes?

Nobody can really tell why you get diabetes. We know that you probably were born with a tendency or chance to get diabetes and you got this tendency through nobody’s fault. Being born with a tendency to diabetes is like being born with a tendency to be tall or short, to have a particular hair colour or eye colour or a particular shaped nose or a tendency to go bald when you are a young man. We all of us inherit things from our parents as they did from their parents. A tendency to get diabetes is just one of those things. Why it should have come out when you are a child rather than when you become an adult nobody can tell at present. Possibly it was just bad luck. Certainly there is no reason to suppose it was anything that you did or your parents did or did not do, that brought it on. Sometimes people who do not know anything about it claim that a child gets diabetes from eating too much sugar. This is not so: perhaps if it were, almost everybody that you know would have diabetes.

Can you ‘catch’ diabetes like you ‘catch’ chickenpox?

No. It is quite impossible to ‘give’ diabetes to anybody else. It is not infectious and we do not think of it as a disease.

I was told I got diabetes from a shock. Could this be so?

Nobody can get diabetes just from a shock. It may be possible for someone who has a tendency to diabetes, and who was going to get it sooner or later, to develop it after some stress or strain like a shock. In this case perhaps the shock has brought the diabetes on.

Can the pancreas start functioning properly again?

Yes, for a short time. After a child first gets diabetes and has been stabilized it is common for the pancreas to function again, and that is why the dose of insulin may be quite small in the early stages. Children in general, however, require steadily increasing doses of insulin, and after a few years it is usual for the pancreas to stop working altogether. When this happens, the pancreas does not function again. It seems that the pancreas has a better chance of functioning again in older teenagers and young adults than young children. The reason for this is not yet clear.

In what way is diabetes in childhood and adults different from that of older people?

Adults, particularly young adults, may develop the same kind of diabetes as children. Older adults are more likely to develop a different type of diabetes, one that does not depend on insulin treatment and therefore is called Non-Insulin Dependent Diabetes.

Although there are many ways in which diabetes is similar in children and adults there are also many differences. When a young person first gets ill with diabetes, he may lose weight and become extremely thirsty. This sort of illness is not so common in older people, many of whom are overweight when they develop diabetes.

Children are also more likely to develop ketones when they are ill, and although some adults do not require insulin for treatment, almost all children do. One of the major differences appears to be that when a young person develops diabetes his pancreas fails to produce enough insulin and eventually produces none at all, whereas in an old person the pancreas may produce insulin, but there is something wrong with the way in which it is produced or the way in which the body can use it. This explains why a child has to have insulin injections to replace the insulin which the pancreas should be making. On the other hand, an adult may be able to take tablets which can affect the way in which the body uses its own insulin or which may stimulate the pancreas to produce insulin more effectively.

What is meant by the term ‘honeymoon period’?

There is usually a time after diabetes is first stabilized when the pancreas makes a partial recovery. At this time it makes some of the insulin needed by the body, so the dose of insulin you inject can be quite small. When this happens, diabetes is usually fairly easy to control (provided you are not given too much insulin) because the body’s own insulin does a lot of the work for you.

This is a phase of partial recovery, and is sometimes called the honeymoon period. It is not a bad term, as it is like the holiday after a marriage and at the start of a lifetime of marital adjustment. Like all honeymoons, it eventually comes to an end – weeks, months or sometimes even years later. Then you have to work at a comfortable relationship with your diabetes.

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