Kawasaki Disease Boston Children’s Hospital

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Kawasaki KD 80 M

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Kawasaki Disease

If and treated early, your can begin to feel better in a few with a low likelihood of long-term issues. Children who receive within the first ten days of have a less than 4 risk of coronary artery

If your child has been with Kawasaki disease, understanding of the condition will you and your family to cope this illness.

Kawasaki (mucocutaneous lymph node is an acute systemic illness by inflammation of the blood vessels It begins with the onset of a fever for at least four along with other and symptoms that develop the course of approximately one to two weeks.

from Kawasaki disease the blood vessels of many in the bodyincluding the hands, feet, of the eyes, mouth, lips, lymph nodes and skin. The lasts for six to eight weeks, and commonly affects children age 5 years (75 percent). Boys are 1.5 as likely to develop Kawasaki as girls.

Without treatment, 20 percent of patients develop to their coronary arteries blood vessels that the heart with oxygen), in those vessels’ enlargement or … formation).

If recognized and early, your child can to feel better in a few days, a low likelihood of long-term heart Children who receive treatment the first ten days of illness a less than 4 percent of coronary artery damage.

symptoms often resemble of other childhood diseases and no definitive test available, the of Kawasaki disease is made by an clinician on the basis of clinical and laboratory findings.

How Boston Hospital approaches Kawasaki

The experienced team members of Children’s Hospital Kawasaki Program provide coordinated for children with Kawasaki during the illness’s acute and in short- and long-term follow up.

year, our multidisciplinary programstaffed by cardiologists, rheumatologists and a pediatric practitionertreats more than 65 new who have confirmed or suspected disease. We follow more 1,500 children and young who’ve had Kawasaki disease in the outpatient Heart Care .

The Kawasaki Disease Program at Children’s serves as a national and resource for parents and physicians. We families with a wealth of and supportand we help pediatricians and specialists to confirm and treat hard-to-diagnose illness.

A member of Children’s Kawasaki Disease is on call for you and your pediatrician 24 a day, seven days a to help make a diagnosis, appropriate treatment, and offer for your family. With our family-centered approach, you and your are in the best possible hands.

Children’s Hospital, 2011

natural for you to be concerned right now your child’s healthKawasaki can be alarming for you and uncomfortable for your However, most children without significant heart And you can be assured that at Boston Hospital, your child is in hands.

What is Kawasaki

First described by T. Kawasaki, MD, in in 1967, Kawasaki disease is the common form of acquired than congenital) heart in the United States and Japan. The is most common in children age 5 years (75 percent), although of any age can develop it. Boys are 1.5 times as as girls to develop the disease.

disease is an acute systemic characterized by inflammation of the blood (vasculitis). It begins with the of a high fever, along other signs and symptoms develop over the course of one to two weeks. The total duration of (before the child is completely to normal) is six to eight weeks.

The from Kawasaki disease the blood vessels of many in the bodywith symptoms that changes in the hands, feet, of the eyes, mouth, lips, lymph nodes and skin. children have a high for at least four days diagnosis.

If recognized and treated your child can begin to better in a few days, with a low of long-term heart issues. In cases (about 4 percent) with treatment, Kawasaki can result in a coronary artery There’s no definitive test for the and its symptoms often resemble of other childhood diseases.

are the signs and symptoms of Kawasaki

The signs and symptoms of Kawasaki often resemble other or medical problems, so always your child’s physician for a Your child’s doctor be looking for typical signs and with a persistent high (101 degrees F to 104 degrees F) for at four days . along four out of five of the following:

in extremities

red, swollen of hands and soles of feet

skin around the fingertips, or feet (occurs later in the

non-specific rash on the body, accentuated in the groin area

eyes (no discharge)

redness in the mouth and tongue

dry, cracked lips

inflamed, red

swollen, red tongue (“strawberry

swollen lymph node(s) in the (more than 1.5 cm), on one side

Photos 1 and 2 from . 2001;103:335. 2001 American Association, Inc. Used permission.

It is possible to have disease without showing all of signs. Such cases are “incomplete” (or atypical) Kawasaki Infants younger than 6 are most likely to have Kawasaki disease, and infants the highest risk for developing artery damage.

Other that may develop include:

symptoms (joint pain and of the joints)

extreme irritability

vomiting

abdominal pain

liver or gallbladder

cough and symptoms

Who’s affected by disease?

Kawasaki disease more often in Japan in any other country. Children of or Asian-American heritage have a risk of Kawasaki disease of where they livealthough disease can occur in any racial or group.

The majority (75 percent) of who develop Kawasaki disease are age 5 or younger, although children of any age can get the The average age of a child with the is approximately 2 years, and boys are 1.5 times as likely to develop disease as girls.

Researchers to explore the genetic factors put some children at higher for Kawasaki disease, since:

of Japanese origin, no matter in the world they live, are likely to get Kawasaki disease.

and sisters of children with disease are slightly more than other neighborhood to develop the illness at a later

Kawasaki disease has been in the children of parents who themselves had affected in childhood.

Who should be treated for Kawasaki

Any child with Kawasaki in the acute phase should treatmentideally within the first to 10 days of the illness. Children in the diagnosis of Kawasaki disease is after the tenth day of illness be treated if they still fever, or if they have aneurysms together with laboratory tests suggesting

Why do you treat Kawasaki disease?

20 percent of untreated children Kawasaki disease develop in their coronary arteries blood vessels that the heart with oxygen), in those vessels’ enlargement/… (dilation of the blood vessel). The of treatment in Kawasaki disease is to the risk of the child developing enlargement/…(s).

In most cases, reduces the duration of fever, as as the risk of developing coronary Rarely (in less than 5 of cases), even with Kawasaki disease can weaken the of one or more of the coronary arteries, in an ….

What are the phases of disease?

There are three of Kawasaki disease:

acute The acute phase comes on with the abrupt onset of a fever that lasts for at four days. In this treatment with IVIG immunoglobulin) is the standard of care, in the hospital as soon as a diagnosis is Besides fever, other and symptoms that may come and go your child’s illness

swelling or redness of the hands and

rash

bloodshot eyes

cracked lips, “strawberry

enlarged lymph node in the

irritability

subacute phase: the subacute phase (between and chronic), your child’s will go down, but the disease continue to affect other Lingering symptoms and laboratory may include:

arthritis in his small or joints

continued irritability

skin on hands and feet

platelet counts

anemia

phase: In the convalescent phase gradual return to health and most findings on your physical exam will returned to normal, but his blood will show resolving

Irritability is a feature of Kawasaki throughout the course of a child’s It may be the last symptom to resolve.

How is disease diagnosed?

One challenge in Kawasaki disease is distinguishing it other childhood diseases have similar symptoms, as some viral infections, measles. adenovirus. enterovirus and virusas well as illnesses by bacterial toxins, such as fever. toxic shock or bacterial infection of the lymph in the neck.

A prolonged high (at least four days), with several other must be present for your doctor to consider Kawasaki as the cause of hisillness, and other need to be ruled out. To at a diagnosis, your child’s will start by taking a medical history and conducting a physical exam. Diagnostic may include:

electrocardiogram (EECG or a test that records the activity of the heart and shows rhythms (arrhythmias or dysrhythmias)

(cardiac ultrasound): a diagnostic that uses sound to produce a moving picture of the and heart valves in order to:

the coronary arteries

evaluate the and function of the heart muscle and valves

complete blood (CBC): a measurement of the size, and maturity of blood cells in a volume of blood; detects in the numbers of white blood which normally multiply in the of infection

erythrocyte sedimentation (ESR, “sed rate”) c-reactive protein (CRP): markers of inflammation in the blood

testing of a urine sample for red blood cells or white cells; helps rule out diseases

Observations and lab results can support a diagnosis of Kawasaki include:

extreme irritability

of the joints (arthritis)

elevated blood cell count

liver function tests

of inflammation in the blood and urine

It is possible to have Kawasaki without showing all of these Such cases are called (or atypical) Kawasaki disease. younger than 6 months are likely to have incomplete disease, and infants have the risk for developing coronary injury.

How is Kawasaki disease

The standard treatment for Kawasaki is IVIG (intravenous immunoglobulin), during the acute phase of the IVIG has been shown to the duration of the fever and decrease the of developing a coronary …. IVIG is given intravenously a vein), your child need to stay in the hospital for at one day, and often longer if is given.

