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How to Tell If Your Child's Cough is Serious

Crying, coughing child on his bed, is it pertussis, croup or RSV?

A coughing child is always concerning to parents and caregivers. Christine Davis, DO, UnityPoint Health, describes three of the most common childhood illnesses causing cough – RSV, croup and whooping cough. Beware, the germs that cause these illnesses are contagious, so you’ll want to take precautions to prevent the spread of infection.

How Do You Know If Your Child Has Whooping Cough?

  • Coughing symptom: Severe, hacking coughing spells; gasping for breath while making the high-pitched whooping sound
  • Other symptoms: Fatigue/tiredness, low-grade fever, runny nose/congestion, apnea (pause in breathing), low heart rate, decreased appetite
  • Time of year: Year-round
  • Treatment: Antibiotics

Pertussis, better known as whooping cough, is an acute, upper respiratory tract infection usually caused by bacteria. It gets the name “whooping cough” due to the characteristic, high-pitched “whooping” sound people make when gasping for breath during severe outbreaks of violent and uncontrollable coughing. This whooping sound is most common in young children. Dr. Davis says whooping cough can last anywhere from two to three months and is characterized by stages of illness.

3 Stages of Whooping Cough

  • Catarrhal stage (1-2 weeks). Symptoms are the same as a mild cold or upper respiratory infection, including fatigue, runny nose/congestion, sneezing and a mild cough.
  • Paroxysmal stage (some studies suggest 6-10 weeks). Symptoms shift to severe coughing spells that can result in vomiting from coughing so hard. Infants can have episodes where they stop breathing (apnea), have low heart rates and poor feeding.
  • Convalescent stage (2-3 weeks). Begins when the severe coughing fades, but infected individuals are at increased risk for respiratory complications if they catch another respiratory infection during this time.

“People with whooping cough can vary in presentation from no symptoms, to mild upper respiratory infection, to severe, persistent cough,” Dr. Davis says. “The degree of illness usually varies by age, with young infants being the most severely affected. We also take into consideration whether someone received the whooping cough vaccine.”

Whooping cough can be deadly in infants. Babies younger than 12 months old are at high risk for severe complications, as they haven’t completed the vaccination series. Infants less than 6 months old usually require hospitalization when infected with pertussis.

When is Whooping Cough Most Contagious?

Whooping cough is contagious and spreads through respiratory droplets (small particles in the air) released from the body by coughing or sneezing. Whooping cough is most contagious during early stages and up to about two weeks after the cough begins. To reduce the spread of the illness, wash hands often with soap and water for at least 20 seconds, and clean toys/frequently touched surfaces often.

Can Adults Get Whooping Cough?

Pertussis can be very mild or show no symptoms at all in adults. But Dr. Davis says whooping cough is one of the most common causes of chronic cough lasting more than three to four weeks in adults and adolescents.

“Pertussis outbreaks largely decreased after universal adoption of the immunization in the 1940s. However, these rates have risen recently, and new vaccination recommendations focus on adult boosters, as adults are the main transmitters of whooping cough to infants. All health care workers, childcare workers and families of pregnant women and infants should get a Tdap (Tetanus, Diphtheria, Acellular Pertussis) shot,” Dr. Davis says.

Dr. Davis recommends adults over 65 years old also receive the Tdap booster, and pregnant women should get a Tdap during every pregnancy, preferably at 27-36 weeks. Kids ages 11-18 also need a Tdap booster from the original vaccine they received as babies, too.

Most primary care offices don’t offer a rapid pertussis diagnosis test, like what is done to determine if you have influenza or strep. Depending on what’s available, your provider will do culture testing or a polymerase chain reaction (PCR) test – similar to what’s done for COVID-19.

“Anyone with pertussis, or exposed to it, should be treated with antibiotics. Unfortunately, antibiotics don’t improve clinical symptoms or decrease the risk of complications, but medication will reduce the transmission of the disease to others,” Dr. Davis says.

