Whooping Cough in Children: Symptoms, Treatment, and Vaccine

Your child has been coughing for weeks. The coughing fits come in bursts, and afterward the child seems exhausted and may vomit. Could it be whooping cough? Even though most children are vaccinated, whooping cough still occurs — and for the very youngest, the illness can be life-threatening.

Whooping cough (pertussis) is a highly contagious bacterial respiratory infection that causes severe, prolonged coughing. The disease is sometimes called the "100-day cough" because it can last up to three months. Whooping cough affects all age groups but is most dangerous for infants under six months.

Here you'll find a thorough overview of symptoms, treatment, and prevention based on updated recommendations from the CDC, WHO, and AAP.

What Is Whooping Cough?

Whooping cough is caused by the bacterium Bordetella pertussis, which attacks the airways. The bacterium produces toxins that irritate the mucous membranes and cause severe inflammation and mucus in the respiratory tract.

Vaccination against whooping cough has been part of childhood immunization programs since the 1950s. Nevertheless, outbreaks still occur. On average, thousands of cases are reported each year across all age groups, with the highest incidence among children and adolescents aged 7–19.

Why Does Whooping Cough Still Occur?

Even though vaccination coverage exceeds 95% in many countries, the vaccine doesn't provide lifelong protection. Immunity gradually wanes, and studies show that protection lasts three to ten years after vaccination. Therefore, both vaccinated children, teenagers, and adults can become infected — but they usually experience a milder course of illness.

Symptoms of Whooping Cough

The course of the disease is divided into two distinct phases.

Phase 1: Cold-Like Symptoms (1–2 weeks)

The first symptoms are difficult to distinguish from a common cold:

• Runny nose
• Mild, dry cough
• Possibly slight fever (fever is rare with whooping cough)
• General fatigue

During this phase, the child is highly contagious, but the symptoms give little cause for concern. Unfortunately, this is also the phase when antibiotic treatment is most effective.

Phase 2: Coughing Fits (6–8 weeks or more)

After the first week, the cough develops into severe fits:

• Coughing fits in bursts — the child coughs many times in succession without being able to breathe in between
• Whooping — a characteristic high-pitched, gasping sound when the child draws breath forcefully after a coughing fit
• Gagging or vomiting after coughing fits
• Redness or blueness in the face during fits
• Exhaustion — the child is worn out after each episode
• Between fits, the child may appear completely healthy

The cough is often worse at night. A typical coughing fit can last one to two minutes, and there may be many episodes throughout the day.

Whooping Cough in Infants — Extra Dangerous

In the very youngest babies, the illness often looks different than in older children:

• Infants under three months less commonly have the typical "whoop"
• The disease may debut with breathing pauses (apnea) instead of coughing
• The baby may become pale, limp, and blue around the lips
• Feeding difficulties are common — the baby doesn't have the energy to eat

Whooping Cough in Vaccinated Children

Children who are vaccinated can still get whooping cough, but symptoms are usually milder:

• Shorter course of illness
• Less intense coughing fits
• Rarely whooping or vomiting
• May feel like a prolonged, bothersome cough

Even though they are less sick, vaccinated children can still transmit the disease to others.

When Should You Contact a Doctor?

It's important to see a doctor early if whooping cough is suspected, because antibiotics are most effective in the first weeks.

Contact your pediatrician or urgent care if:

• The child has had a cough lasting more than two weeks
• The cough comes in severe fits with gagging
• You hear a whooping sound when the child breathes in after coughing fits
• The child has been in contact with someone diagnosed with whooping cough
• You have an infant with an unusual cough or breathing difficulties

Call emergency services (911) if:

• The baby stops breathing
• The child turns blue around the lips or fingertips
• The child is limp or unresponsive
• The child has severe breathing difficulties

Diagnosis

The doctor may suspect whooping cough based on symptoms, especially the characteristic cough. To confirm the diagnosis:

• Nasal swab (nasopharyngeal aspirate) — analyzed for the whooping cough bacterium using a PCR test
• Blood test — can show antibodies against whooping cough, but is most useful with prolonged illness

The earlier in the course of the illness the test is taken, the more reliable the result.

Treatment of Whooping Cough

Antibiotics

Whooping cough is treated with antibiotics. Treatment is most effective when started early — ideally in the first cold-like phase or at the beginning of the coughing-fit stage.

Common antibiotics for whooping cough:

• Azithromycin — given for three days, often the first choice for infants
• Erythromycin — given for ten days
• Clarithromycin — given for seven days

After three weeks of illness, antibiotics have limited effect on the disease itself but can shorten the contagious period.