In addition, high of aspirin will help your child’s fever it has resolved, after which the dose of aspirin is lowered. aspirin helps prevent clotting during this

Most children respond to first treatment with with reduced fever. If child’s fever continues, he may a second dose. Some are resistant to IVIG (i.e. to have fever despite treatment) and may be treated with therapies.

The expert team in Children’s Kawasaki Disease has wide experience treating with IVIG-resistant Kawasaki

What are the risks to the heart Kawasaki disease?

A small but percentage (approximately 20 percent) of children with the disease abnormalities in their coronary (the blood vessels supply the heart with resulting in coronary artery or aneurysms. Prompt treatment IVIG reduces the risk of a developing coronary complications to than 5 percent.

What Kawasaki disease?

Despite of research, the cause of Kawasaki is still unknown. The disease is not (spread from person to Outbreaks have been in waves within geographical and the disease tends to occur frequently in winter and early

Because no bacteria or virus has proven to cause Kawasaki some experts believe Kawasaki disease is an immune that children may have to a of infectious agents. Genetic may play a role.

How often Kawasaki disease occur?

disease is a major cause of disease in children. It has replaced rheumatic fever as the leading of acquired heart disease in in the United States and Japan.

Can disease be prevented?

Currently, no known way to prevent Kawasaki Nothing you’ve done has your child’s condition, and are no precautions you could have to prevent it.

What is my child’s outlook?

Most children a full recovery after Kawasaki disease resolves. Any who has had Kawasaki disease should periodic follow-up.

Kawasaki was first described in the late so information about the longer-term of the illness is restricted to the first few of life. Within this frame, children who never coronary aneurysms at any time in early illness have not future coronary artery causing clinical symptoms.

However, we do like to make that children who’ve had disease do not have additional factors for coronary heart as they get older. Since the long-term health risks Kawasaki disease aren’t known, your child be sure to eat a heart-healthy diet, regularly and avoid smoking. At point after the illness one year later), he should a cholesterol profile checked as of his routine well-child care.

If child developed an … as a of Kawasaki disease, he’ll more frequent cardiac The frequency of follow-up and cardiac is determined individually for each depending on the extent of coronary Coronary arteries that are may heal over time.

In arteries with large or coronary aneurysms, the healing may result in tightness (stenosis) of the artery, especially at the ends of the If a coronary artery blockage or occurs, the child is at risk for too blood flow to the heart ischemia) or a heart … infarction).

Aneurysms may also occur in other arteries, as those supplying the arms, or kidneys. These peripheral rarely cause symptoms, and are seen only in patients who giant coronary aneurysms.

FAQ

Q: is Kawasaki disease?

A: Kawasaki is an acute systemic illness by inflammation of the blood vessels It begins with the onset of a fever for at least four along with other and symptoms that develop the course of approximately one-two The inflammation from Kawasaki affects the blood vessels of tissues in the bodyincluding the hands, whites of the eyes, mouth, throat, lymph nodes and

Q: If my child has Kawasaki disease, he be OK?

A: If recognized and treated early, you can begin to feel better in a few with a low likelihood of long-term issues. Without treatment, 20 percent of patients develop to their coronary arteries blood vessels that the heart with oxygen), in those vessels’ enlargement or … formation).

Children who treatment with IVIG the first ten days of illness a less than 5 percent of coronary artery damage. Any who’s had Kawasaki disease receive periodic follow-up for the of time that his cardiologist

Q: How does Boston Children’s Kawasaki disease?

A: The standard for Kawasaki disease is IVIG immunoglobulin), given during the phase of the illness. IVIG has shown to shorten the duration of the and decrease the risk of developing a …. Because IVIG is intravenously (through a vein), child will need to in the hospital for at least one day, and longer.

In addition, high of aspirin will help your child’s fever it has resolved, after which the dose of aspirin is lowered. aspirin helps prevent clotting during this

Most children respond to first treatment with with reduced fever. If child’s fever continues, he may a second dose. Some are resistant to IVIG (i.e. to have fever despite treatment) and may be treated with therapies.

The expert team in Kawasaki Disease Program has experience treating children IVIG-resistant Kawasaki disease.

Q: are the signs and symptoms of Kawasaki

A: The signs and symptoms of Kawasaki often resemble other or medical problems, so always your child’s physician for a Your child’s doctor be looking for typical signs and with a persistent high (101 degrees F to 104 degrees F) for at four days . along four out of five of the following:

in extremities

red, swollen of hands and soles of feet

skin around the fingertips, or feet (occurs later in the

non-specific rash on the body, accentuated in the groin area

eyes (no discharge)

redness in the mouth and tongue

dry, cracked lips

inflamed, red

swollen, red tongue (“strawberry

swollen lymph node(s) in the (more than 1.5 cm), on one side

It is possible to have disease without showing all of signs. Such cases are “incomplete” (or atypical) Kawasaki Infants younger than 6 are most likely to have Kawasaki disease, and infants the highest risk for developing artery damage.

Other may develop that include:

symptoms (joint pain and of the joints)

extreme irritability

vomiting

abdominal pain

liver or gallbladder

cough and symptoms

Q: If my child has Kawasaki what should I ask my Boston doctor?

A: Ask your doctor:

How you diagnose my child?

What might you take after you a diagnosis?

What therapies are

What should we expect he comes home?

Will be restrictions on my child’s activities?

there be long-term effects?

Q: How is disease usually diagnosed?

A: A high fever along several other symptoms to be present for your child’s to consider Kawasaki disease as the for his illness, and other illnesses be ruled out. To arrive at a your child’s doctor/practitioner start by taking a full history and by conducting a thorough examination. Additional diagnostic may include:

electrocardiogram (ECG or

echocardiogram (cardiac ultrasound)

tests

urine tests

Q: should we do at home after disease?

A: It’s important to your child’s temperature discharge and to contact your if his fever returns. Low-dose is used to prevent clotting for six to eight weeks after child goes homeeven if he’s had any heart or blood complications, such as an ….

him to feel tired and irritable for a few after he comes home. is often the last symptom to In addition, children may have of the skin of their hands and (beginning at the tips).

This occurs in the second week of and although it’s not painful, the new may be somewhat tender.

Your lips may be cracked for a few weeks he’s been discharged, and his overall may be dry. You can apply to his lips and an unscented lotion to his for hydration. Some children may a temporary arthritis that can for up to a few months.

Q: What causes Kawasaki

A: Despite decades of research, the of Kawasaki disease is still The disease is not contagious (spread person to person). Outbreaks been reported in waves geographical areas, and the disease to occur more frequently in and early spring.

Because no or virus has been proven to Kawasaki disease, some believe that Kawasaki is an immune reaction that may have to a variety of infectious Genetic susceptibility may play a

Q: Who gets Kawasaki disease?

A. disease occurs more in Japan than in any other Children of Asian or Asian-American have a higher risk of disease regardless of where livealthough Kawasaki disease can in any racial or ethnic group.

The (75 percent) of children who develop disease are age 5 years or younger, children of any age can get the disease. The average age of a with the illness is approximately 2 and boys are about 1.5 times as to develop Kawasaki disease as

Q: What is Boston Children’s treating Kawasaki disease?

A: Children’s serves as a national and Kawasaki disease resource for and physicians. Our Kawasaki Disease staffed by cardiologists, rheumatologists and a nurse practitionertreats more 65 new patients each year for or suspected Kawasaki disease, and we more than 1,500 and young adults long-term.

Q: heart research and innovations are from Boston Children’s?

A: still a lot to learn about disease. Ongoing research in disease at Boston Children’s studies in several areas, as:

searching for genetic factors may play a role in the susceptibility of disease

finding a test to aid in the of Kawasaki disease


advances in options for children who don’t to conventional therapy

delineating the sequelae of Kawasaki disease in with and without coronary

Causes

Despite decades of the cause of Kawasaki disease is unknown. The disease is not contagious from person to person). have been reported in within geographical areas, and the tends to occur more in winter and early spring.

no bacteria or virus has been to cause Kawasaki disease, experts believe that disease is an immune reaction children may have to a variety of agents. Genetic susceptibility may a role.

Signs and symptoms

The and symptoms of Kawasaki disease resemble other conditions or problems, so always consult child’s physician for a diagnosis. child’s doctor will be for typical signs and symptomsstarting a persistent high fever for at four days . along four out of five of the following:

in extremities

red, swollen of hands and soles of feet

skin around the fingertips, or feet (occurs later in the

non-specific rash on the body, accentuated in the groin area

eyes (no discharge)

redness in the mouth and tongue

dry, cracked lips

inflamed, red

swollen, red tongue (“strawberry

swollen lymph node(s) in the (more than 1.5 cm), on one side

When to seek advice

Call your care provider if your or child has a persistent high for at least four days with some or all of the diagnostic described above.

