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PubMed This is a summary of 21 peer-reviewed journal articles Updated
Infectious Disease · Pertussis

Symptoms & Warning Signs: Recognizing the "Whoop" and Beyond

At a Glance

Whooping cough symptoms vary significantly by age. While children often have severe coughing fits followed by a high-pitched "whoop," infants may simply stop breathing or turn blue without coughing, and adults typically experience a persistent, lingering cough.

While the “whoop” is the most famous symptom of pertussis, it is not present in everyone. In fact, the way whooping cough looks and sounds depends heavily on the person’s age and vaccination history [1][2][3]. Recognizing the specific symptoms for your age group is essential for getting the right care at the right time.

Symptoms Across Different Ages

Whooping cough is a “great imitator” and can look very different depending on who is sick.

Infants: The Silent Threat

Infants, especially those under three months old, are at the highest risk for severe disease [4][5]. They often do not have a typical cough or a “whoop” [6][2].

  • Apnea: This is a “quiet” symptom where the baby stops breathing for several seconds [7][8].
  • Cyanosis: The baby may turn blue, purple, or pale, particularly around the mouth or face [9].
  • Gasping: Instead of a cough, you may see your baby struggling for air or looking exhausted [10].
    Read more about infant risks on our High-Risk Scenarios page.

Children: The Classic “Whoop”

Children are the most likely to experience the textbook version of the disease.

  • Paroxysms: Sudden, violent coughing fits that make it hard to breathe [11].
  • The “Whoop”: At the end of a coughing fit, the child may take a sharp, deep breath that creates a high-pitched “whooping” sound [11].
  • Post-tussive Vomiting: Many children will vomit immediately after a coughing fit because the intensity of the cough triggers the gag reflex [12][13].

Adults and Teens: The “Nagging” Cough

In adults and those who have been vaccinated, the symptoms are often much milder, leading many to think they just have a lingering cold or bronchitis [14][15].

  • Chronic Cough: The main symptom is often just a persistent, dry cough that lasts for weeks [14].
  • Absent “Whoop”: The classic whooping sound is frequently missing in adults [1][16].
  • Exhaustion: The main complication is often extreme fatigue and sleep disruption due to coughing fits that happen mostly at night [17].

When to Seek Emergency Care

Pertussis can escalate quickly, especially in the very young. Seek immediate medical attention if you or your child experience:

  • Difficulty Breathing: Rapid breathing, flaring nostrils, or the skin “sucking in” around the ribs or neck [9].
  • Color Changes: Any bluish or dusky tint to the lips, tongue, or skin (cyanosis) [9].
  • Apnea: Any noticeable pauses in breathing, even if the person seems fine afterward [7].
  • Extreme Lethargy: Difficulty waking up or appearing unusually limp or unresponsive.
  • Signs of Dehydration: Especially if frequent vomiting (post-tussive emesis) makes it impossible to keep fluids down [18].

Understanding Complications

The physical toll of violent coughing can lead to secondary issues. Post-tussive vomiting occurs because the intense pressure of the cough forces the stomach contents upward [12]. Beyond vomiting, the sheer force of the cough can occasionally cause rib fractures, hernias, or burst blood vessels in the eyes [17]. In rare, severe cases (sometimes called “malignant pertussis”), the infection can lead to extreme white blood cell counts and respiratory failure, requiring intensive hospital care [19]. While vaccination reduces the risk of these severe outcomes, it does not entirely eliminate the possibility of infection, so staying vigilant for these warning signs is critical [20][21].

Common questions in this guide

Can you have whooping cough without the whoop sound?
Yes. The classic whooping sound is often absent in adults, teenagers, and individuals who have been vaccinated. In these groups, the infection typically presents as a persistent, chronic cough. Infants under three months old also rarely whoop, instead showing silent signs like pauses in breathing.
What are the signs of whooping cough in a baby?
Infants with whooping cough often do not have a typical cough. Critical warning signs in babies include apnea (pauses in breathing), gasping for air, extreme lethargy, or cyanosis, which is a blue, purple, or pale tint around the mouth and face.
Why does whooping cough cause vomiting?
The intense, violent coughing fits associated with whooping cough create significant pressure in the abdomen and can trigger the gag reflex. This intense physical pressure forces stomach contents upward, resulting in vomiting immediately after a severe coughing spell.
When should I seek emergency care for whooping cough?
You should seek immediate medical attention if you or your child experience rapid breathing, flaring nostrils, skin sucking in around the ribs, pauses in breathing, any bluish skin color changes, extreme lethargy, or an inability to keep fluids down due to frequent vomiting.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.My child's cough doesn't have a 'whoop'—does that rule out pertussis?
  2. 2.What exactly should I look for to know if my baby's breathing has become 'distressed'?
  3. 3.Are there specific warning signs of secondary pneumonia that I should monitor for?
  4. 4.How can we manage the post-tussive vomiting to ensure my child stays hydrated and nourished?
  5. 5.Given our family's vaccination history, are we still at risk for severe complications?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (21)
  1. 1

    Clinical Characteristics of Pertussis-Associated Cough in Adults and Children: A Diagnostic Systematic Review and Meta-Analysis.

    Moore A, Ashdown HF, Shinkins B, et al.

    Chest 2017; (152(2)):353-367 doi:10.1016/j.chest.2017.04.186.

    PMID: 28511929
  2. 2

    Bordetella Pertussis Infection in Hospitalized Infants with Acute Bronchiolitis.

