Kawasaki disease symptoms in children: the signs, what to do and how the heart is checked

The main sign of Kawasaki disease is a fever that lasts 5 days or more, the NHS says. NUH lists the other Kawasaki disease symptoms: red eyes with no discharge, red cracked lips or a strawberry tongue, a rash, red swollen hands and feet, and swollen glands in the neck. If your child has a long fever with any of these, see a doctor the same day and ask about Kawasaki disease by name. It's treated in hospital, and NUH says treatment within 10 days of the first symptoms makes heart problems unlikely.

What to do if you think it's Kawasaki disease, step by step

1. Write down the day the fever started and every reading after that. HealthHub counts a temperature above 38 degrees C as a fever (how to take your child's temperature).
2. Check your child's eyes, lips, tongue, skin, hands and feet each day. NUH also lists a red, swollen BCG vaccination scar as a sign.
3. Photograph each sign on the day you see it, in good light. Keep the photos with your fever log.
4. See a GP, polyclinic doctor or paediatrician the same day if the fever comes with any of these signs. The NHS advises an urgent GP appointment for Kawasaki symptoms, so you don't need to wait for day 5.
5. Ask the doctor about Kawasaki disease by name, and show the log and photos. NUH says no single test exists for it, so the doctor goes by the signs and rules out other illnesses.
6. Go to KKH or NUH Children's Emergency straight away if you see any warning sign in the list further down. In an emergency, KKH says to call 995.
7. Keep your child comfortable while you wait. HealthHub suggests sponging with lukewarm water, thin clothes, a cool room, rest and plenty of fluids.
8. Never give aspirin at home. HealthHub says to never give your child aspirin, because it can lead to Reye's syndrome, which causes swelling in the liver and brain.
9. Tell grandparents, your helper and the preschool what you're watching for. Ask them to add readings to the same log and send you a photo of any new sign.

The signs, and which children get it

Singapore's public hospitals and the NHS list these signs.

• A fever that lasts 5 days or more (NHS)
• Red eyes with no discharge (NUH)
• Red, dry, cracked lips, or a strawberry tongue (NUH)
• A rash (NUH)
• Red, swollen hands and feet, with peeling skin on the fingers and toes later on (KKH)
• Swollen glands in the neck (NUH)
• A red, swollen BCG vaccination scar (NUH)
• Being very irritable (NHS)

Not every child has every sign, NUH says. Doctors generally look for a fever of at least 4 to 5 days plus at least 4 of the other signs. The NHS notes that red palms can be harder to see on brown or black skin. It also says the symptoms look like many more common childhood illnesses. That's why your fever log and photos help.

KKH says Kawasaki disease usually affects children under 4, though older children can get it too. NUH says it's seen in all ethnic groups and is more common in children of Japanese and Korean descent. Nobody knows what causes it, KKH says.

It isn't contagious. KKH says it isn't known to spread between children through close contact, and the NHS says you can't catch it from other people.

Why early treatment matters for the heart

Kawasaki disease inflames the medium-sized arteries in the body, NUH says. The ones doctors watch most are the coronary arteries, which supply blood to the heart muscle. KKH says most children recover well with no problems. Between 5 and 20% may develop heart problems, and early treatment lowers that risk.

Timing is the part you can help with. NUH says that if treatment starts within 10 days of the first symptoms, heart complications are unlikely. Waiting beyond 12 to 14 days raises the risk. Symptoms usually settle within two days of starting treatment, NUH adds.

The NHS counts babies under 6 months among the children at higher risk of getting seriously unwell, and says those children may also be offered steroid medicine.

What happens in hospital

If the doctor thinks it's Kawasaki disease, your child will be treated in hospital. NUH says to expect blood and urine tests and a heart ultrasound called an echocardiogram. The main treatment is immunoglobulin (IVIG), a medicine made from blood. KKH says it can only be given in hospital, through a drip over several hours.

Your child also gets aspirin by mouth. KKH says doctors start with high doses to bring the fever down. They lower the dose once the fever settles and may keep it going for several weeks. In more severe cases, NUH says steroids may be added. KKH says your child is monitored very closely the whole time.

Your child stays in hospital until there's been no fever for at least 24 hours, KKH says, and most children stay 3 to 7 days. Your child may still feel a little weak afterwards, and may need about a week at home before going back to school.

Hospital aspirin is a doctor's decision for this one illness. At home, HealthHub's rule stands: never give your child aspirin on your own. The NHS says the same for anyone under 16 unless a healthcare professional prescribes it. If your child catches flu or chickenpox while on aspirin, KKH asks you to see your family doctor or paediatrician and tell them about the aspirin.

Follow-up heart scans and vaccines

KKH books a review about 1 to 2 weeks after discharge. Your child has a heart scan 2 weeks after the illness started, and another in about 3 months. NUH says a cardiologist repeats these scans at the outpatient clinic.

Peeling on the fingers and toes in the second or third week is expected. NUH says you can leave it alone.

IVIG changes the timing of some jabs. KKH says the MMR and chickenpox vaccines wait until 11 months after the IVIG. The rest of the schedule carries on as normal. HealthHub says the first MMR dose is due at 12 months, so a baby treated before then may have it pushed back. Tell the clinic about the IVIG before each jab, bring the Child Health Booklet, and check the dates on our vaccination schedule.

Kawasaki disease or another fever with a rash?

Several childhood illnesses cause a fever with a rash, and only a doctor can tell them apart. This table shows what Singapore sources describe for each one. Use it to know what to point out to the doctor, not to decide which one your child has.

A strawberry tongue shows up in both Kawasaki disease and scarlet fever, so the tongue alone won't settle it. Measles is highly contagious, HealthHub says, while Kawasaki disease isn't.

For other rashes, see our baby rash guide. HFMD care and preschool rules are in HFMD in Singapore. Scarlet fever is caused by group A strep, which our strep throat guide covers. Red, sticky eyes are in our pink eye guide, and the wider list is in common childhood illnesses in Singapore.

When to see a doctor

See a GP, polyclinic doctor or paediatrician the same day if your child has:

• A fever with any of the Kawasaki signs above. The NHS advises an urgent GP appointment.
• A fever that has lasted more than 5 days, even with no other sign. A KKH doctor writing on HealthXchange says most viral fevers last 3 to 5 days, and a doctor may order a blood test after that.
• Flu or chickenpox while taking aspirin after Kawasaki disease. Tell the doctor about the aspirin (KKH).

KKH says polyclinic and family doctors can treat common illnesses in young children, and can refer your child to KKH if needed. Our paediatrician map lists clinics near you.

Go to KKH Children's Emergency or NUH Children's Emergency straight away if your child:

• Is under 3 months old with a fever: more than 37.5 degrees C under the arm or 38.0 degrees C in the ear (NUH)
• Has a temperature above 41.0 degrees C (HealthHub)
• Is hard to wake, or seems confused (HealthHub)
• Cries constantly and you can't settle them (HealthHub)
• Has trouble breathing (HealthHub)
• Has pale or grey skin, or bruising spots (HealthHub)
• Has a fit (HealthHub)
• Is drinking less and passing much less urine than usual (HealthHub)

KKH lists fits, trouble breathing and loss of consciousness as emergencies. For any of these, call 995. For fevers in general, our fever checker and guide to when a baby's fever is a worry go further.

Frequently asked questions

What are the first signs of Kawasaki disease?

Fever is the main sign. The NHS says it lasts 5 days or more. NUH says it comes with other signs, such as red eyes, cracked lips, a rash, swollen hands and feet, and swollen neck glands. Not every child gets all of them.

Is Kawasaki disease contagious?

No. The NHS says you can't catch it from other people, and KKH says it isn't known to spread between children through close contact. The week at home after hospital is for recovery, since KKH says your child may still feel weak.

Can older children get Kawasaki disease?

Yes. KKH says it usually affects children under 4, and that older children can get it too. The NHS says adults can get it as well.

Can a child have Kawasaki disease without all the symptoms?

Yes. NUH says not every child has every sign. A child with a long fever and only some of the signs still needs a doctor to check, so bring your fever log and photos.

Can I give my child aspirin for a Kawasaki fever?

No. HealthHub says never give your child aspirin. In hospital, doctors use aspirin for Kawasaki disease and monitor your child closely, and only they decide the dose. Before you see a doctor, follow HealthHub's comfort steps: lukewarm sponging, thin clothes and fluids.

How long does Kawasaki disease treatment take?

KKH says most children stay in hospital 3 to 7 days, until there's been no fever for at least 24 hours. NUH says aspirin usually carries on for a few weeks, and KKH books heart scans at about 2 weeks and 3 months.