Whooping Cough: Babies May Not Cough at All

Key takeaways

According to CDC, many babies with whooping cough do NOT cough at all — instead they have pauses in breathing, and those pauses can turn them blue. Waiting to hear a cough before worrying is waiting for the wrong sign.
CDC's materials for healthcare professionals say it plainly: in babies, pauses in breathing may be the ONLY symptom, with little or no cough. If you see a baby stop breathing or turn blue, call 115.
According to CDC, whooping cough starts out looking like an ordinary cold — and for some babies it can look like a cold for the WHOLE illness, not just at the beginning.
In older children and adults the signs are coughing in long bursts, a high-pitched whoop on breathing in, vomiting after a bout, and exhaustion after it — but between bouts they usually look perfectly well.
According to CDC, many babies who catch whooping cough get it from an older sibling, a parent or a carer — people who do not know they have it. If anyone in a house with a baby under one has a persistent cough, that person must be seen and must not hold the baby.
According to CDC, do not use cough medicines unless a doctor prescribes them because they hardly help in this illness; antibiotics started early can make the illness milder, while starting after three weeks is of almost no benefit.

The most important thing first, because it runs against what everyone expects: in a baby, whooping cough may not produce a cough at all.

Recognising it: in a baby, whooping cough may not cough

According to CDC, many babies with whooping cough do not cough at all; instead they have pauses in breathing — CDC calls these life-threatening pauses in breathing — and such a pause can turn the baby blue or leave them struggling for air.

CDC's materials for healthcare professionals add that in babies, pauses in breathing may be the only symptom, with little or no cough. CDC also says that for some babies the illness looks like an ordinary cold for the whole of it — so “she is only snuffly, she is still feeding” rules nothing out.

In older children and adults: coughing in bursts

According to CDC, the first one to two weeks look exactly like a cold: a runny or blocked nose, a mild fever, a mild occasional cough; only after that do the violent coughing bouts begin.
The cough comes in BOUTS: a long burst of rapid coughs one after another, almost without a chance to draw breath, and then it stops.
According to CDC, breathing in after a coughing bout can produce a high-pitched whoop — the name of the illness comes from it; vomiting during or just after a bout is another common sign.
According to CDC, the characteristic whoop is less common in teenagers and adults — not hearing it rules nothing out.

What to do

With a baby: take the clothes off and look at the chest, and look at the baby's face while they are asleep too — do not wait to see whether there is a cough.
Write down three dates on paper: when the runny nose began, when the cough began, when the cough turned into bouts.
Film a bout of coughing and take it with you to the appointment — according to CDC, between bouts the person usually looks well.
According to CDC: drink plenty of fluids; eat small amounts more often so there is less vomiting; keep the house free of tobacco smoke, dust and chemical fumes; a clean cool-mist vaporiser can be used to loosen the mucus.
Keep whoever is coughing away from babies and from anyone pregnant: a mask, a separate room to sleep in, separate towels and cups.
Name everyone who has been close to the person who is ill — people living in the household may need antibiotics to prevent it, which is for the health authorities to decide.

What NOT to do

Do NOT buy cough medicine yourself. According to CDC, do not use cough medicines unless a doctor prescribes them — they hardly help in this illness.
Do NOT buy antibiotics yourself and wait at home. Whether any are needed, which ones, and who in the household should take them to prevent it, are decided by a doctor and the health authorities after testing.
Do NOT wait for the cough to stop before being seen. According to CDC, antibiotics started early can make the illness milder, while starting after three weeks is of almost no benefit — even though the cough is still there.
Do NOT let anyone with a persistent cough hold a baby or sleep beside one, even if they believe they just have a lingering cough after a cold.
Do NOT treat “no high fever yet” or “the baby is still feeding” as evidence that rules it out.
Do NOT treat having been vaccinated as the end of it — according to CDC, protection fades over time. Being vaccinated and having a sign from the box below still means being seen.

An adult with a persistent cough is where a baby catches it

According to CDC, babies under one year old are at the highest risk both of catching whooping cough and of severe complications, and many of them catch it from an older sibling, a parent or a carer — people who do not know they have it. The bacteria spread easily through the air, and according to CDC someone who is ill remains infectious for at least two weeks after the cough begins.

How serious it gets: according to CDC's materials, about one in three babies under one year old who catch whooping cough need treatment in hospital; the two commonest complications are pauses in breathing and pneumonia.