    Gökçe Ş, Kurugöl Z, Şöhret Aydemir S, et al.

    Indian journal of pediatrics 2018; (85(3)):189-193 doi:10.1007/s12098-017-2480-4.

    PMID: 29076101
  3. 3

    Pertussis prevalence among adult patients with acute cough.

    İlbay A, Tanrıöver MD, Zarakol P, et al.

    Turkish journal of medical sciences 2022; (52(3)):580-586 doi:10.55730/1300-0144.5349.

    PMID: 36326303
  4. 4

    Analysis of clinical characteristics of severe pertussis in infants and children: a retrospective study.

    Wang C, Zhang H, Zhang Y, et al.

    BMC pediatrics 2021; (21(1)):65 doi:10.1186/s12887-021-02507-4.

    PMID: 33546645
  5. 5

    Whooping cough in the most vulnerable: A case series of pertussis in infants younger than three months in Qatar.

    Alesali M, Elhamidi M

    Qatar medical journal 2025; (2025(1)):18 doi:10.5339/qmj.2025.18.

    PMID: 40432985
  6. 6

    Comparison of the clinical and laboratory characteristics of pertussis or viral lower respiratory tract infections.

    Selbuz S, Çiftçi E, Özdemir H, et al.

    Journal of infection in developing countries 2019; (13(9)):823-830 doi:10.3855/jidc.10558.

    PMID: 32074092
  7. 7

    Discharge without alarm(s)!

    Silvestri JM, Patra K

    Journal of perinatology : official journal of the California Perinatal Association 2018; (38(1)):1-2 doi:10.1038/jp.2017.175.

    PMID: 29348520
  8. 8

    Achievement of maturational milestones among very low birth weight infants.

    Sullivan BA, Slevin CC, Ahmad SM, et al.

    Journal of neonatal-perinatal medicine 2022; (15(1)):155-163 doi:10.3233/NPM-200698.

    PMID: 33967061
  9. 9

    Severe pertussis complicated by pulmonary hypertension in a Moroccan infant: a case report.

    Belhakim M, El Jaouhahri Z, Boudar A, et al.

    Journal of medical case reports 2025; (19(1)):379 doi:10.1186/s13256-024-04898-1.

    PMID: 40751219
  10. 10

    Pertussis outbreak in children hospitalized in Rabat (Morocco).

    Bennai RM, Zouaki A, El Amin G, et al.

    Diagnostic microbiology and infectious disease 2024; (109(2)):116225 doi:10.1016/j.diagmicrobio.2024.116225.

    PMID: 38492491
  11. 11

    Pertussis: The Identify, Isolate, Inform Tool Applied to a Re-emerging Respiratory Illness.

    Koenig KL, Farah J, McDonald EC, et al.

    The western journal of emergency medicine 2019; (20(2)):191-197 doi:10.5811/westjem.2018.11.40023.

    PMID: 30881535
  12. 12

    Clinical characteristics of 967 children with pertussis: a single-center analysis over an 8-year period in Beijing, China.

    Kang L, Cui X, Fu J, et al.

    European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2022; (41(1)):9-20 doi:10.1007/s10096-021-04336-w.

    PMID: 34398346
  13. 13

    Pertussis surveillance in a children hospital in Bangkok, Thailand.

    Suntarattiwong P, Kanjanabura K, Laopipattana T, et al.

    International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2019; (81()):43-45 doi:10.1016/j.ijid.2019.01.031.

    PMID: 30684746
  14. 14

    [Prevalence of Bordetella pertussis infection in children with chronic cough and its clinical features].

    Wu DX, Chen Q, Li L, et al.

    Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics 2019; (21(1)):18-23.

    PMID: 30675858
  15. 15

    Under-recognized pertussis in adults from Asian countries: a cross-sectional seroprevalence study in Malaysia, Taiwan and Thailand.

    Koh MT, Liu CS, Chiu CH, et al.

    Epidemiology and infection 2016; (144(6)):1192-200 doi:10.1017/S0950268815002393.

    PMID: 26468043
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    [Serological evaluation of Bordetella pertussis infection in adults with prolonged cough].

    Sönmez C, Çöplü N, Gözalan A, et al.

    Mikrobiyoloji bulteni 2016; (50(3)):361-70 doi:10.5578/mb.27692.

    PMID: 27525392
  17. 17

    [Complications of pertussis].

    Jia J, Yuan L, Gao W, Yao KH

    Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics 2019; (21(7)):713-717.

    PMID: 31315774
  18. 18

    Clinical characteristics of pediatric pertussis cases, Quebec 2015-2017.

    Desjardins M, Iachimov D, Mousseau S, et al.

    Canada communicable disease report = Releve des maladies transmissibles au Canada 2018; (44(9)):190-195 doi:10.14745/ccdr.v44i09a01.

    PMID: 31015808
  19. 19

    Neonatal malignant pertussis and exchange transfusion: A case report.

    Lalaoui A, Kassal G, Haidar C, et al.

    Journal of neonatal-perinatal medicine 2025; (18(6)):597-600 doi:10.1177/19345798251330800.

    PMID: 40152897
  20. 20

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  21. 21

    Impact of pertussis vaccination on PT-IgG levels and clinical characteristics in 3-12-month-old infants with acute pertussis.

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    PMID: 40711589

This page provides educational information about whooping cough symptoms and warning signs. It does not replace professional medical advice. Seek immediate emergency care if you or your child experience difficulty breathing, skin color changes, or pauses in breathing.

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