Kawasaki disease

The symptoms of Kawasaki disease usually develop in three phases. The phases are outlined below.

Phase one: acute (weeks 1-2)

During the acute phase, your child's symptoms will appear very suddenly and can often be severe. The symptoms of the acute phase are described below.

High temperature (fever)

A high temperature (fever) of 38C (100.4F) or above is usually the first and most common symptom. This can come on rapidly and will not respond to antibiotics or antipyretics (medicines that are used to reduce a fever, such as ibuprofen or paracetamol). If your child has a fever, they may be very irritable.

The fever will usually last for at least five days. However, without appropriate treatment, it can last for around 11 days. In some cases, it may last as long as three to four weeks. The fever will be remittent (come and go) and it may reach a high of up to 40C (104F). 

Changes in hands and feet

The skin on your child’s palms or the soles of their feet may become red or hard, and their hands and feet may swell up. Your child’s hands and feet may also be tender (painful) to touch or to put weight on, so they may be reluctant to walk or crawl.

Rash

A blotchy, red rash may appear. This usually starts in the genital area, before spreading to the trunk (torso), arms and legs, and the face. There may be flat or raised red spots, but there will not be any blisters (fluid-filled pockets of skin).

Conjunctival injection

Conjunctival injection is when the whites of the eyes become red and swollen. It usually affects both eyes and does not cause any pain. Unlike conjunctivitis (when part of the eye is infected), the conjunctival injection that is associated with Kawasaki disease does not cause fluid to leak from the eyes. 

Lips, mouth and tongue

Your child’s lips may be:

• red
• dry
• cracked
• peeling
• swollen
• bleeding

The inside of your child’s mouth and throat may also be red, and they may have ‘strawberry tongue’. This is when your child's tongue appears red and inflamed (swollen) and is covered in small lumps.

Swollen lymph glands

If you gently feel your child's neck, you may be able to feel swollen lumps on one or both sides. The lumps could be swollen lymph glands.

The lymph glands are part of the immune system (the body’s defence system that helps fight infection). They may swell to over 1.5cm in diameter and feel firm and slightly painful.

Second phase: sub-acute (weeks 3-4)

During the sub-acute phase, your child's symptoms will become less severe, but they may last for longer. Your child's fever should subside, but they may still be persistently irritable and in considerable pain.

The symptoms during the sub-acute stage may include:

• peeling skin on your child’s fingers and toes, and sometimes on their palms or the soles of their feet
• abdominal pain 
• vomiting
• diarrhoea
• urine that contains pus
• lethargy (feeling drowsy)
• headache
• joint pain and swollen joints
• jaundice (yellowing of the skin and whites of the eyes)

It is during the second phase that complications, such as coronary artery aneurisms (a bulge in one of the blood vessels that supply blood to the heart) are more likely to develop. For more information, see Complications of Kawasaki disease.

Third phase: convalescent (weeks 4-6)

During the convalescent phase, your child will begin to recover. Your child's symptoms should improve and all signs of the illness should eventually disappear. However, your child may still be listless (lacking energy) and easily worn out during this time. Complications can occasionally develop during the third phase.

Glossary

Disease
A disease is an illness or condition that interferes with normal body functions.

Fever
A fever is when you have a high body temperature of 38C (100.4F) or over.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Lymph glands
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.

Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.

Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.

Jaundice
Jaundice is a condition that causes yellowing of the skin and the whites of the eyes, brought on by liver problems.

Blood vessel
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Heart
The heart is a muscular organ that pumps blood around the body.

Aneurysms
An aneurysm is a blood-filled sac that forms in a weakened part of a blood vessel.