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When Your Child Has Kawasaki Disease

Kawasaki disease is a rare illness that most commonly affects children from birth to age 5, but can sometimes affect children up to the age of 13. It's a type of vasculitis. Vasculitis means inflammation of the blood vessels. It can affect the whole body, including the blood vessels of the heart (coronary arteries). The cause of Kawasaki disease is unknown. Without treatment, affected children are at higher risk of developing problems with the coronary arteries in the future. Other areas of the heart may also be affected. With timely treatment, most children recover with no lasting problems.

What are the signs of Kawasaki disease?

The most common sign of Kawasaki disease is a fever. The fever is usually high between 102°F to 104°F (38.8°C to 40°C). It tends to rise and fall, but stays above 101.3°F (38.5°C). It may not get better even after taking a fever-reducing medicine. The fever usually lasts more than 5 days. To prevent complications, your child's doctor may make an initial diagnosis and start treatment before that time. Other signs include:

  • Red rash

  • Red palms

  • A swollen lymph node, usually in the neck

  • Swollen hands and feet

  • Red eyes

  • Red and dry cracked lips

  • Red tongue with white spots (called “strawberry tongue”)

  • Irritability

  • Fast heart rate

  • Diarrhea or vomiting

  • Skin peeling

How is Kawasaki disease diagnosed?

Your child's healthcare provider can usually diagnosis Kawasaki disease based on his or her symptoms and a physical exam. Your child will likely be referred to a pediatric cardiologist. This is a doctor with special training to diagnose and treat heart problems in children. Tests may be done as well. These can include:

  • Lab tests. Blood and urine samples are taken to check for signs of inflammation. These are also used to help rule out other health problems.

  • Electrocardiography (ECG). This test records the electrical activity of the heart through small, sticky patches on the child's chest. The patches are connected to a machine with wires. The machine records the electrical activity. This helps check for problems with heart rhythm and heart structure.

  • Echocardiography (echo). This test uses sound waves to create a picture of the heart. This can show problems with heart structure, valves, and heart function. This can also show problems with the coronary arteries.

How is Kawasaki disease treated?

  • Treatment starts as soon as the problem is suspected. A hospital stay of a few days or longer may be needed.

  • The main treatment for Kawasaki is medicine. These can include:

    • High-dose gamma globulin (IVIg). This is given through an IV line. It helps boost the body’s immune system response. It also helps reduce the risk of damage to the coronary arteries and the heart.

    • High-dose aspirin. This helps reduce inflammation. It also helps reduce the risk of blood clots.

    • Corticosteroids. These may be given if your child doesn't respond to immunoglobulin.

  • Your child is observed until symptoms improve. Once at home, your child may need to take low-dose aspirin for 6 to 8 weeks. Your child may need to take aspirin longer if the doctor is concerned about abnormal heart vessels.

When to call your child's healthcare provider

Call the doctor right away if your child has any of the following:

  • Fever (see Fever and children, below)

  • Symptoms that return or worsen

  • Shortness of breath

  • Chest pain

  • Your child acts very ill, is unusually sleepy, or is very irritable

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds of digital thermometers. They include ones for the mouth, ear, forehead (temporal), rectum, or armpit. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Use a rectal thermometer with care. It may accidentally poke a hole in the rectum. It may pass on germs from the stool. Follow the product maker’s directions for correct use. If you don’t feel OK using a rectal thermometer, use another type. When you talk to your child’s healthcare provider, tell him or her which type you used.

Below are guidelines to know if your child has a fever. Your child’s healthcare provider may give you different numbers for your child.

A baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

A child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

What are the long-term concerns?

  • After treatment, your child’s health should improve. Some symptoms may not resolve for 2 to 3 weeks. These can include joint pain and peeling skin on the hands and feet.

  • Going forward, your child may need regular visits with the doctor. Also, routine tests may need to be done to check your child’s heart and blood vessels.

  • If your child develops heart problems, he or she will need ongoing care. The doctor will discuss your child’s health with you and tell you more about treatment options.

Online Medical Reviewer: Glenn Gandelman MD MPH
Online Medical Reviewer: Lu Cunningham RN BSN
Online Medical Reviewer: Pat F Bass MD MPH
Date Last Reviewed: 12/1/2019
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