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Fast Fact

Pertussis is commonly known as whooping cough.
Pertussis is caused by bacteria that attach themselves to the cilia (little hairs) that line the respiratory tract. These bacteria produce a potent toxin that inflames the respiratory tract and that prevents the cilia from functioning properly.
The disease can be serious or fatal in infants and unimmunized children. It is much milder in teens, adults, and in immunized children - but still can be a real nuisance.
People with pertussis go through four stages:

Incubation. For 5 to 21 days after exposure (usually 7 to 10 days) there are no symptoms at all while the bacteria multiply.
Prodrome. For the next 1 to 2 weeks, pertussis is not unlike a cold. People have runny noses, sneezing, and perhaps a low-grade fever. A mild cough begins that gradually worsens.
Paroxysms. The worst part of the illness lasts from 1 to 6 weeks. Spasms or attacks of coughing may come up to 15 times per day. Sometimes, especially in children, the cough is followed by a "whoop" noise as they breathe in rapidly, attempting to get air. Even so, young infants will often turn blue with the spells from lack of oxygen. The mucus is often thick and sticky. Gagging, choking, and vomiting are common. Sometimes young infants will stop breathing for varying lengths of time. This stage of pertussis is much milder in adults, teens, older children, and immunized children.
Convalescence. As if this disease were not already long enough, the cough continues for another 2 to 4 weeks, but gradually becomes less severe and less frequent. Even after the cough seems finally over, the spasms often recur briefly for the next several months - especially during colds and during exertion.

Current lab tests to detect pertussis are either slow, cumbersome, not readily available, or often fail to pick up the disease.
According to the Centers for Disease Control and Prevention people are considered to have pertussis if they have a cough lasting for at least 14 days (with no other confirmed cause) and any one of the following symptoms (even if they have been immunized): Coughing spasms or fits (coughs comes in clusters), a whooping noise while breathing in, or vomiting caused by the cough.
The case is called confirmed pertussis if there is a positive lab test or if there has been exposure to someone with a positive lab test.
During a pertussis outbreak, anyone who has a cough lasting at least 14 days (with no other known cause) probably has pertussis, even in the absence of other specific symptoms.
Pertussis is treated with an antibiotic (Biaxin, erythromycin, Septra, or Zithromax). The antibiotic doesn't much affect the length of the illness, but is very effective at stopping its spread.
People with pertussis are highly contagious for up to 5 days after starting the antibiotic.
You or your child have been exposed if you spend a total of 5 hours in the same room with someone with the disease (over a week), or if you sit next to someone with pertussis for any length of time, or if you have any contact at all with infected mucus or saliva.
Between 70 and 100 percent of susceptible people will catch pertussis if they are exposed.
Currently, most adults and teens are susceptible because the protective effect of their childhood pertussis immunizations has waned. To address this problem, it is now recommended that all teens receive a booster vaccine at 11-18 years of age (preferably between 11-12 years).
Between 60 and 80 percent of infants are protected after the first 3 doses of vaccine, but this protection begins to disappear when they are toddlers. After the 4th immunization at 18 months old, 80 percent are protected for the next 3 to 4 years. The 5th dose, at kindergarten entry, protects them for another few years. A booster dose is recommended during the teen years to bolster immunity to pertussis.
People who have been exposed to probable or confirmed pertussis should either receive a course of preventative antibiotics (and I say this as someone strongly opposed to the overuse of antibiotics), or be kept home from daycare, school, or work for at least 3 weeks. If the exposed individual develops symptoms, they should receive antibiotics to prevent further spread of pertussis to others.
Children under age 7 who have been exposed should receive a pertussis vaccine, unless they have already had 4 doses of pertussis vaccine (and the last dose within 3 years), or unless there is a compelling reason not to immunize them. Exposed teens 11-18 years old who have not already received a booster vaccine should receive one.

see Fast Facts about Pertussis »

Divorce

10.24.2001 Add new comment Send to friend Print this article

I am concerned about the effect that my recent separation will have on my 26-month old. It was one of the hardest decisions of my life to decide to leave my husband, but now I want to ensure that my relationship with my son remains strong. His Dad still spends time with him, but do you have any suggestions on how I can keep positive and ensure my child's happiness, while I go through this very emotional time. This is not a pediatric question as such, but it involves my son, who is the most important person in my whole life. I would appreciate any pointers, or suggestions regarding this topic.

L. Chalker - St. John's, New Foundland, Canada

Deciding to end a long-term relationship is never easy -- especially when children are involved. It is a decision that will impact many people for years to come.

You ask how you can ensure your child's happiness during this emotional time. I'm afraid I must tell you, you can not ensure your child's happiness -- now, or ever. There are, however, several things you can do, or avoid doing, that will help your son navigate his way through your, and his, current emotional storm.

First, set your mind and your will to the task of building up your son's father in your son's eyes. This will undoubtedly be very difficult, but it is the number one thing that will help you stay close to your son and help him remain positive about life. When parents don't follow this advice, children are put in the difficult position of having to choose to whom to be loyal. No child should ever have to choose between his or her parents! When children feel that they must, they will undoubtedly feel conflict and inner tension. This will result in stress and anxiety. Even if your son were to choose you over his father, he would feel sad and angry because he wants to have a great relationship with both of his parents.

[There is an exception to the advice in the paragraph above. If your child's father is seriously abusive -- i.e., he regularly beats your son -- then you need to take a modified approach to building him up in your son's eyes. You should avoid appearing to support his father in any abusive behaviors he might have toward his son. If he beats your child, you don't need to seem supportive of that -- indeed, you may need to express disapproval and protectiveness. If your son's father is an alcoholic who drinks heavily on the weekends he has your son, perhaps you should help your son to understand that you are working to make that situation safer for him, i.e., you may be working with the legal system, or else trying to get someone else, such as a grandparent, to be in his father's home with them on those weekends, etc.]

One specific way to help your son is worked out through visitation. He needs to have lots of rich time in both his parents' homes. Whatever visitation schedule you and your son's father agree upon, keep it! When it is your son's father's turn to have your son, don't do or say anything that would make your son feel guilty for leaving you. When it is your turn to get your son back, welcome him with hugs and kisses and tell him how glad you are that he is at his home with you (as opposed to his home with his father) now.

This can be especially difficult around special times such as holidays and birthdays. You and your son's father must agree in advance upon an equitable holiday visitation schedule and stick to it! This won't be easy for anyone, but your son desperately needs to know in advance where and how he will be spending special days. This doesn't mean that either you or your son's father have to give up having special days with your son. Kids love having two birthdays as long as they know in advance that a special time is being planned for them.

It is also important not to put your son "in the middle." At his age, he is too young to make decisions about things like visitation. If you ask him whom he wants to spend time with, he will most likely be unable to make a decision. If he does make one, he will probably regret it and try to change his mind.