EXPERT ADVICE: Why is my baby coughing so violently?

Does your baby cough till he throws up? He may have whooping cough, also known as pertussis.

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Her baby suffered endless nights and days having coughing fits, recalls mum of two Lynn Tay.

Her oldest child, Chevelle, now 6, was a “sickly baby”, who always seemed to have some illness or other, she says.

When Chevelle was 3 months old, she contracted a nasty cough which led to difficulty in breathing and sleeping. Tay says, “She would cough continuously for as long as 5 minutes, and it was heartbreaking for us, because she was so tiny.”

Because of her illness, Chevelle didn’t have much of an appetite, so she didn’t put on much weight. Tay adds, “As a new mum who was breastfeeding, I worried about whether she was getting enough milk.”

As Chevelle was so young, the doctor didn’t prescribe any medication for her at first, and told Tay that it was caused by a viral bug.

Some two weeks after the cough started, Tay noticed that her daughter seemed to be extremely lethargic and listless, so she took her to the A&E at a hospital. “She was drinking even less than before, so the doctor advised to have her warded. We later found out that she had pertussis.

Pertussis can affect people of all ages, but can be very serious, even deadly, for babies below 1.

Pertussis ― also known as a whooping cough ― is a highly contagious respiratory disease caused by the bordetella pertussis bacteria. The bacteria attaches to the cilia (hair-like structures) lining of the patient’s upper respiratory system and releases toxins, damaging the cilia and causing airways to swell.

The condition gets its name from the “whooping sound” that the patient may make while trying to take in deep breaths while coughing. This uncontrollable, violent coughing often makes it difficult to breathe. Pertussis can affect people of all ages, but can be very serious, even deadly, for babies below 1.

Dr Terence Tan, a paediatrician at Kinder Clinic at Mount Alvernia Hospital, notes that babies who have not yet received their vaccination that includes the pertussis vaccine are very susceptible to being infected.

“Typically these are babies younger than 6 to 12 weeks of age who have not received their DTPa vaccines (which is part of the 5-in1 or 6-in-1 combination vaccines).”

Pertussis can cause serious and even deadly complications in babies and you children who have not been vaccinated. These complications include pneumonia, convulsions and apnea. Many infected babies younger than 1 year old need to be hospitalised.

Thankfully, since the pertussis vaccine is part of the standard infant and childhood vaccination programme in Singapore, the condition is relatively uncommon compared to other viral infections.

Dr Tan says, “This is because most kids receive their vaccines after 6 to 12 weeks of age. However, there remains a window of susceptibility in the pre-vaccinated young babies in whom most of the infections occur.”

Adults aren’t spared from the condition ― though grownups usually suffer only a mild form of the infection. “As the protection from the vaccine wanes in adolescents, adult pertussis is thought to be quite common but mild,” says Dr Tan.

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What are the signs of pertussis?

Once the patient is exposed to the bacteria, symptoms usually develop within five to 10 days. Early symptoms may include a runny nose, low-grade fever and a mild, occasional cough. The mild symptoms make it difficult to diagnose.

Some babies, however, may show a symptom known as apnea, or a pause in the child’s breathing pattern.

The more “traditional” symptoms of pertussis may appear later. These include:

· Violent coughing fits followed by a “whoop” sound.

· Vomiting during or after coughing fits.

· Exhaustion after coughing fits.

The coughing fits may happen more frequently at night, and can go on for up to 10 weeks or more. That’s why the whooping cough is sometimes known as the “100 day cough.”

An extremely contagious condition, pertussis can spread to another person through coughing or sneezing, or when you spend a lot of time near an infected person in the same space. Babies usually get infected by older siblings, parents, or caregivers who might not even know they have the disease.

Diagnosis is often late – since early pertussis symptoms resemble a simple cough and cold

How do you prevent your baby from getting this disease?

While there’s a vaccine for pertussis, it’s not 100 per cent effective.

“Protection from the vaccine wanes as the children reach adolescence. So, adults are susceptible to pertussis infection unless they’re given a booster vaccination,” Dr Tan explains.

To prevent the spread of pertussis, it’s important to practise proper hand hygiene, and to cover your mouth, or wear a mask when sneezing and coughing. It’s also important to keep babies, as well as other people at high risk of complications, away from infected people.

How is pertussis treated?

Antibiotics may be used to treat pertussis. The response to the antibiotics is more effective when the condition is diagnosed early ― this shorten the duration of the illness and may even prevent the transmission of the infection.

However, Dr Tan notes that the illness is often diagnosed late, since early pertussis symptoms resemble a simple cough and cold.

He adds, “In such cases, antibiotic treatment may not be very effective and infected babies and children continue to have very prolonged and troublesome symptoms.”

Treating the cough and soothing the symptoms in young babies is difficult, too, because cough suppressants are not suitable for them. He says, “Humidification of the air seems to help with bouts of severe cough. The effect of other methods such as diffusing of essential oils, is not known.”

He has tips on stemming the spread of pertussis:

· Get vaccinated Make sure your children get their routine vaccinations on time.

· Be responsible Adults and adolescents ― who may only display mild or minimal symptoms ― are the most common sources of pertussis infection, passing their germs to unvaccinated babies. The most common symptom is a “cough that doesn’t seem to go away.”

· Expectant mums should look into prevention Get advice from your ob-gyn about getting vaccinated.

· Prepare for the arrival of your newborn If possible, all adults in the household involved in caring for the newborn should get the pertussis jab.

Photos: iStock

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