Paediatrics - Queensland Health - Queensland Government

Respiratory problems
1. May present with
• URTI symptoms
• Cough (typically paroxysmal i.e. intermittent episodes of prolonged coughing
followed by the characteristic inspiratory ‘whoop’ as the child catches his / her
breath)
• Vomiting, typically after an episode of coughing
• Cyanosis, typically during an episode of coughing
• Young babies usually do not have the characteristic whoop but are likely to be very
distressed by coughing and vomiting. They can develop apnoea (stop breathing)
and become cyanosed during a coughing bout
• Adults usually have a persistent troublesome cough only, without a whoop. A
cough of several weeks duration, that is worse at night, in an adult, is pertussis
until proven otherwise
2. Immediate management
• If severe consult MO immediately
3. Clinical assessment
• See Upper respiratory tract infection
• The ‘whoop’ can be characteristic but may not always be present. The child may
not be distressed in periods between paroxysms of coughing, with few clinical
signs, however the overall impression is of a sick child
• Check vaccination status. See Immunisation program
4. Management
• Consult MO who may advise:
-- evacuation / hospitalisation if young child (< 6 months) or if symptoms are
significant, appropriate tests to confirm diagnosis - serum for IgA and / or
nasopharyngeal aspirate / swab for PCR testing and / or MC/S
-- antibiotics may shorten the length of the illness if given early and will also
reduce infectivity to others. Person can be considered not infective after 5
days of treatment. It is important to explain that coughing will continue for 6 - 8
weeks, and may recur with the next URTI. The recurrence will not last long
-- household and child care contacts may require prophylactic antibiotics to
prevent further clinical cases of pertussis
-- advise to avoid contact with other individuals, especially young children and
infants until at least 5 days of antibiotics have been received [3]
-- consult Public Health Unit for advice
5. Follow up
If not evacuated / hospitalised review daily, at least initially
6. Referral / consultation
Consult MO on all occasions whooping cough is suspected
Primary Clinical Care Manual 2011 Controlled copy V 1.0 565