After five days of antibiotic treatment, the child is considered non-contagious.

Supportive Care at Home

In addition to antibiotics, you can do a lot to ease symptoms:

• Rest — let the child rest, avoid physical activity that triggers coughing fits
• Fluids — give plenty of fluids, preferably in small and frequent amounts
• Small meals — large meals can trigger vomiting after coughing fits
• Elevated head position — can help reduce nighttime coughing fits
• Fresh air — some children find relief from fresh, humid air
• Calm and comfort — coughing fits can be frightening, so comfort and reassure your child

Things to avoid:

• Cough suppressants — especially in young children, as they can suppress the cough reflex
• Smoke and irritants — can worsen coughing fits
• Don't give the child medication without consulting a doctor

Hospital Treatment

Infants and severely ill children may need hospitalization for:

• Monitoring of breathing and oxygen levels
• Supplemental oxygen as needed
• Intravenous fluids if the child can't drink
• Suctioning of mucus from the airways
• Intensive monitoring for breathing pauses

Whooping Cough Vaccine

Vaccination is the most important prevention against whooping cough.

Childhood Immunization Schedule

Children receive the whooping cough vaccine as part of the standard immunization schedule:

After the primary series, over 85% protection against whooping cough is achieved. Even if the vaccine doesn't prevent illness in everyone, it makes the course milder and reduces the risk of complications.

Whooping Cough Vaccine During Pregnancy

Health authorities recommend the whooping cough vaccine (Tdap) for all pregnant women during weeks 27–36 of pregnancy. Antibodies are transferred to the baby through the placenta and provide protection during the first months of life — precisely the period when the baby is most vulnerable and hasn't yet received their own vaccine doses.

Read more in our article about whooping cough vaccine during pregnancy.

Booster Doses for Adults

The CDC recommends that adults get a Tdap booster every ten years. This protects you and reduces the risk of transmitting the disease to vulnerable infants.

Infection Control and Prevention

At Home

• Wash hands thoroughly and often
• Avoid coughing or sneezing toward others — use your elbow
• Keep sick family members away from infants as much as possible
• Ventilate rooms well

At Daycare and School

When whooping cough occurs at daycare or school:

• Children should stay home for five days after starting antibiotic treatment
• Without treatment, the child is considered contagious for up to three weeks
• Unvaccinated or partially vaccinated children under two who are close contacts should receive preventive antibiotics
• Healthy close contacts on preventive treatment don't need to stay home

Preventive Antibiotics for Close Contacts

Preventive antibiotic treatment is recommended for:

• Unvaccinated or partially vaccinated children under two in the same household
• Household members of unvaccinated infants
• People with weakened immune systems or severe lung disease

Possible Complications

Most children with whooping cough recover without lasting effects, but complications can occur:

• Pneumonia — the most common complication
• Ear infections
• Weight loss — due to vomiting and reduced food intake
• Bleeding — under the eye's conjunctiva or in the skin (petechiae) from coughing pressure
• Hernia — from forceful coughing

In infants, serious complications can include:

• Breathing pauses (apnea)
• Seizures
• Brain damage from oxygen deprivation
• In very rare cases: death

Frequently Asked Questions

How long does whooping cough last?

Whooping cough is called the "100-day cough" for good reason. The typical course of illness is two to three months. The severe coughing gradually subsides but can persist for many weeks. With early antibiotic treatment, the course can be somewhat shortened.

Can my child get whooping cough even though they're vaccinated?

Yes, vaccinated children can get whooping cough, but the illness is usually milder. The vaccine provides over 85% protection, but immunity wanes over time. Vaccinated children have a lower risk of serious complications and hospitalization.

When can the child go back to daycare?

The child can return to daycare five days after starting antibiotic treatment, provided they feel well enough. Without antibiotic treatment, the child should stay home for at least three weeks after illness onset.

Can adults get whooping cough and infect my child?

Yes. Adults with waning immunity from vaccination can get whooping cough, often with milder symptoms resembling a prolonged cough. They can still infect infants who aren't fully vaccinated. That's why the CDC recommends booster doses for adults every ten years.

Are there natural remedies for whooping cough?

No. Whooping cough is a serious bacterial infection that requires antibiotic treatment to shorten the course and reduce contagiousness. Natural remedies and alternative treatments are not documented as effective and should not be used as a substitute for antibiotics. Always consult your doctor.

Read More

• Whooping cough vaccine during pregnancy
• Fever in children: When to contact a doctor
• Your baby's immune system

Sources

• CDC — Pertussis (Whooping Cough)
• WHO — Pertussis
• AAP — Pertussis Guidelines