3 Symptoms, Causes, And Treatment for Pertussis in Children

Pertussis or whooping cough is an upper respiratory tract infection caused by Bordetella pertussis bacteria (1). Although seen in all age groups, pertussis in children and babies is more common. It is a highly contagious disease that spreads through coughing or sneezing from one person to another. Pertussis begins with cold-like symptoms and progresses to extreme coughing fits (paroxysms), causing breathing difficulties. Delayed diagnosis and treatment could lead to complications. Therefore, vaccination is the preferable preventive measure against pertussis in all ages (2) (3).

Read on to know about the signs and symptoms, diagnosis, treatment, and prevention of pertussis in children.

Symptoms Of Pertussis In Children

The symptoms of pertussis usually develop within five to ten days of infection. However, in some cases, the symptoms may not appear for up to three weeks. According to the WHO, whenever the symptoms develop, they go in three phases (4).

1. Stage 1 (Catarrhal stage): It’s the early stage of pertussis that may last for one to two weeks. During this period, the infected child is highly contagious and may have common cold-like symptoms, such as

• Runny nose

• Low-grade fever

• Mild cough (occasional)

• Breathing cessation (apnea)

Since the symptoms at this stage are not specific, a healthcare provider usually doesn’t suspect pertussis as the cause.

2. Stage 2 (Paroxysmal stage): After one to two weeks, typical symptoms of pertussis may appear, and include:

• Coughing spells or fits: During this stage, a child develops severe coughing (but not always) that the child has to catch their breath by inhaling deeply, causing them to make a “whooping sound”.

• Vomiting: Pertussis causes violent coughing with thick mucus that can cause the child to throw up. A child may vomit during an intense coughing episode or after it.

• Exhaustion: Severe coughing and vomiting can make a child feel exhausted. As the disease progresses, the coughing gets intense and occurs more often during the night.

This phase usually lasts for two to six weeks and may extend up to ten weeks.

3. Stage 3 (Convalescent stage): It’s also known as the recovery stage when the child’s frequency and intensity of the coughing decreases. This stage lasts for about two to three weeks. However, coughing fits may return with other respiratory infections months after the infection first happened.

Note: Vaccinated individuals develop mild symptoms and don’t experience a “whooping sound” while coughing.

Causes Of Pertussis In Children

Pertussis is a bacterial infection caused by Bordetella pertussis bacteria. It occurs only in humans and transmits from an infected person to others through (1)

• Coughing and sneezing (airborne droplets) without covering the mouth and nose

• Sharing common breathing spaces for a long time

Children with weakened immune systems and those who have not got the whooping cough vaccine are at higher risk of infection (3).

Diagnosis Of Pertussis In Children

Diagnosis of pertussis relies on the child’s symptoms and physical examination. If the doctor suspects pertussis, they are likely to order the following tests (5).

1. Culture: The doctor will take a swab from the area between the child’s nose and throat or collect the secretions from the nose and throat (mucus) for culture. The culture will check the swab for the presence of Bordetella pertussis bacteria.

2. Blood tests: After taking culture, the doctor may take the child’s blood sample as well. It’s a general test done to check one’s white blood cell count (WBC). WBCs rise when a body fights infection or inflammation.

3. Chest X-ray: It’s a precautionary test that the doctor may order to check for fluid retention or inflammation in the lungs. If the child has fluid in the lungs, it indicates pneumonia which can worsen whooping cough.

As soon as the results come and the suggestive findings are confirmed, the treatment starts.

Treatment For Pertussis In Children

The precise treatment for pertussis depends on the child’s age, the severity of the symptoms, and overall health. However, in most cases, the treatment course includes antibiotic therapy and home care (3) (5).

1. Antibiotics

Antibiotics help fight infection and work best when administered during the early stages of infection. They may also be given to the person taking care of the child even if they are vaccinated. The affected child should be kept away from the rest of the family members for five days after initiating antibiotic therapy.

2. Home care

When detected early, most children can be treated with antibiotics and proper home care. Here are some simple tips for caring for your child at home.

• Keep your child in a well-ventilated room that’s comfortably warm.

• Give them medications, such as antibiotics, as prescribed by your healthcare provider. Don’t give any medicines for cough unless directed by your doctor.

• Keep your house irritant-free to ensure coughing doesn’t worsen. Some of the common irritants that can aggravate coughing are smoke, dust, and chemical fumes.

• Relieve congestion using a cool-mist vaporizer. Ensure to clean the vaporizer thoroughly before and after use.

• Encourage your child to maintain proper hygiene by washing hands frequently using soap and water and covering their mouth with a tissue while coughing and sneezing.

• Give them plenty of fresh, hydrating fruits and fluids, such as water, soups, and fresh, unstrained, and unsweetened juices, to prevent dehydration.

• Motivate your child to eat small, frequent meals (like every few hours) to avert vomiting.

Taking proper care and following the medication course helps most children recover from whooping cough with relative ease. However, pertussis can turn serious in some cases requiring hospitalization. In such cases, if the child isn’t breathing properly, they might need breathing support. Also, if they have dehydration or aren’t eating properly, they would need IV (intravenous) fluids until recovery starts.

Complications Of Pertussis In Children

If treatment delays, pertussis symptoms may worsen and cause complications, such as (6):

• Bacterial pneumonia

• Apnea

• Convulsions and seizures due to brain inflammation

However, most of these complications are more likely to occur in babies than children. The reason for the same is their immature immune system. Hence, prevention with vaccination is important.

Prevention Of Pertussis In Children

Vaccination against pertussis is the best way to prevent its occurrence. Generally, the whooping cough vaccine is given to children routinely in the first 12 months of life. However, the vaccines aren’t 100 percent effective, and babies may still get the infection, though the effect will be less severe.

The Centers for Disease Control and Prevention (CDC) recommends two age-dependent vaccines – DTaP and Tdap, to prevent whooping cough. DTap is administered to children below seven years, whereas Tdap is for all individuals above seven years (2). These vaccines also offer protection against two other contagious illnesses – tetanus and diphtheria.

Generally, children get five DTaP shots, where the first three shots are given at the ages of two months, four months, and six months respectively. The fourth shot is administered between 15 and 18 months, and the fifth shot is between four and six years. Then, at age 11 or 12, children get a Tdap booster dose. After this, the child should get a booster dose every ten years. It’s essential as the vaccine offers protection only for about 10 to 20 years (3).

References

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Reviewer

Dr. Dur Afshar AghaMS

   

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha