Consumer Information

Kawasaki Disease

GENERAL INFORMATION:

What is Kawasaki disease? Kawasaki disease (KD) is a rare illness in children that causes fever and vasculitis. Vasculitis is a condition where the walls of your child's blood vessels become inflamed (swollen). KD is commonly seen in children from 6 months to 5 years old. It may also occur in older children as well as in those younger than six months old. Kawasaki disease may damage the blood vessels in your child's heart causing heart problems. The heart problems may continue as he becomes an adult, and may lead to a heart attack. Treatment during the early stage of your child's illness may resolve his fever and prevent further heart problems.

What causes Kawasaki disease? The exact cause of KD is not known. It normally occurs during late winter and early spring. Caregivers believe KD may be caused by an infection from germs called bacteria or viruses. Germs causing KD may be inhaled (breathed in). When the germs are inside your child's body, they may grow and divide. The germs may spread and cause damage to your child's organs and tissues.

What increases my child's risk of having Kawasaki disease? Your child's risk of having KD is increased by any of the following:

Family History: Your child's risk of having KD increases if another family member has the disease. The risk for your child is higher if the family member is a sibling.
Gender: Male children are at a higher risk of having KD than female children.
Problems with the immune system: The immune system is your child's defense against certain diseases and infections. When your child's immune system weakens, his risk of getting KD increases.
Race: Children from Asian countries, such as Japan, are at higher risk of having the condition.
Skin disorder: If your child has eczema, his risk of having KD may be increased. Eczema is when your child has a red and itchy rash that comes and goes over time.

What are the signs and symptoms of Kawasaki disease? Fever is normally present for five days before other signs and symptoms.

Typical signs and symptoms: With typical KD, your child will have a fever and four of the following signs and symptoms:
- Dry, red, cracked lips with a strawberry tongue (red tongue with small raised bumps).
- Red eyes.
- Redness, swelling, and peeling of his skin on the palms of his hands and bottoms of his feet. This peeling can occur within 2 to 3 weeks after the start of your child's first symptoms.
- Skin rash.
- Swollen lymph nodes (glands) in his neck.
Atypical signs and symptoms: Atypical, also called incomplete KD, is more common in children less than one year old. Your child will have a fever and at least two of the above signs and symptoms.

What other signs and symptoms may my child have with Kawasaki disease? Your child may also have any of the following signs and symptoms:

Fast heartbeat.
Irritability.
Joint pain and swelling.
Nausea (upset tummy), vomiting (throwing up), diarrhea (loose, watery stools), and tummy pain.
Pain or trouble passing urine.
Swelling of his scrotum (testes).
Yellowing of his skin and the whites of his eyes.

How is Kawasaki disease diagnosed? Your child's caregiver will ask how long your child has been having symptoms, and when they started. He will examine your child and check for other conditions that may be causing his symptoms. There is no test to diagnose KD. Your child's caregiver may do any of the following tests to learn more about his condition:

Blood tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. Blood tests can give caregivers more information about your child's health condition. Your child may need to have blood drawn more than once.
Chemical stress test: During this test, medicine is used to make your child's heart work like it would when he exercises. If his heart has blocked or damaged blood vessels, the medicine may make his heart work harder. Chemical stress testing may also show changes in your child's heart activity while he is active or at rest. Ask your caregiver for more information about this test.
Imaging tests: Your child may be given dye before the pictures are taken. The dye may help your child's caregiver see the pictures better. Children who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child's caregiver if your child is allergic to shellfish, or has other allergies.
- Computed tomography: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your child's body. It may be used to look at your child's heart and blood vessels.
- Echocardiogram: This test is also called an echo. Sound waves are used to show pictures of the size and shape of your child's heart. The echo can also show how well the heart is pumping and how well blood flows through it. Your child will lie down during the test. Caregivers will squirt clear gel onto your child's chest to help the echo probe move easily. The echo pictures are shown on a TV-like screen. The whooshing noise that you may hear is the sound of blood flowing through the heart. Caregivers may ask you to stay in the room with your child during this test.
- 12 Lead EKG: This test helps caregivers see your child's heart activity. It helps caregivers look for changes or problems in different areas of the heart. Sticky pads are placed on your child's chest, arms, and legs. Each pad has a wire that is hooked to a machine or TV-like screen. This machine shows a tracing of your child's heart beat. This test takes about five to ten minutes. Your child must lie very still during the test.
- Magnetic resonance angiography: This is also known as a MRA. This test is used to look at the blood vessels in your child's heart. The test is also done to see how his blood flows through his heart. Your child will need to lie still during his MRA. Never enter the MRA room with an oxygen tank, wrist watch, or any other metal objects. This can cause serious injury.
- Chest x-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection (such as pneumonia) or other problems.

