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Pertussis (Whooping Cough): When to Go to the ER

Pertussis (also known as whooping cough) is a highly contagious infection of the respiratory tract. It spreads easily from person to person through droplets when an infected person coughs, sneezes, or talks. With whooping cough, thick mucus forms deep inside the airways. This leads to severe coughing spells that produce a "whooping" sound from the sharp intake of breath. Because pertussis can be very serious, it’s important to know when to seek medical care.

Woman sitting in rocking chair with crying baby.

Risk factors for whooping cough

Children who have received all the vaccines are usually protected from whopping cough. Babies and preschool-age children are most at risk. At age 2 months, most infants in the United States start the vaccination series to prevent pertussis. But the effects of the vaccine fade as children get older, so teens and adults can also get the disease. But, others are at risk including:

  • Infants 6 months and younger who haven't received at least 3 doses of whooping cough vaccine

  • Children and teens age 11 to 18 who haven't had a booster shot of the vaccine

  • Anyone who hasn't been vaccinated or who hasn't had a booster shot of the vaccine

What are the symptoms of pertussis?

At first, whooping cough seems like a common cold. Symptoms include:

  • Runny nose

  • Sneezing

  • Mild fever

  • Slight cough

One to 2 weeks later, the cough becomes severe. It usually comes in spells that last a minute or more and end up with a high-pitched whoop. The intense coughing can cause a child to break a rib, vomit, turn blue, or even pass out. This stage can last 1 to 6 weeks or longer.  

When to go to the emergency room (ER)

At first, pertussis may seem like a cold. Your child is likely to have a runny nose, mild fever, and a slight cough. After 1 to 2 weeks, the cough tends to become very severe. Coughing spells may last as long as a minute. These produce a “whooping” sound as your child gasps for air. Sometimes, your child may turn red or blue or vomit from the cough. Call your health care provider right away if you suspect pertussis. Seek emergency help if your child:

  • Has a blue color to his or her skin (check fingertips and around mouth). (If there is a blue color, call 911.)

  • Stops breathing, even for an instant. (Call 911.)

  • Has a high fever within the following ranges:

    • Has a fever of 100.4°F (38°C) or higher (in infants under 3 months)

    • In a child of any age who has a repeated temperature of 104°F (40 °C) or higher (over age 3 months)

    • A fever that lasts more than 24 hours in a child younger than age 2 years, or for 3 days in a child ages 2 years or older

    • Has had a seizure caused by the fever (such as sunken eyes, dry mouth, dark or strong-smelling urine, or no urine output in 6 to 8 hours

  • Vomits often, or becomes dehydrated

What to expect in the ER

A health care provider will ask about your child’s symptoms and do a physical exam. He or she will likely take samples of secretions from your child’s nose or throat. These will be checked in a lab for the bacteria that cause pertussis. Your child also may have blood tests or X-rays. However, if these tests are done, they will most likely be negative.

How is whooping cough treated?

Infants and children with severe pertussis are likely to be admitted to the hospital for treatment with antibiotics and fluids. Milder cases may be treated at home with antibiotics, fluids, and bed rest. Cough and cold medicines are not very helpful. Because of the possibility of serious side effects, they should not be used unless your health care provider recommends them. Never give aspirin to a child under age 18 years. It could cause a rare but serious condition called Reye's syndrome. Generally, ibuprofen is not recommended for infants younger than age 6 months. During a visit to the ER, children with whooping cough:

  • May be given medications to relieve inflamed airways

  • Have their breathing carefully monitored

  • May have their airways suctioned to remove mucus

  • Receive antibiotics through an IV line

If antibiotics are prescribed

Antibiotics won’t cure whooping cough in most cases. But the health care provider may prescribe antibiotics to help make your child less contagious. In that case:

  • Make sure your child takes ALL the medication, even if he or she feels better. Otherwise, the infection may come back.

  • Be sure your child takes the medication as directed. For example, some antibiotics should be taken with food.

  • Ask your child’s health care provider or pharmacist what side effects the medication may cause and what to do about them.

Your child should stay home from school until he or she has completed at least 5 days of antibiotic treatment. If appropriate antibiotic treatment is not used, he or she should wait  3 weeks or 21 days after the onset of the cough.

Caring for your child at home

To help your child recover fully from whooping cough:

  • Provide plenty of fluids, such as water, juice, or warm soup. Fluids help loosen mucus, so your child can breathe more easily. They also help prevent dehydration.

  • Offer smaller meals. Small amounts of food are easier to eat when coughing is severe.

  • Make sure your child gets enough rest. Ask your child’s doctor about the best position to improve breathing.

  • Run a humidifier in your child’s bedroom to relieve coughing and loosen mucus in the airways. Be sure to clean the humidifier regularly to prevent growth of mold and bacteria.

  • Keep your house free of irritants that can trigger coughing spells. These include tobacco smoke and fumes from fireplaces.

  • Avoid giving your child over-the-counter cough syrups. They won’t ease your child’s cough and may be harmful.

  • Don’t take your child with whooping cough to school or daycare until the health care provider says it’s OK.

  • Ask your child’s health care provider if others in your household should receive a booster shot to help keep them from getting sick.

Preventing whooping cough

Getting vaccinated is the best way to protect against pertussis. Talk to your health care provider about whether your child needs a booster vaccination. Also, be sure to ask whether you need a booster as well. Most children receive a vaccine against whooping cough starting at 2 months of age. It’s often combined with vaccines for two other diseases, diphtheria and tetanus. The combination vaccine (called DTaP) is given in a series of 5 shots at these ages:

  • 2 months

  • 4 months

  • 6 months

  • 15 to 18 months

Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Online Medical Reviewer: Pierce-Smith, Daphne, RN, MSN, CCRC
Last Review Date: 9/5/2014
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