Questions to ask doctor

How will you diagnose my

What actions might you after you reach a diagnosis?

therapies are offered?

Will my be OK if he has Kawasaki disease?

Will be restrictions on my child’s activities?

should we expect when he home?

Will there be effects?

Who’s at risk

disease occurs more in Japan than in any other Children of Asian or Asian-American have a higher risk of disease regardless of where livealthough Kawasaki disease can in any racial or ethnic group.

The (75 percent) of children who develop disease are age 5 years or younger, children of any age can get the disease. The average age of a with the illness is approximately 2 and boys are about 1.5 times as to develop Kawasaki disease as

Researchers continue to explore the factors that put some at higher risk for Kawasaki since:

Children of Japanese no matter where in the world live, are more likely to get disease.

Brothers and sisters of with Kawasaki disease are more likely than neighborhood children to develop the at a later time.

Kawasaki has been reported in the children of who themselves had been affected in

Complications

A small but significant (approximately 20 percent) of untreated with the disease develop in their coronary arteries blood vessels that the heart with oxygen), in coronary artery dilation or Prompt treatment with reduces the risk of a child coronary complications to less 5 percent.

Long-term outlook

children make a full after their Kawasaki resolves. Any child who has had Kawasaki should receive periodic

Kawasaki disease was first in the late 60’s, so information the longer-term complications of the illness is to the first few decades of life. this time frame, who never developed coronary at any time in their early have not developed future artery disease causing symptoms.

However, we do like to sure that children had Kawasaki disease do not have risk factors for coronary disease as they get older. the very long-term health from Kawasaki disease conclusively known, your should be sure to eat a heart-healthy exercise regularly and avoid At some point after the (about one year later), he have a cholesterol profile as part of his routine well-child

If your child developed an as a result of Kawasaki disease, need more frequent follow-up. The frequency of follow-up and testing is determined individually for patient, depending on the extent of injury. Coronary arteries are damaged may heal over

In coronary arteries with or giant coronary aneurysms, the process may result in tightness of the coronary artery, especially at the of the …. If a coronary artery or stenosis occurs, the child is at for too little blood flow to the (myocardial ischemia) or a heart (myocardial infarction).

Aneurysms may occasionally occur in other such as those supplying the legs or kidneys. These aneurysms rarely cause and are generally seen only in who’ve giant coronary

What you can do at home

Expect child to feel tired and for a few weeks after he comes He may be able to go back to school/daycare about a week, but may not feel 100 better until about six to weeks after his illness. your child’s temperature at and contact your health if the fever returns.

Your may be prescribed low-dose aspirin to clotting for as long as six to eight after he goes home. A will need ongoing if he has coronary enlargement or aneurysms. that affect clotting, as aspirin, will cause bruising.

While the child is on an …, he should avoid that have a high of physical injury, and should usual precautions such as seat belts in the car and helmets on

Prevention

Currently, there’s no way to prevent Kawasaki disease. you’ve done has caused child’s condition, and there are no you could have taken to it.

Kawasaki disease glossary

phase: the first phase of disease, involving a high and vasculitis resulting in the typical and symptoms of Kawasaki disease

a bulged out area of a weakened artery wall. Blood can form in the ballooned area, blood flow through the artery.

blood clot: a mass of blood that may or partially block, the flow of through an artery

cardiac/cardio-: to the heart

cardiac magnetic imaging (MRI): a non-invasive tool using 3-D imaging produced by magnets to accurately the blood flow, structure and of your child’s heart

Kawasaki KD 80 M

surgery: surgical procedure on the heart

cardiologist: doctor who and treats heart problems A pediatric cardiologist treats and children with heart

complete blood count a measurement of the size, number and of different blood cells in a volume of blood; detects in the numbers of white blood which normally multiply in the of inflammation or infection

convalescent: returning to health and strength

arteries: blood vessels supply the heart muscle oxygen-rich blood

c-reactive (CRP): a non-specific marker of in the blood

diagnosis: medical of illness or disease based on physical examinations and advanced diagnostic testing tools

