Whooping Cough in Babies

When to get help

NHS guidance asks you to call 999 or go to A and E if your or your child's lips, tongue, face or skin suddenly turn blue or grey, noting that on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet; if you or your child are finding it hard to breathe properly, described as shallow breathing; if there is chest pain that is worse when breathing or coughing, which could be a sign of pneumonia; or if your child is having seizures. It adds that you should not drive to A and E, but ask someone to drive you or call 999 for an ambulance.

Ask for an urgent GP appointment or get help from NHS 111 if your baby is under six months old and has symptoms of whooping cough; if you or your child have a very bad cough that is getting worse; or if you have been in contact with someone with whooping cough and you are pregnant. NHS guidance notes that you can check symptoms on 111 online for children aged five and over, but should call 111 for children under five.

Why under six months is the line

NHS guidance states that babies under six months old with whooping cough have an increased chance of having problems such as dehydration, breathing difficulties, pneumonia and seizures. That is why age alone, without any red-flag sign, is enough to warrant urgent advice in this group.

What it looks like, and why the whoop misleads

NHS guidance describes the first signs of whooping cough as similar to a cold, such as a runny nose and sore throat, and specifically notes that a high temperature is uncommon. That absence of fever is a genuine trap, because it makes the illness seem milder than it is in the first week.

After about a week, the guidance continues, you or your child will get coughing bouts that last for a few minutes and are worse at night; may make a whoop sound, which is a gasp for breath between coughs; may have difficulty breathing after a coughing bout and may turn blue or grey; may bring up a thick mucus which can make you vomit; and may become very red in the face.

The crucial qualification is in the same guidance: young babies under three months old and some adults may not whoop. A young baby with whooping cough may instead have coughing spasms followed by exhaustion, or may stop breathing briefly, which is called apnoea, rather than making any characteristic noise. Waiting for a whoop before taking a young baby's cough seriously is the mistake that matters most.

The cough may last for several weeks or months, which is why whooping cough is sometimes called the hundred-day cough.

Treatment and staying away from others

NHS guidance says treatment depends on age and how long the infection has been present, and that hospital treatment is usually needed if whooping cough is severe, or if your baby is under six months old and has whooping cough. If whooping cough is diagnosed within three weeks of the cough starting, antibiotics are given to help stop it spreading to others, though the guidance notes that antibiotics may not reduce symptoms.

On infectiousness, NHS guidance states that if you have whooping cough you are contagious for up to three weeks after the coughing starts, and asks people to stay off school, work or nursery until 48 hours after starting antibiotics, or three weeks after the cough started if antibiotics have not been taken.

For symptom relief the guidance advises plenty of rest and fluids, and says to take paracetamol or ibuprofen if you or your child are uncomfortable, checking the leaflet if you are not sure it is suitable. It also warns not to give aspirin to children under 16 years of age. This page gives no amounts of any medicine; follow the packaging or ask a pharmacist.

The two vaccinations that protect a baby

Protection for a newborn comes from the mother's vaccination in pregnancy, because a baby's own course does not start until eight weeks and is not complete for months.

NHS guidance says that if you are pregnant you should have the whooping cough vaccine, that you usually have it when you are around 20 weeks pregnant, and that this helps protect your baby for the first few weeks of their life. It asks you to speak to your GP surgery or midwife if you are 20 weeks pregnant and have not been offered it. UK Health Security Agency material on the programme describes vaccination in pregnancy as highly effective at protecting babies in the weeks before their own immunisations begin.

For the baby, NHS guidance states that the whooping cough vaccine is routinely given as part of the 6-in-1 vaccine for children at 8 weeks, 12 weeks, 16 weeks and 18 months, and as part of the 4-in-1 pre-school booster for children aged 3 years 4 months. NHS guidance on the 6-in-1 vaccine confirms it protects against whooping cough alongside diphtheria, hepatitis B, Hib, polio and tetanus.

A baby who has had one or two doses is partly protected but not fully, so the same urgency applies to a symptomatic baby part-way through the schedule.

Why cases still occur

The World Health Organization describes pertussis as a highly contagious respiratory disease that remains a significant cause of infant illness and death worldwide, and notes that immunity from both infection and vaccination wanes over time. That waning is why older siblings, parents and grandparents can carry and pass on the infection while feeling only mildly unwell with a persistent cough. Australia's healthdirect service makes the same point about adults being a common source of infection in babies.

If someone in your household has had a cough lasting more than two weeks with coughing fits, and there is a young baby at home, mention whooping cough by name when you seek advice.

Caring for a baby at home

If your baby has been assessed and is being managed at home, feed little and often, because coughing fits and vomiting make full feeds hard to keep down, and watch for signs of dehydration such as fewer wet nappies, a dry mouth or unusual drowsiness. Keep the air free of smoke. Stay with your baby during coughing bouts so you can see their colour and breathing, and be ready to call 999 if either changes.