When you must go to hospital

GO TO EMERGENCY CARE or call 115 (the emergency number in Vietnam) NOW if any of the following is present — according to CDC, difficulty breathing on its own is a sign to be seen immediately. In a baby: any pause in breathing, even of a few seconds; the lips, the area around the mouth, the face or the fingertips turning blue or grey; struggling to breathe, with the hollow at the breastbone and the spaces between the ribs sucking in and the nostrils flaring; refusing the breast or unable to feed; floppy, drowsy, hard to wake; seizures. At any age: difficulty breathing or rapid breathing; coughing so hard that no breath can be drawn between bouts; a face going blue or grey-pale during a bout; new confusion; seizures; vomiting so much that nothing can be drunk; not passing urine. — BE SEEN THE SAME DAY: anyone in a house with a baby under one year old or someone pregnant has a persistent cough; or you have just been close to someone diagnosed with whooping cough, even with no symptoms. — BE SEEN WITHIN 24–72 HOURS: coughing in long bursts, vomiting after a bout, or a whoop on breathing in; a persistent cough of several weeks that is not easing; a coughing child who is not fully vaccinated against whooping cough. — If you are unsure, ring and ask; with a sign from the group above, go first and ring afterwards.

What belongs at home, and what belongs in hospital

Put plainly: suspected whooping cough in a baby is a matter for hospital. The confirming test is done at a medical facility and pauses in breathing need continuous monitoring — at home it can be neither diagnosed nor treated; we are not a substitute for the child's paediatrician.

The role of Y Te Xanh (GreenCare) is mainly with the adults or the older children in the household who are coughing: a remote consultation so you can decide between being seen now and waiting for an appointment, and a doctor coming to the house to take a history, examine, and say clearly which cases must go to a medical facility. With a sign in the box above, go in first and call afterwards.

Prevention: CDC recommends whooping cough vaccination for everyone, adults and pregnant women included. Which dose, when, and for whom are questions for a doctor or an immunisation service.

The points in this article follow the public materials of the US CDC on whooping cough, including the pages for healthcare professionals; it passes them on and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

CDC — About Whooping Cough

Frequently asked questions

My baby does not cough but sometimes stops breathing — could that be whooping cough?

Nobody can say by eye, but this is exactly the kind of presentation that means going now rather than watching longer. According to CDC, many babies with whooping cough do not cough at all but have life-threatening pauses in breathing, and such a pause can turn the baby blue; CDC's materials for healthcare professionals go further and say that in babies the pause in breathing may be the only symptom. Whether the cause is whooping cough or something else, a baby who stops breathing or turns blue is an emergency: call 115 or go to the nearest medical facility, do not wait for morning.

How does whooping cough differ from an ordinary cough — can you tell from the sound?

The sound helps a little, but not enough to rule anything out. According to CDC, what is characteristic is coughing in long bursts of rapid coughs one after another, a high-pitched whoop on breathing in after a bout, vomiting during or after it, and great exhaustion afterwards while between bouts the person looks well. But also according to CDC, that whoop is less common in teenagers and adults, and in babies there may be no cough at all. So the reliable way to tell is not to keep listening but to be seen and tested, particularly once a cough has run for several weeks.

Do adults get whooping cough? I have been coughing for weeks and still going to work.

They do, and this is a situation worth being seen for. According to CDC, the illness in teenagers and adults is usually milder with the characteristic whoop less often heard, so many people simply think they have a lingering cough after a cold. The problem is the route of transmission: according to CDC, many babies with whooping cough catch it from an older sibling, a parent or a carer who does not know they have it, and someone who is ill can be infectious from the first symptoms until at least two weeks after the cough begins. If there is a baby under one or anyone pregnant at home or where you go, be seen the same day and keep away from the baby while you wait.

Someone in our household has been diagnosed with whooping cough — what should the family do?

The family's job is not to buy preventive medicine themselves but to give the medical facility full information and then follow their instructions. According to CDC, people living in the same household as a case of whooping cough and those in groups at high risk of severe illness — babies under one year old among them — should be given antibiotics to prevent it, and this needs assessing by a doctor or the health authorities. Meanwhile: whoever is coughing wears a mask, sleeps in a separate airy room and does not hold the baby; everyone washes their hands; and you name the people who have been close to the person so the health service knows who to monitor.

Can you still get whooping cough after being vaccinated?

Vaccination reduces the risk a great deal, but it is not a reason to ignore the signs. According to CDC, whooping cough vaccines work well but protection fades over time, and CDC recommends vaccination for everyone, adults and pregnant women included. So if you are coughing in bursts, vomiting after a bout, or there is a baby in the house, be seen and tell the doctor clearly whether you have been vaccinated and roughly when you last had a dose. The schedule and boosters are questions for a doctor or an immunisation service, not something to settle from an article.

How long does whooping cough last? If the cough goes on, has the treatment failed?

Not necessarily. According to CDC, the coughing bouts of whooping cough usually last one to six weeks and can run to ten, so still coughing after treatment is a common course rather than a sign the medicine is not working. Also according to CDC, starting antibiotics after three weeks of illness is of almost no benefit even though the person still has symptoms — which is why being seen early matters more than waiting to see whether the cough stops. What to watch during recovery is breathing and feeding: difficulty breathing, vomiting so much that nothing can be drunk, or any pause in breathing in a baby means being seen again straight away.