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

Healthcare provider preparing to give baby a shot.

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. Thick mucus forms deep inside the airways. This leads to serious coughing spells that make a "whooping" sound. The sound is caused by a sharp intake of breath. Because pertussis can be very serious, it’s important to know when to seek medical care.

What are the risk factors for whooping cough?

Children who have had all of their vaccines are usually protected from whooping cough. Babies and preschool-age children are most at risk. At age 2 months, most infants in the U.S. start the vaccine 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. They include:

  • Infants 6 months and younger who have not had at least 3 doses of the whooping cough vaccine

  • Children and teens ages 11 to 18 who have not had a booster shot of the vaccine

  • Anyone who has not had the vaccine or a booster shot of the vaccine

What are the symptoms of whooping cough?

At first, whooping cough seems like a common cold. Symptoms at that point include a runny nose, sneezing, mild fever, and a slight cough.

The cough gets more severe 1 to 2 weeks later. The coughing usually comes in spells that last a minute or more and end 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)

Call your healthcare 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 fever (see Fever and children, below)

  • Has had a seizure cause by the fever

  • Vomits often, or becomes dehydrated

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

What to expect in the ER

A healthcare provider will ask about your child’s symptoms and perform 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. If these tests are done, the results will be negative most of the time.

What is the treatment for whooping cough?

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 healthcare 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 medicine to relieve inflamed airways

  • Have their breathing carefully monitored

  • May have their airways suctioned to remove mucus

  • Get antibiotics through an IV (intravenous line)

If antibiotics are prescribed

Antibiotics won't cure whooping cough in most cases. But, the doctor may prescribe them to help make your child less contagious. In that case: 

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

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

  • Ask your child's doctor or pharmacist what side effects the medicine may cause and what to do about them.

Keep your child home from school until he or she has completed at least 5 days of antibiotic treatment. If antibiotics are not prescribed, keep your child home 3 weeks (21 days) after the onset of the cough before returning to school. 

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 a fireplace. 

  • 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 doctor says it's OK.

  • Ask your child's doctors if others in the household should get a booster shop to help keep them from getting sick.


When to call your child's healthcare provider

Call your child's doctor right away if your child: 

  • Turns blue or has trouble breathing

  • Is exhausted after coughing spells

  • Has loss of appetite and eats poorly

  • Vomits after coughing spells

  • Is weak and looks sickly

  • Has a fever (see Fever and children, above)

  • Has signs of dehydration such as sunken eyes, dry mouth, dark or strong-smelling urine, or no urine output for 6 to 8 hours

  • Develops seizures

How can I prevent whooping cough?

Being vaccinated is the best way to protect against pertussis. Talk to your healthcare provider about whether your child needs a booster vaccination. Also, be sure to ask whether you need a booster as well. Most children get a vaccine against whooping cough starting at 2 months of age. It's often combined with vaccines for 2 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