Symptoms of whooping cough infant

Whooping Cough (Pertussis) (for Parents)

Whooping cough (pertussis) is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It mainly affects babies younger than 6 months old who aren't yet protected by immunizations, and kids 11 to 18 years old whose immunity has started to fade.

Whooping cough causes severe coughing spells, which can sometimes end in a "whooping" sound when the child breathes in.

Signs & Symptoms

The first symptoms of whooping cough are similar to those of a common cold:

runny nose
sneezing
mild cough
low-grade fever

After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, a child may turn red or purple. At the end of a spell, the child may make the characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.

While many infants and younger kids with whooping cough develop the coughing fits and accompanying whoop, not all do. And sometimes babies don't cough or whoop as older kids do. Infants may look as if they're gasping for air with a reddened face and may actually stop breathing (this is called apnea) for a few seconds during very bad spells.

Adults and teens may have milder or different symptoms, such as a prolonged cough (rather than coughing spells) or coughing without the whoop.

P

Contagiousness

Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person's nose or mouth. These may become airborne when the person sneezes, coughs, or laughs. Others then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.

Infected people are most contagious during the earliest stages of the illness for up to about 2 weeks after the cough begins. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment.

Prevention

Whooping cough can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization.

DTaP immunizations are routinely given in five doses before a child's sixth birthday. For additional protection in case immunity fades, experts recommend that kids ages 11-18 get a booster shot of the new combination vaccine (called Tdap), ideally when they're 11 or 12 years old.

The Tdap vaccine is similar to DTaP but with lower concentrations of diphtheria and tetanus toxoid. It also should be given to adults who did not receive it as preteens or teens. The vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had the vaccine before, or when it was last given.

Getting the vaccine is especially important for people who are in close contact with infants, because babies can develop severe and potentially life-threatening complications from whooping cough. An adult's immunity to whooping cough lessens over time, so getting vaccinated and protecting yourself against the infection also helps protect your infant or child from getting it.

As is the case with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information.

People who live with or come into close contact with someone who has pertussis should receive antibiotics to prevent the spread of the disease, even if they've already been vaccinated against it. Young kids who have not received all five doses of the vaccine may need a booster dose if exposed to an infected family member.

Incubation

The incubation period (the time between infection and the start of symptoms) for whooping cough is usually 7 to 10 days, but can be as long as 21 days.

P

Duration

Pertussis usually causes prolonged symptoms — 1 to 2 weeks of common cold symptoms, followed by up to 3 months of severe coughing.

The last stage consists of another few weeks of recovery with gradual clearing of symptoms. In some children, the recovery period can last for months.

Treatment

Call the doctor if you suspect that your child has whooping cough. To make a diagnosis, the doctor will take a medical history, do a thorough physical exam, and may take nose and throat mucus samples to be checked in a lab. Blood tests and a chest X-ray also might be done.

Whooping cough is treated with antibiotics. Many experts believe that antibiotics are most effective in shortening the length of the infection when they're given in the first stage of the illness, before coughing spells begin. But even if antibiotics are started later, they're still important because they can stop the spread of the pertussis infection to others. Ask your doctor whether preventive antibiotics or vaccine boosters for other family members are needed.

Some kids with whooping cough need to be treated in a hospital. Babies and younger children are more likely to be hospitalized because they're at greater risk for problems like pneumonia. Whooping cough can be life-threatening for infants younger than 6 months, so they almost always need hospital treatment.

Other potential complications include difficulty breathing, periods of apnea, needing oxygen (particularly during a coughing spell), and dehydration.

While in the hospital, a child may need suctioning to clear the airways. Breathing will be watched closely, and oxygen given if needed. Intravenous (IV) fluids might be needed if a child shows signs of dehydration or has difficulty eating. Precautions will be taken to prevent the infection from spreading to other patients, hospital staff, and visitors.

P

Home Care

If your child is being treated for pertussis at home, follow the schedule for giving antibiotics exactly as your doctor prescribed. Giving cough medicine probably will not help, as even the strongest usually can't relieve the coughing spells of whooping cough. The cough is actually the body's way of trying to clear the airways. (Due to potential side effects, cough medicines are never recommended for children under age 6.)

During recovery, let your child rest in bed and use a cool-mist vaporizer to help soothe irritated lungs and breathing passages. (Be sure to follow directions for keeping it clean and mold-free.) And keep your home free of irritants that can trigger coughing spells, such as aerosol sprays; tobacco smoke; and smoke from cooking, fireplaces, and wood-burning stoves.

Kids with whooping cough may vomit or not eat or drink much because of the coughing. So offer smaller, more frequent meals and encourage your child to drink lots of fluids. Watch for signs of dehydration, including thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to pee (or in infants, fewer wet diapers).

When to Call the Doctor

Call the doctor if you think that your child has whooping cough or has been exposed to someone with whooping cough, even if your child has already had all scheduled pertussis immunizations.

This is especially important if your child has long coughing spells and:

the coughing make your child's skin or lips turn red, purple, or blue
your child vomits after coughing
there's a whooping sound after the cough
your child has trouble breathing or seems to have brief periods of not breathing (apnea)
your child seems very sluggish

If your child has been diagnosed with whooping cough and is being treated at home, get immediate medical care if he or she develops difficulty breathing or shows signs of dehydration.

Whooping cough - Symptoms and causes

Overview

Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop."

Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded.

Deaths associated with whooping cough are rare but most commonly occur in infants. That's why it's so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.

Products & Services

Book: Mayo Clinic Guide to Raising a Healthy Child

Symptoms

Once you become infected with whooping cough, it takes about seven to 10 days for signs and symptoms to appear, though it can sometimes take longer. They're usually mild at first and resemble those of a common cold:

Runny nose
Nasal congestion
Red, watery eyes
Fever
Cough

After a week or two, signs and symptoms worsen. Thick mucus accumulates inside your airways, causing uncontrollable coughing. Severe and prolonged coughing attacks may:

Provoke vomiting
Result in a red or blue face
Cause extreme fatigue
End with a high-pitched "whoop" sound during the next breath of air

However, many people don't develop the characteristic whoop. Sometimes, a persistent hacking cough is the only sign that an adolescent or adult has whooping cough.

Infants may not cough at all. Instead, they may struggle to breathe, or they may even temporarily stop breathing.

When to see a doctor

Call your doctor if prolonged coughing spells cause you or your child to:

Vomit
Turn red or blue
Seem to be struggling to breathe or have noticeable pauses in breathing
Inhale with a whooping sound

Request an Appointment at Mayo Clinic

From Mayo Clinic to your inbox

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Causes

Whooping cough is caused by a type of bacteria called Bordetella pertussis. When an infected person coughs or sneezes, tiny germ-laden droplets are sprayed into the air and breathed into the lungs of anyone who happens to be nearby.

Risk factors

The whooping cough vaccine you receive as a child eventually wears off. This leaves most teenagers and adults susceptible to the infection during an outbreak — and there continue to be regular outbreaks.

Infants who are younger than age 12 months who are unvaccinated or haven't received the full set of recommended vaccines have the highest risk for severe complications and death.

Complications

Teens and adults often recover from whooping cough with no problems. When complications occur, they tend to be side effects of the strenuous coughing, such as:

Bruised or cracked ribs
Abdominal hernias
Broken blood vessels in the skin or the whites of your eyes

Infants

In infants — especially those under 6 months of age — complications from whooping cough are more severe and may include:

Pneumonia
Slowed or stopped breathing
Dehydration or weight loss due to feeding difficulties
Seizures
Brain damage

Because infants and toddlers are at greatest risk of complications from whooping cough, they're more likely to need treatment in a hospital. Complications can be life-threatening for infants younger than 6 months old.

Prevention

The best way to prevent whooping cough is with the pertussis vaccine, which doctors often give in combination with vaccines against two other serious diseases — diphtheria and tetanus. Doctors recommend beginning vaccination during infancy.

The vaccine consists of a series of five injections, typically given to children at these ages:

2 months
4 months
6 months
15 to 18 months
4 to 6 years

Vaccine side effects

Side effects of the vaccine are usually mild and may include a fever, crankiness, headache, fatigue or soreness at the site of the injection.

Booster shots

Adolescents. Because immunity from the pertussis vaccine tends to wane by age 11, doctors recommend a booster shot at that age to protect against whooping cough (pertussis), diphtheria and tetanus.
Adults. Some varieties of the every-10-year tetanus and diphtheria vaccine also include protection against whooping cough (pertussis). This vaccine will also reduce the risk of your transmitting whooping cough to infants.
Pregnant women. Health experts now recommend that pregnant women receive the pertussis vaccine between 27 and 36 weeks of gestation. This may also give some protection to the infant during the first few months of life.

Preventive medications

If you've been exposed to someone who has whooping cough, your doctor may recommend antibiotics to protect against infection if you:

Are a health care provider
Are pregnant
Are younger than age 12 months
Have a health condition that could put you at risk of severe illness or complications, such as a weakened immune system or asthma
Live with someone who has whooping cough
Live with someone who is at high risk of developing severe illness or complications from a whooping cough infection

By Mayo Clinic Staff

Associated Procedures

Products & Services

Symptoms and treatment of whooping cough in children.

Advice to parents

Whooping cough can affect both adults and children. Immunity from this respiratory infection is developed only after a person has been ill once. In children, the manifestations are more severe, and complications can be very serious, even fatal. Vaccination is done in the first months of life. It does not guarantee complete protection against infection, but in vaccinated children, the disease occurs in a much milder form. Doctors recommend that parents, when caring for children with whooping cough, protect them as much as possible from any factors that provoke the appearance of a suffocating cough.

Features of whooping cough

The causative agent of this disease is whooping cough (a bacterium called Bordetella). The infection affects the trachea and bronchi.

The airways are lined with what is known as ciliated epithelium, whose cells have "cilia" that allow sputum to move and be expelled to the outside. When irritated by their toxic substances secreted by whooping cough pathogens, the nerve endings transmit a signal from the epithelium to the brain (to the area responsible for coughing). The response is a reflex cough, which should push out the source of irritation. Bacteria are firmly held on the epithelium due to the fact that they have special villi.

It is characteristic that the cough reflex becomes so fixed in the brain that even after the death of all bacteria, strong urges to cough continue to persist for several more weeks. Waste products of pertussis bacteria cause general intoxication of the body.

Warning: Humans have no innate immunity to this disease. Even a baby can get sick. Therefore, it is so important to protect him from contact with adults who have a strong persistent cough. It may well be a sign of whooping cough, which in an adult, as a rule, does not have other characteristic manifestations.

A person's susceptibility is so great that if a baby falls ill, the rest of the family will certainly get infected from it. Whooping cough lasts 3 months as long as the cough reflex exists. In this case, for about 2 weeks, the disease has practically no symptoms. If somehow it is possible to establish in the very first days that pertussis bacteria are present in the body, then the disease can be quickly suppressed, since the dangerous cough reflex has not yet had time to gain a foothold. Usually, the symptoms of whooping cough in children are detected already at a severe stage. Then the disease continues until the cough gradually disappears on its own.

How infection occurs

Children under the age of 6-7 are most often infected with whooping cough. Moreover, in babies younger than 2 years, the probability of infection is 2 times higher than in older children.

The incubation period for whooping cough is 1-2 weeks. Within 30 days, the child should not attend a childcare facility, contact with other children, since whooping cough is very contagious. Infection is possible only by airborne droplets in close contact with a sick person or a carrier when he sneezes or coughs.

Outbreaks of the disease occur more often in the autumn-winter period. This is due to the fact that whooping cough bacteria quickly die under the rays of the sun, and the duration of daylight hours in winter and autumn is minimal.

Forms of whooping cough

When infected with whooping cough, the disease may occur in one of the following forms:

Typical - the disease develops sequentially with all its inherent signs.
Atypical (erased) - the patient only coughs slightly, but there are no severe attacks. For some time, the cough may disappear altogether.
In the form of a bacteriocarrier, when there are no signs of the disease, but the child is a carrier of bacteria.

This form is dangerous because other people can be infected, while the parents are sure that the baby is healthy. Most often, this form of whooping cough occurs in older children (after 7 years), if they have been vaccinated. The baby remains a carrier also after recovery from a typical whooping cough up to 30 days from the moment the infection enters his body. Often in such a latent form, whooping cough manifests itself in adults (for example, workers in child care facilities).

The first signs of whooping cough

At the initial stage, the disease does not cause much concern for parents, because the first signs of whooping cough resemble the common cold. The baby has severe chills due to rising temperature, headache, weakness. Snot appears, and then an increasing dry cough. And the usual cough medicines do not help. And only after a few days, symptoms of a typical whooping cough may appear, which gradually increase.

Periods of illness and characteristic symptoms of whooping cough

There are the following periods for the development of symptoms of whooping cough in a child:

Incubation. The infection has already occurred, but there are no first signs of the disease. They appear only on the 6-14th day from the moment the bacteria enters the body.
Prodromal. This is a period associated with the appearance of whooping cough harbingers: a dry, gradually increasing (especially at night) cough, a slight increase in temperature. At the same time, the child feels well. But this state lasts 1-2 weeks without change.
Spasmodic. There are bouts of convulsive coughing associated with an attempt to push out something that irritates the respiratory tract, it is difficult to inhale air. After several coughing exhalations, a deep breath follows with a characteristic whistling sound (reprise) arising from a spasm of the larynx in the vocal cords. After that, the baby convulsively shudders several times. The attack ends with the release of mucus or vomiting. Coughing fits with whooping cough can be repeated from 5 to 40 times a day. The frequency of their occurrence is a characteristic of the severity of the disease. During an attack, the child's tongue sticks out, the face has a red-blue color. The eyes turn red, as blood vessels burst due to stress. It is possible to stop breathing for 30-60 seconds. This period of illness lasts approximately 2 weeks.
Reverse development (permission). The cough gradually weakens, attacks appear for another 10 days, the pauses between them increase. Then severe symptoms disappear. The child coughs a little for another 2-3 weeks, but the cough is normal.

Note: In infants, painful attacks do not last long, but after a few coughing movements, respiratory arrest may occur. Oxygen starvation of the brain causes diseases of the nervous system, developmental delays. Even death is possible.

Possible complications

Complications of whooping cough can be inflammation of the respiratory system: lungs (pneumonia), bronchi (bronchitis), larynx (laryngitis), trachea (tracheitis). As a result of the narrowing of the lumen of the respiratory passages, as well as spasms and swelling of the tissues, death can occur. Especially quickly bronchopneumonia develops in children under the age of 1 year.

Possible complications such as emphysema (bloating), pneumothorax (damage to the wall of the lung and the release of air into the surrounding cavity). Strong tension during an attack can cause an umbilical and inguinal hernia, nosebleeds.

After whooping cough due to cerebral hypoxia, tissue damage to individual centers sometimes occurs, as a result of which the child has impaired hearing or epileptic seizures. Seizures are very dangerous, which also occur due to disruption of the brain and can lead to death.

As a result of straining when coughing, there is damage to the eardrums, hemorrhage in the brain.

Diagnosis of whooping cough in children

If a child has mild and atypical whooping cough, diagnosis is very difficult. The doctor may assume that the malaise is caused by this particular disease in the following cases:

the child has a cough that does not go away for a long time, the symptom only intensifies, while the runny nose and fever stopped after 3 days;
expectorants do not have any effect, on the contrary, the state of health worsens after taking them;
Between coughing fits, the baby seems healthy and has a normal appetite.

In this case, to make sure that the patient has whooping cough, a bacteriological culture of a throat swab is done. The difficulty lies in the fact that the bacterium is sufficiently firmly held by the ciliated epithelium and is not brought out. The likelihood that even in the presence of pertussis pathogens they can be detected in this way is reduced to zero if the child has eaten or brushed his teeth before the procedure. They will be completely absent in the sample if the baby was given even an insignificant dose of antibiotic.

A general blood test is also done, which allows you to detect a characteristic increase in the content of leukocytes and lymphocytes.

Methods for diagnosing pertussis bacilli by blood tests for antibodies (ELISA, PCR, RA) are used.

Warning: If there are symptoms of whooping cough, the child must be isolated to avoid infecting others. In addition, his situation may worsen after communicating with patients with a cold or flu. Even after recovery, the body is weakened, the slightest hypothermia or infection causes severe complications of whooping cough.

Treatment of whooping cough in children

Whooping cough is mainly treated at home, unless it occurs in infants under 1 year of age. Their complications develop rapidly, the baby can simply not have time to save. A child of any age is hospitalized if complications arise.

First aid at home for whooping cough

During a coughing fit, the baby should not lie down. He must be planted immediately. The temperature in the room should be no more than 16 degrees. Turn off the heating completely and use a sprinkler to humidify the air.

It is important to calm and distract the baby with the help of toys and cartoons. Since the cause of coughing is the excitation of the nerve center of the brain, fear and excitement provoke increased coughing and spasm in the respiratory tract. At the slightest deterioration in the condition, it is urgent to call an ambulance.

How to alleviate the condition and speed up recovery

A sick baby needs to walk every day to prevent brain hypoxia and improve breathing. At the same time, one must remember that it can infect other children. The patient should not be nervous.

An attack can be provoked by improperly organized nutrition. It is necessary to feed the baby often and little by little, mainly liquid food, since the chewing movement also causes coughing and vomiting. Warning: In no case is it recommended to self-medicate, use "grandmother's remedies" to get rid of a cough. The nature of the cough in this case is such that heating and infusions do not get rid of it, and an allergic reaction to plants can lead to a state of shock.

Treatment with antibiotics

Whooping cough is usually detected at a stage when the cough reflex, which is the main danger, has already developed. In this case, antibiotics do not help.

At the early warning stage, the baby is given only antipyretic medicine if there is a slight rise in temperature. It is impossible to give him expectorants when a dry paroxysmal cough appears on his own, since the movement of sputum will cause increased irritation of the respiratory tract.

Antibiotics (namely erythromycin, which has no harmful effect on the liver, intestines and kidneys) are used to treat children for whooping cough at a very early stage, before severe coughing fits have yet appeared.

They are taken more often for preventive purposes. If someone in the family has whooping cough, then taking an antibiotic will protect children from the action of the bacterium. It kills the microbe before a cough develops. The antibiotic will also help not to get sick to adult family members caring for a sick baby.

Prevention

Since whooping cough is highly contagious, if cases of the disease are detected in a children's institution, all children and adults who have been in contact with the patient are examined and preventively treated.

Infection with whooping cough is especially dangerous for infants. Therefore, it is necessary to limit the child's stay in crowded places and communication with unfamiliar children and adults. If a child is brought from the hospital, while one of the family members is sick, it is necessary to completely exclude his contact with the baby.

Vaccination is the main preventive measure. It reduces the risk of infection. In the case of whooping cough, the course is much easier.

Whooping cough in children: symptoms, treatment

Whooping cough in children is an infectious disease caused by pertussis bacillus Borde-Jangu, which affects the organs of the respiratory system. The pathological process is accompanied by an hysterical paroxysmal unproductive cough, at the end of which vomiting may occur.

Causes of development

Whooping cough in children is perhaps one of the most common childhood infections, which is transmitted by airborne droplets through contact with an ill child. A feature of this disease is that even a newborn child can get sick, that is, there is no innate immunity, and the younger the child, the more difficult the infectious process will be. Fortunately, whooping cough outbreaks can be prevented by routine childhood vaccinations.

Whooping cough symptoms in children

The incubation period of the disease from the moment the whooping cough bacillus enters the body until the first signs of infection appear in the child is from 2 to 7 days. Whooping cough begins with a child's frequent dry cough that gets worse at night. An increase in body temperature up to 37-37.5 degrees can also be observed, but more often it still remains within the normal range.

Unfortunately, diagnosing the disease at this stage of the course is almost impossible - unless you know for sure that your child has been in close contact with whooping cough. Many parents do not attach importance to the child's cough at all, and continue to take him to kindergarten or school, which is sad, since it is at this stage that the patient is extremely contagious to others. Then the next period of whooping cough begins, characterized by an increase and rapid progression of symptoms:

the child develops a paroxysmal spasmodic cough, which consists of several jumps (convulsive breaths) following one after another without stopping - this leads to the fact that the child cannot even inhale;
wheezing noisy breath after the end of the attack - since during the coughing shocks the child was not able to fully inhale the air, he does this after the attack, which is clearly audible even at a distance. Such a noisy whistling breath is called in medicine a reprise, which implies a spasm of the glottis during a coughing fit;
blueness of the skin during a coughing fit or its purplishness;
after the attack of coughing in most cases, the patient vomits or spits out a large amount of viscous mucus.

In fact, it is not difficult for an experienced doctor to diagnose whooping cough in a child, one has only to hear the characteristic reprises during an attack and look at the patient at that moment.

So, let's summarize: whooping cough is characterized by a triad of symptoms - attack, reprise, vomiting or spitting of viscous mucus .

Depending on the frequency and duration of the course of attacks in a patient, doctors determine the severity of the course of the disease. The duration of the period of coughing attacks can reach from several weeks to several months, despite the treatment carried out by the parents. For whooping cough, in the first 10 days, an increase and progression in the frequency and intensity of attacks is very characteristic, then a slight improvement and stabilization of the child's condition, after which a very slow decrease in the severity of the signs of the disease - this takes about several months.

Whooping cough in children of the first year of life: features of the course

The younger the child, the more severe the disease. In infants, at moments of coughing with reprises, respiratory arrest can last from a few seconds to a minute or more! In this regard, the risk of acute hypoxia of the brain and other vital organs and systems increases. Against the background of oxygen deficiency, as a complication, the baby may develop deviations in mental, mental and physical development.

In general, these are the main features of the course of whooping cough in young children, and with proper organization of care and treatment, the signs of the disease disappear without a trace. That's what you should be wary of, as these are possible complications, such as pneumonia. It is not caused by whooping cough at all, but by conditionally pathogenic microflora, which is activated against the background of reduced immunity and insufficient clearance of the respiratory tract from mucus during coughing.

How to know that a cough that has begun is a manifestation of whooping cough and immediately begin the correct treatment? Parents should remember some rules that will help to avoid a protracted course of the disease, if infection has occurred:

remember who your baby has been in contact with - inform these parents that you have whooping cough and ask them to examine their child.
The choice of antibiotic is up to the doctor! If, even before the start of the examination of the child, the parents arbitrarily give him antibiotics, then the diagnosis is difficult, which leads to even greater progression of the disease and increased coughing attacks in the patient.
Do not panic or frighten the child during coughing spells - act calmly, speak kindly to the baby, let him cough up mucus and do not be afraid of vomiting. At the onset of an attack, the patient should be raised vertically so that he does not choke on mucus or vomit.
During the period of illness, avoid active games and physical exertion, as they will provoke another attack of coughing in the patient.

Feeding a child with whooping cough

With whooping cough, it becomes a huge problem for parents to feed their baby, because eating often provokes another coughing attack or the contents of the stomach are still excreted during vomiting after such an attack.

It is important to give food in small portions, preferably in semi-liquid or liquid form, so that the patient makes as few chewing movements as possible up to 5-6 times a day.

Peculiarities of home treatment of whooping cough in children

Parents of a sick child should remember the main rule - the warmer the room where the child is, the drier the air, which means the more frequent and longer coughing fits will be!

If possible, the patient should stay as long as possible in the open air, of course, away from playgrounds and places where other children gather, so as not to infect them.