(echo, cardiac ultrasound): a tool that uses waves to produce a moving of the heart and heart valves in to:

measure the coronary arteries

the structure and function of the heart and valves

electrocardiogram (ECG, a test that records the activity of the heart and shows rhythms (arrhythmia)

erythrocyte rate (ESR or “sed a non-specific marker of inflammation in the

incomplete (atypical) Kawasaki a form of the disease in which not all of the diagnostic signs and symptoms up. Infants younger than 6 are most likely to have Kawasaki disease.

inflammation: the that makes living swell, become painful and red

IVIG (intravenous immunoglobulin): the for Kawasaki disease.

Kawasaki (KD, mucocutaneous lymph syndrome): an acute illness by a high, sustained fever and chiefly affects children

lymph node syndrome: term for Kawasaki disease

inflammation and irritation of the heart

myocardium: the heart muscle

proliferation: the multiplying of cells the blood vessels

myopericarditis: and irritation of the heart muscle and the covering the heart

pericardium: covering the heart

stenosis blockage, blockages

symptoms: the physical complaints for which a seeks medical attention

testing of a urine sample for red blood cells or white cells

vasculitis: inflammation of the vessels

For a more complete of cardiovascular terms, visit Children’s Cardiovascular glossary .

For visual information on several of the diagnostic tools and procedures above, visit our cardiovascular library .

One challenge in diagnosing disease is distinguishing it from childhood diseases that similar symptoms, such as viral infections, including adenovirus. enterovirus and Epstein-Barr well as illnesses caused by toxins, such as scarlet toxic shock syndrome or infection of the lymph nodes in the

A prolonged high fever (at four days), along several other symptoms, be present for your child’s to consider Kawasaki disease as the of hisillnessand other illnesses to be ruled out. To arrive at a your child’s doctor start by taking a full history and conducting a thorough exam. Diagnostic tests may

electrocardiogram (ECG or EKG): a that records the electrical of the heart and shows abnormal (arrhythmias or dysrhythmias)

echocardiogram ultrasound): a diagnostic tool uses sound waves to a moving picture of the heart and valves in order to:

measure the arteries

evaluate the structure and of the heart muscle and heart

complete blood count a measurement of the size, number and of blood cells in a specific of blood; detects elevation in the of white blood cells, normally multiply in the presence of

erythrocyte sedimentation rate “sed rate”) and/or protein (CRP): non-specific of inflammation in the blood

urinalysis: of a urine sample for protein, red cells or white blood helps rule out other

Observations and lab results that can a diagnosis of Kawasaki disease

extreme irritability

inflammation of the (arthritis )

elevated white cell count

elevated function tests

signs of in the blood and urine

anemia

Kawasaki disease

It is possible to Kawasaki disease without all of these signs. Such are called “incomplete” (or atypical) disease. Infants younger 6 months are most likely to incomplete Kawasaki disease, and have the highest risk for coronary artery injury.

Children’s development of interventional

You’ll be comforted to know Boston Children’s pioneered the use of catheterization for many congenital defects and is a leader in the use of this

Heart surgery at Boston

Watch a fascinating webcast of surgery at Boston Children’s.

your child for Kawasaki within seven to 10 days of the of illness will help his risk of coronary complications. at Boston Children’s Hospital to:

reduce fever and inflammation

platelet activity

make child more comfortable

the heart from damage

The standard treatment for Kawasaki is IVIG (intravenous immunoglobulin), during the acute phase of the IVIG has been shown to the duration of the fever and decrease the of developing a coronary …. IVIG is given intravenously a vein), your child need to stay in the hospital the IVIG is given and until his goes away.

In addition, doses of aspirin will control your child’s until it has resolved, after time the dose of aspirin is Lower-dose aspirin helps blood clotting during time.

Response vs. resistance to

Most children respond reduced fever to their treatment with IVIG. If child’s fever continues, he may a second dose. Some are resistant to IVIG (i.e. to have fever despite treatment) and may be treated with therapies.

The expert team at Children’s Kawasaki Disease has wide experience treating with IVIG-resistant Kawasaki

At home: caring for your after Kawasaki disease

your child to feel and irritable for a few weeks after he home. He may be able to go back to after about a week but may not 100 percent better until six to eight weeks after his Monitor your child’s at home and contact your professional if the fever returns.

child may be prescribed low-dose to prevent clotting for as long as six to weeks after your goes home. A child need ongoing … if he has enlargement or aneurysms. Medications affect clotting, such as will cause easy

While the child is on an anti-clotting he should avoid activities have a high risk of injury, and should take the precautions, such as wearing a belt in the car and a helmet when his bike.

Follow-up care

children make a full after Kawasaki disease. appointments will be scheduled one to two weeks after treatment, and four to six weeks after At these visits, your will have a cardiac (echocardiogram) to assess his coronary size and heart and valve

At the same intervals, your will also have work, which may include a blood count, platelet liver function tests and for inflammation in the blood.

Following disease, your child receive periodic follow-up. The of follow-up and the testing that’s will be determined on an individual The clinician will continue to your child for coronary disease risk factors, as high blood pressure and cholesterol.

Your child be sure to eat a heart-healthy diet, regularly and avoid smoking.

As he your child’s long-term after Kawasaki disease

If child has no coronary artery Kawasaki disease was first in the late 60’s, so information the longer-term complications of the illness is to the first few decades of life. this time frame, who never developed coronary at any time in their early have not developed future artery disease causing symptoms.

However, we do like to sure that children had Kawasaki disease do not have risk factors for coronary disease as they get older. the very long-term health from Kawasaki disease conclusively known, your should be sure to eat a heart-healthy exercise regularly and avoid At some point after the (about one year later), he have a cholesterol profile as part of his routine well-child

Research at Children’s has also the psychosocial and physical functioning of who’ve recovered from disease. We’ve found children without aneurysms similar in psychosocial and physical to the general population.

If your developed aneurysms. If your developed an …(s) as a result of disease, he’ll need frequent cardiac follow-up. The of follow-up and cardiac testing is individually for each patient, on the extent of coronary injury.

arteries that are damaged may over time. In coronary with large or giant aneurysms, the healing process may in tightness (stenosis) of the coronary especially at the ends of the …. If a artery blockage or stenosis the child is at risk for too little flow to the heart (myocardial or a heart … (myocardial

Testing is done at regular to make sure that the muscle is getting enough flow. Testing may include echocardiograms, stress tests, MRIs, cardiac CT scans and imaging studies that heart function and blood to the heart. Cardiac catheterization may in patients who still have coronary abnormalities one year the initial illness, or if there are or symptoms that the heart getting enough oxygen.

may also occasionally occur in arteries, such as those the arms, legs or kidneys. peripheral aneurysms rarely symptoms, and are generally seen in patients who have giant aneurysms.

Coping and support

At Children’s, we understand that a visit can be difficult, and sometimes So, we offer many amenities to your child’sand your experience as pleasant as possible. The Center for Families for all you need to about:

getting to Boston

accommodations

navigating the hospital

resources that are available for family

In particular, we understand you may have a lot of questions if your is diagnosed with Kawasaki How will it affect my child term? What do we do next? We can you with a number of resources to you and your family through difficult time, including:

education: From the hospital to our doctors and nurses will be on to walk you through your course and help answer any you may have. Upon your discharge, they’ll also out to you by phone, continuing the care and he received while at Boston

parent-to-parent: Want to talk someone whose child has treated for Kawasaki disease? We can put you in touch with other who’ve been through the process that you and your are facing, and who can share their

faith-based support: If you’re in of spiritual support, we’ll you with the Boston Children’s Our program includes nearly a clergy representing Protestant, Muslim, Roman Catholic and faith traditionswho will to you, pray with you and you observe your own faith during your hospital

social work: Our social and mental health clinicians helped many families in situation. We can offer counseling and with issues such as with your child’s stresses relating to coping illness and dealing with difficulties.

Boston Children’s Care Center

The Heart Center at Boston Children’s is one of the pediatric heart programs in the States. Our staff of more 80 pediatric cardiac specialists for thousands of children and adults congenital and acquired heart each year, from to complex cases. We have treating rare heart results that are among the in the world.

Keep family and friends during your child’s .