How is Kawasaki disease treated? Ask your child's caregiver for more information on the following treatments:

Medicines:
- Aspirin: This medicine is also an anti-platelet drug. It helps thin your child's blood so clots do not form. Aspirin may also help decrease your child's fever. If caregivers tell your child to take aspirin, do not let him take acetaminophen or ibuprofen. Aspirin may cause a very serious illness called Reye's syndrome. Reye's syndrome may cause brain and liver damage. Do not give more or less aspirin to your child than what his caregiver says. Ask your child's caregiver for more information about Reye's syndrome.
- Blood thinners: This medicine helps stop clots from forming in your child's blood. Clots can cause strokes, heart attacks, and death.
- Clot busters: This medicine helps break apart blood clots. Once the blood clots are gone, blood flow may increase to your child's heart muscle. The medicine is given in your child's IV. An IV is a tube placed in your child's vein for giving medicine or liquids. This medicine may decrease the amount of damage to your child's heart muscle.
- Immune globulin: This medicine may be given to help your child’s immune system fight his infection. Ask your child's caregiver for more information about how immune globulin medicine may help your child.
- Steroids: This medicine may be given to decrease inflammation, which is redness, pain, and swelling. There are many different reasons to take steroids. With KD, steroid medicine may help prevent problems with your child's immune system. Be sure you understand why your child needs steroids. Do not let your child stop taking this medicine unless his caregiver tells you to.
Other treatments: Ask your child's caregiver for more information on the following treatments:
- Cardiac catheterization: A cardiac catheterization is a test to see how well your child's heart is working. It is also used to see how well the blood vessels connected to the heart are doing. A special tube is threaded into your child's heart through a blood vessel in his arm, leg, or neck. Dye may be given so x-ray pictures of your child's blood vessels show up better on a TV-like screen. Your child's caregiver may also measure the pressure inside your child's heart.
- Surgery:
  - Angioplasty: This is done to increase blood flow to your child's heart. A thin tube with a balloon on the end is placed into the narrowed or blocked blood vessel. The balloon is then inflated (filled with air) to widen the artery and restore blood flow. A stent (small mesh tube) may also be placed into your child's narrow blood vessel.
  - Coronary bypass surgery: This surgery is done to replace a blocked blood vessel. A healthy artery or vein from another part of your child's body may be used. This may decrease your child's risk of having a heart attack in the future.
  - Heart transplant: This is when your child's diseased heart is replaced with a healthy heart. This is done when your child's heart is badly damaged by KD. Your child will be given a heart from someone else (a donor). The heart transplant is done while your child is in the hospital. This may cure your child's illness, but it may cause other health problems.

How can I help my child who has Kawasaki disease? You may help your child by doing the following:

Apply balm on your child's sore lips or peeling skin.
If your child smokes, tell him to stop smoking. Talk to your child's caregiver if he needs help to quit smoking.
If your child has constipation (hard, dry stools), talk to his caregiver about what medicines may be helpful.
If your child has diarrhea (loose-watery stools), talk to his caregiver about what medicines may be helpful.
Talk to your child's caregiver before he returns to any physical activities. If your child is taking blood thinning medicines, he may bleed or bruise easily. Your child may need to avoid certain activities for a period of time after treatment.
Wait to have your child vaccinated for 9 months after treatment for KD.

When should I call my child's caregiver? Call your child's caregiver if:

Your child has a fever.
Your child is not eating or drinking, and is getting weaker.
Your child is taking aspirin medicine, and has been around someone with the flu or chicken pox.
You have questions or concerns about your child's condition, treatment, or care.

When should I seek immediate help? Seek care for your child immediately or call 911 if:

Your child has a reaction to his medicines.
Your child has blood coming out of his nose, mouth, urine, or stool.
Your child has fainted (passed out).
Your child has very bad tummy pain.
Your child suddenly has trouble breathing.

Where can I find more information? Contact the following:

American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone: 1-847-434-4000
Web Address: http://www.aap.org

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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