Kawasaki disease (KD) is a rare childhood illness that affects the blood vessels. The symptoms can be severe for several days and can look scary to parents. But then most children return to normal activities.
KD is a systemic inflammatory disease, meaning that it is not localized to any particular organ but may have an inflammatory response involving anywhere with blood vessels, including the arteries of the heart.
The most serious complications happen when the coronary arteries (arteries that carry blood to the heart) is involved, which may include heart failure, arrhythmia, or even sudden death. Infants are most susceptible to long term sequelae. However, most children who are treated recover from the disease without long-term problems. Continue to follow-up for a few weeks to a few months after treatment.
The disease is most common in children under 5 years old. It is not contagious. Its etiology remains unknown.
KD is also called mucocutaneous lymph node syndrome. Diagnosis is based upon evidence of systemic inflammation (fever) in association with any four of the following symptoms：
Fever over 39 ºC for over 5 days
Red eyes
Swollen, red skin on the palms of the hands and soles of the feet
Skin rash, often starting in the genital area. It can also be on the back, chest, belly, arms, and legs
Cracked, red lips and tongue
Swollen lymph nodes in the neck
Fever management：
Fever is when armpit temperature is over 37.5ºC or anal, forehead, or temporal temperature is over 38ºC.
When your child has chills, keep him/her warm by adding another blanket or elevating the thermostat temperature. Do not give him/her an ice pillow.
If your child has fever but the limbs are warm, give him/her a warm bath (water temperature 26~36ºC).
Encourage your child to drink plenty of water to prevent dehydration. Dry off the sweat immediately. Do not wear too many layers of clothes or use too many blankets.
Fever medication (antipyretics) may be given when the child’s temperature is above 38.5℃. Repeat if necessary with at least 4 to 6 hours between the antipyretics. If your child has a history of febrile convulsion, use antipyretics at a lower temperature to help prevent convulsion.
Antipyretics usually need around 30 minutes to work. You may check your child’s body temperature every hour until the fever has reduced.
IV (intravenous therapy) and IV pump care：
Keep the dressing and injection cannula (the small plastic tube which is inserted into the vein) clean and dry.
Periodically check that the the distal extremities (far end of the limb with the injection; ie. fingers or toes) that they are warm and pink.
Keep the injected limb lowered to avoid IV fluid or blood refluxing into the tubes.
Do not adjust the IV rate or touch the buttons of the pump by yourself. Inform the staff if you think adjustment is needed.
The IV pump has a rechargeable battery. You may remove the electric the charging cable when walking around. Please keep the cable plugged in when possible.
Gently compress the injection site for 1~3 minutes with a sterile cotton ball after the cannula has been removed. Remove the cotton balls if there is no more bleeding.
If any of the following conditions occur, please inform the nursing staff：
Pain, swelling, redness, or wetness at the injection site.
Painful or reddening of the skin after the cannula was removed.
You heard the sound of pump alarm.
Your child needs a shower or change the clothes.
Oral ulcer management：
Make observation of the changes of the oral ulcers at least once everyday.
Practice good oral hygiene. Use a soft toothbrush or a gauze wrapped on a popsicle stick and clean the mouth and teeth with normal saline or boiled water. This will help promote wound healing and prevent bad breath from bacterial growth.
Drink or gurgle directly from a cup instead of a straw to avoid contact pain from the straw or wound irritation from sucking motion.
Cool soft diet will reduce the painful sensation during swallowing. Try ice cream, yogurt, jelly, cold milk, or flan.
Try lip balms or vaseline to moisten the lips.
Eat frequent small meals. Do not force feed.
Always practice good hygiene. Gently wipe off drool with wet towelette. Always wash your hands before and after touching your child.
Avoid scratching or manipulating the skin rash to prevent secondary infection. Try gentle lotion on dry itchy skin.
Inform our medical staff immediately if there are the following symptoms：
Chest pain
Shortness of breath
Abnormal breathing sounds or signs of difficulty breathing
Vomiting
Skin turning blue or gray
Abnormal irritability or odd behaviours
Convulsion
Loss or change of consciousness
Follow-up regularly with your pediatrician or a pediatric cardiologist.
Aspirin may be prescribed for blood-thinning and anti-inflammation. It should not be discontinued or changed without the doctor’s orders. Continue to follow-up regularly when taking aspirin. If your child contracts the flu or chickenpox during aspirin treatment course, stop the medication and see your pediatrician as soon as possible.