There’s still a lot to learn Kawasaki disease. Ongoing in Kawasaki disease at Boston Hospital includes studies in areas, such as:

searching for factors that may play a in the susceptibility of Kawasaki disease

a test to aid in the diagnosis of Kawasaki

advances in treatment options for who don’t respond to conventional delineating the long-term sequelae of disease in patients with and coronary aneurysms

Genetic in Kawasaki disease

Boston investigators participate in a multi-center aimed at increasing our understanding of why children become affected Kawasaki disease. Experts that there may be genetic in determining why some children get illness. DNA is obtained from the with Kawasaki disease and from both biological

Developing a diagnostic test for disease

By analyzing the urine of with Kawasaki disease, are working to identify the “biomarkers”the telltale signsthat can serve as and prognostic indicators for the condition. A diagnosis of Kawasaki disease lead to more efficient with the potential for fewer and less discomfort.

Our Proteomics has excelled in developing fast, and minimally invasive diagnostics by biomarkers for disease that are in urine. Urine is easier to than blood and has a narrower of molecules and proteins to study. innovations that diagnose early by finding these biomarkers have encouraged the study to find biomarkers for disease, which is funded by a grant from Boston Translational Research Program .

Kentsis, MD, PhD. Hanno PhD. director of Boston Proteomics Center. and Susan MD, MMSc, rheumatologist and the clinical enrolling patients for the study, continue to build the molecular for Kawasaki disease by studying the of children with the condition, and after treatment. They’ll these samples to urine from children with similar to Kawasaki disease, but from a known, separate

Finding these markers may help researchers characterize the of Kawasaki disease, which is unclear to scientists. “If proteins are elevated in the urine, we may be to determine where those originate from, and possibly more effective treatment,” Kim.

Vascular health in disease

The study examines the effects of Kawasaki Disease on health by comparing test of 200 patients who’ve had KD to the test of 50 age- and gender-matched healthy We use three non-invasive techniques to vessel reactivity: EndoPAT, ultrasound and Millar tonometry. of these techniques provides into the health of the patient’s vessels, evaluating the stiffness of the in different parts of the body, and the vessel reactivity.

In addition to tests, we gain information the patient through questionnaires exercise habits, eating and personal and family medical Finally, we measure cholesterol and markers of inflammation in the blood. We to determine if there are long-term between those who’ve had disease and those who haven’tand, if what those differences

We also hope to explore the that might lead to effects based on the initial of the illness and the current condition of the arteries in each patient.

In to these studies, for which with a history of Kawasaki are currently being recruited, investigators also participate in a of studies analyzing the database of patients with Kawasaki (e.g. “retrospective” studies). is a member of the Pediatric Heart (PHN), a group of researchers combined their efforts to Kawasaki disease, among heart conditions in young

A significant amount of Boston groundbreaking cardiac research to refine and advance the open surgery and catheterization procedures treat congenital heart in newborns and young children. Cardiac Surgery Research is studying the mechanisms of heart and new treatments for children with heart defects.

Duncan’s

What 4 1/2-year-old Duncan about his eight-day stay at Children’s Hospital two years ago is he ate a gummy worm, watched the Cars and met a dog. I remember else. And because I have a background, I unfortunately understood how he was at the time.

Kawasaki disease inflammation of many tissues of the including the hands, feet, of the eyes, mouth, lips and But the aspect of Kawasaki disease we most concerned about was its effect on Duncan’s heart and vessels.

What will stand out in my mind is how Duncan’s were able to make a situation not so terrible. Due to his do everything the way nature, Duncan became enough to end up in the Cardiac Intensive Unit (CICU) with an in this rare disease for him. He initially responded to treatment, but by the third day, he had two pounds of fluid and was getting worse.

Dr. Jane Newburger to see him, along with students, doctors, and members of the team. While examining and talking to me, she also took the to teach, passing around her to everyone in the room to listen to best medical student you’ll ever hear.”

night, Duncan was moved to the had central and arterial lines and was put on dopamine to improve the working of his The many medications and other he had there made a huge and I was soon taking him on rides in the newly appreciative of how fortunate we were. Several days and later, we were able to go

Kawasaki disease could have left Duncan serious, life-long heart but two years later, he is as happy and as any other 4-year-old. I look on our time at Boston Children’s, if not fondly, with an immeasurable of gratitude to those who cared for

Thank you to those who enabled me to beyond the rash, the fever, the medications and interventions, and made me that my baby would be fine. I never doubted he was receiving the best care in the

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