WHOOPING COUGH IN CHILDREN: SYMPTOMS, HOME CARE AND MEDICAL TREATMENT
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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