Croup in Kids

  • Coughing symptom: Barking or seal-sounding cough causing a raspy/hoarse voice, cough worse at night; squeaky breathing noises from stridor
  • Other symptoms: Low-grade fever, runny nose/congestion
  • Time of year: Worse in the fall and winter
  • Treatment: Oral steroid

Croup is a virus characterized by a low-grade fever with runny nose/congestion, followed by a “barking” cough, and sometimes, respiratory distress in children 6 months to 3 years old. Dr. Davis says children over 3 years old can get croup, but it is more unusual, and it would be extremely unusual over age 5.

“A croup cough is very distinctive and often alarming to parents. The viruses that cause croup cause swelling in the upper airways, which results in a raspy voice, barking cough (often compared to a seal) and stridor – a high-pitched, squeaky noise with breathing. Symptoms of croup tend to become much worse at night,” Dr. Davis says.

Mild cases of croup are treated with a single dose of oral steroid, called dexamethasone. This helps croup symptoms improve within two to three days. But Dr. Davis says occasionally, if croup is severe, a child may be in enough respiratory distress to have a special type of nebulizer treatment done in the office or emergency room.

“Irritation and crying can make croup worse. Comfort your child and keep them calm and distracted by cuddling, reading a book or singing,” Dr. Davis says.

When is Croup Most Contagious?

Croup is contagious and spreads through respiratory droplets (small particles in the air) released from the body by coughing or sneezing. Croup is most contagious for three days after the illness begins or until the fever is gone. Remember, to reduce the spread of the illness, wash hands often with soap and water for at least 20 seconds, and clean toys/frequently touched surfaces often.

Treating Croup at Home

Once your child receives the oral steroid, you can take some measures to keep them comfortable at home. Dr. Davis suggests:

  • Encourage fluids
  • Reduce fever with acetaminophen or ibuprofen (ibuprofen only if 6 months old and above)
  • Try using a humidifier for calming; studies show it doesn’t change croup severity
  • If it’s cool outside, take a car ride with the windows slightly down. Cold air can help.

RSV in Infants & Toddlers

  • Coughing symptom: Wet and forceful cough; sounds like fluid-filled lung; includes wheezing and labored breathing
  • Other symptoms: Runny nose/congestion, fever, decrease appetite, dehydration
  • Time of year: Typically, between December and March
  • Treatment: Supportive care, like most colds

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis, a lower respiratory tract infection. Most often, bronchiolitis occurs in infants and young children 2 years old and younger. Children with RSV typically have two to four days of upper respiratory tract symptoms, such as fever and runny nose/congestion. These are then followed by lower respiratory tract symptoms, like increasing wheezing cough that sounds wet and forceful with increased work breathing. Many infants exhibit poor feeding and signs of dehydration as well.

“At some point, nearly all children have been infected with RSV prior to 2 years old. Some children may require supplemental oxygen to maintain their oxygen levels, which would require a hospital stay,” Dr. Davis says.

Infants at increased risk for severe RSV include those:

  • Born before 29 weeks
  • With chronic lung disease of prematurity
  • With certain types of heart disease

“Children with any of these situations should receive medication called Synagis to protect them during RSV season. Talk to your pediatrician or provider if you have further questions,” Dr. Davis says.

When is RSV Most Contagious?

RSV is contagious and spreads through respiratory droplets (small particles in the air) released from the body by coughing or sneezing. RSV is most contagious for 3 to 8 days when symptoms are showing. Remember, to reduce the spread of the illness, wash hands often with soap and water for at least 20 seconds, and clean toys/frequently touched surfaces often.

How to Treat RSV at Home

RSV varies depending on the severity of the illness, but mild cases can be managed at home. It usually lasts five to seven days, but the cough can linger. Dr. Davis says the main RSV treatment is the same as most colds:

  • Maintain hydration and regular eating habits
  • Reduce fever with acetaminophen or ibuprofen (ibuprofen only if 6 months old and above)
  • Use saline nasal drops and suction nasal passageways with a bulb or nasal aspirator (like NoseFrida)

Warning Signs of RSV, Croup & Whooping Cough

Any signs of respiratory distress or difficulty breathing are red flags. If your child appears to be working hard to breathe (breathing quickly, retracting, has blue lips) or is wheezing, please seek medical attention immediately. Also, watch for signs of dehydration, such as poor feeding, decreased amount of wet diapers and inactivity.

If your child is having respiratory distress, immediately call your child’s primary care office, go to urgent care or consider a visit to the emergency department.

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