When should I consider referring a patient with whooping cough for specialist care?

Consider referring a patient with whooping cough (pertussis) for specialist care if:

• They are infants under 1 year old, especially if they show signs of respiratory distress or apnea.
• There is diagnostic uncertainty or severe symptoms such as persistent vomiting, cyanosis, or seizures.
• They have complications such as pneumonia or secondary bacterial infections.
• They have underlying chronic respiratory conditions or immunocompromise that may worsen the disease course.
• They require hospital admission for supportive care or monitoring.

Referral should be urgent if the patient presents with life-threatening features or severe respiratory compromise. In less severe cases, clinical judgement should guide referral to a paediatrician or respiratory specialist for further assessment and management.

This approach aligns with general principles for referring children with respiratory infections and severe symptoms to specialist care, as outlined in UK guidelines for fever in under 5s and other respiratory conditions, where red or amber features prompt urgent or specialist referral ⁴.