Kawasaki Disease in Children

Kawasaki disease is a rare illness that most commonly affects children ages 0 to 5, but it can sometimes affect children up to the age of 13. It is 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. Other areas of the heart may also be affected. With timely treatment, most children recover with no lasting problems.

Children of any race or ethnic group can get Kawasaki disease. It's more common in children whose families are from East Asia or Asian ancestry. Most children who get Kawasaki disease are younger than 5 years old. It occurs in boys more often than in girls.

The cause of Kawasaki disease is not known. Researchers think it may be the result of an infection.

These are common symptoms of Kawasaki disease:

• Quick onset of high fever of 102.0° F to 104.0° F (38.8°C to 40.0°C) that lasts for at least 5 days

• Red rash

• A swollen lymph node, usually on one side of the neck

• Swollen hands and feet with redness (erythema) of the palms and soles

• Red eyes

• Red and dry cracked lips

• Redness and swelling of the mouth

• Red tongue with white spots (called strawberry tongue)

• Irritability

• Fast heart rate

• Abdominal pain, diarrhea, or vomiting

• Skin peeling

• Nail changes

The symptoms of Kawasaki disease can look like other health conditions. Make sure your child sees their health care provider for a diagnosis.

Your child's provider can often diagnose Kawasaki disease by their symptoms and physical exam.

To diagnose Kawasaki, other causes for the symptoms must be ruled out. A fever for 5 days must be present in addition to having 4 out of 5 of the following symptoms:

• Red eyes

• Changes in the lining of the mouth

• Skin changes in the hands and feet

• Rash

• Swollen lymph nodes

Other recommended tests 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 that may mimic Kawasaki disease.

• 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 vessels, structure, valves, and heart function.

• Cardiac catheterization. This test uses a small tube that goes into the blood vessels and takes pictures of the coronary arteries using contrast and X-ray. This test is rarely needed. It's needed only in cases with significant heart involvement.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment typically starts as soon as the problem is suspected. Your child may need to stay in the hospital for a few days or longer.

Your child's provider may prescribe aspirin or IV (intravenous) gamma globulin (IVIG). Corticosteroids and other medicines may also be prescribed if aspirin and IVIG don't work well. Once your child is home, they may need to take low-dose aspirin for 6 to 8 weeks. Don't give your child aspirin without first talking with their provider.

If your child develops heart problems, the provider may send you to a pediatric cardiologist. This is a doctor with special training to treat children’s heart problems. Your child may need medicine or procedures. In rare cases, surgery is needed.

Most children with Kawasaki disease get better within a few weeks. But serious complications may occur. Those involving the heart include:

• Weakening of one of the heart's arteries (coronary artery aneurysm).

• Heart muscle that doesn't work well or heart attack.

• Inflammation of the heart muscle (myocarditis), lining of the heart (endocarditis), or covering of the heart (pericarditis).

• Heart valves that don't work well.

• Heart failure.

Kawasaki disease may also affect other body systems. This includes the nervous, immune, digestive, and urinary systems.

If your child has a coronary artery aneurysm, they will need echocardiograms, sometimes for several years after the illness. Your child may need more treatment, including blood thinners to prevent clots. It's important to keep follow-up visits with your child's provider, even if your child is feeling well.

There is a risk for early coronary artery disease after having Kawasaki disease, including early heart attacks. Your child will need to follow a heart-healthy lifestyle for life. This includes eating healthy foods, getting regular exercise, maintaining a healthy body weight, managing stress, abstaining from alcohol, and not smoking. Your child should have regular follow-up with a cardiologist throughout their life.

Talk with your child's provider about what to expect for your child.

Call your child's health care provider if your child has the symptoms of Kawasaki disease. If your child is diagnosed with Kawasaki disease, keep all follow-up appointments. Also watch for signs or symptoms of complications, including:

• Tiredness.

• Poor feeding or eating.

• Trouble breathing.

• Swelling.

• Chest pain.

• Kawasaki disease is a serious condition that affects young children. It can damage blood vessels throughout the body.

• Kawasaki disease is diagnosed by having certain symptoms. For example, a fever lasting at least 5 days.

• Your child’s provider will treat Kawasaki with aspirin, intravenous immune globulin (IVIG), or other medicines.

• A child with Kawasaki disease may have serious complications, especially ones affecting the heart.

Tips to help you get the most from a visit to your child’s provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.