When a fever will not break and the eyes turn red, parents worry. Most fevers come from ordinary infections, but a fever lasting five days or more is one situation in which doctors also consider Kawasaki disease.
Why It Happens
The CDC describes Kawasaki disease as an acute febrile illness of unknown cause that mainly affects children younger than 5. It inflames blood vessels, and the CDC calls it a leading cause of acquired heart disease in children in the United States. The most serious complication is damage to the coronary arteries, which can widen or form aneurysms. The American Heart Association says there is no evidence that it spreads from person to person and that it is not hereditary.
How It Differs by Age
The CDC clinical overview defines typical Kawasaki disease as fever lasting 5 or more days along with four or more of these features: red eyes, changes of the lips and mouth, changes of the hands and feet, rash, and swollen neck lymph nodes. HealthyChildren.org adds that the fever is often above 102°F and that a rash may be worse in the diaper area, the eyes are red without discharge, one neck lymph node may be swollen and tender, and the lips can be red and cracked with a strawberry-like tongue and marked irritability. Skin on the fingers and toes may peel 2 to 3 weeks after the fever starts. In very young infants only a few signs may appear, or only vague ones such as vomiting, diarrhea, stomachache, or cough, so doctors consider incomplete Kawasaki disease when a fever lasts long without another explanation.
Care at Home
Kawasaki disease cannot be managed at home; it needs diagnosis and treatment in a hospital. Before the visit, write down when the fever began, temperatures through the day, and take photos of the eyes, lips, rash, and hands and feet. Offer plenty of fluids. Do not give aspirin on your own: HealthyChildren.org notes that aspirin is used in young children only under medical supervision because of the risk of Reye syndrome.
Common Misunderstandings
Some parents wait until day five before calling, but a child who looks very ill can be seen sooner. Others assume red eyes mean pinkeye, yet in Kawasaki disease the eyes are typically red without discharge, which is a useful clue. Some think a child with only one or two symptoms cannot have it, but young infants may show only a few. And a fever that breaks does not end the matter, since heart involvement is checked with tests such as an echocardiogram.
When to Seek Medical Care
No single test confirms Kawasaki disease, so doctors combine symptoms, blood tests, and a heart ultrasound. Standard treatment is intravenous immunoglobulin (IVIG) plus aspirin, which the CDC says substantially lowers coronary artery problems. Treatment is generally started within the first 10 days of illness, ideally sooner, and roughly 10% to 20% of children need further treatment. If a fever lasts 5 days with red eyes, lip changes, or rash, see a doctor or go to the emergency room without delay, and go right away for chest pain, fast breathing, or unusual limpness. Talk with your pediatrician about any long fever. This information is based on U.S. (CDC/AAP) guidance; if you live elsewhere, check with a local pediatrician for country-specific recommendations. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.