Kawasaki Disease in Children

If you have been listening to the news or reading articles online lately, you may have heard some reports that COVID-19 can cause Kawasaki Disease-like symptoms. What is Kawasaki anyways? We don’t know exactly if or how Kawasaki and COVID-19 are linked, but what we can do is go over Kawasaki Disease, what you need to know, and when to get checked out.

What is Kawasaki Disease?

Kawasaki Disease (KD) or Kawasaki Syndrome is the most common cause of acquired heart disease in children in developed countries, according to the American Heart Association. It usually affects children younger than five years of age but can affect children of all ages. It is also more common in boys than girls, and although it can affect any race or ethnicity, it is more commonly seen in those of Asian descent. 

Kawasaki causes inflammation of the heart vessels and different tissues of the body, including the hands, feet, mouth, nose, throat and whites of the eyes. It can cause damage to the coronary arteries, which are the blood vessels that supply the heart with oxygen, and this can worsen if undetected. 

Early detection is important, as the sooner the treatment for KD starts, the more likely your child will fully recover with no lasting effects. Most children don’t have long term damage to their coronary arteries, so don’t panic. However, in some cases KD can cause permanent damage such as weakened vessels, coronary artery aneurysms and very rarely, death.

Although this sounds scary, remember that Kawasaki Disease is quite rare! Most children with high fevers and other symptoms that may sound like the disease most likely have some other infection that is way more common in childhood, such as a viral infection (most common!). 

How do I know if I have Kawasaki Disease?

Kawasaki Disease is rare but we do see it here in the US. The exact cause of the disease is not super clear and it’s likely that there are multiple factors that put certain children at an increased risk of having the disease. For some children, it occurs after being ill with viral-type symptoms, such as with cold symptoms or stomach bug symptoms like diarrhea and vomiting. 

To meet the criteria for Kawasaki Disease, one of the major indicators is a fever that won’t break, or go away. This means that the fever lasts more than four days, which is when most fevers associated with common illnesses will break. This means the child in question must have a fever of at least 100.4 degrees Fahrenheit for five days before we even start considering Kawasaki Disease. In our experience however, children that truly have the disease have very high fevers for five or more days – fevers of 102 and above on a daily basis.

Fever for five days or more is the main symptom of Kawasaki Disease, but it’s commonly accompanied by four out of five of the following symptoms:

  1. Rash often seen in genital area, but also on arms, legs, back, belly and chest
  2. Swollen lymph nodes (small painless bumps under the skin usually around your neck)
  3. Red eyes (with no eye goop)
  4. Swelling or redness in any part of the lips or mouth such as cracked red lips or swollen tongue (sometimes called “strawberry tongue”)
  5. Swelling or redness or peeling of the skin on the hands and feet

If your child has a fever for more than five days (must be consecutive!) you should always get checked out, but if you have any of these symptoms as well as a fever, it is important to call your doctor’s office right away. In our experience, children with this disease, in addition to the symptoms above, are also incredibly fussy, uncomfortable, and agitated. If your child has daily fevers but is happy as a clam, it’s probably not this disease (though best to still get checked out). Some children have something called “Atypical Kawasaki Disease”, and have only a few of these additional symptoms with their prolonged fever. 

Your provider may order some additional testing, such as a blood or urine test, and you may need an Echocardiogram, which is an ultrasound of your heart. If there is suspicion of KD, they will send you to the hospital to be evaluated and treated.

Tell me about Kawasaki Disease treatment

If you are diagnosed with KD, your child will be hospitalized for treatment. According to the American Academy of Pediatrics, patients with KD are treated with a few medications. One of these is called Intravenous Immunoglobulin (IVIG) and the other is a small amount of aspirin. Occasionally a steroid is also given. These medications are specially dosed for your child and given based on criteria for your specific situation and child. These medications are thought to help decrease inflammation, and can decrease damage to the coronary arteries in some cases. Most children do not have lasting heart damage from KD. 

Should I be worried about Kawasaki Disease?

Kawasaki Disease is very rare and presents with very specific criteria. If you think your child has these symptoms, it is very important to get checked out. In general, it is important to know about this disease, but it is significantly less common than other illnesses that children get such as Coxsackie (Hand, Foot and Mouth Disease), Strep Throat, or the common cold

What does COVID-19 have to do with Kawasaki Disease?

Recently, there are increasing reports of children hospitalized with symptoms of Kawasaki Disease who are also testing positive for coronavirus or testing positive for antibodies against coronavirus (meaning they had coronavirus previously). One theory is that children who fight off coronavirus (even if they don’t have symptoms) may then go on to get a Kawasaki-like syndrome. NPR reports “The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation and evidence of one or more organs that are not functioning properly, says cardiologist Jane Newburger, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children’s Hospital.” Why this happens is complicated and not entirely clear, but is sometimes related to the body’s immune system going haywire. 

So far, it seems that the Kawasaki-like syndrome related to COVID-19 is impacting children’s bodies differently than the disease prior to the coronavirus outbreak. It’s too early to tell exactly what the differences may be. 

We hope that you never have to experience Kawasaki Disease. We know things we read in the news can be scary, and it is very important to be knowledgeable so that you are aware of the facts. You can always ask a nurse first if you are worried about any symptoms or concerns. 

Kim Liner, PNP

Nurse-1-1 Chief Nurse Practitioner

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