Treatment & Care
Treating your child for Kawasaki disease within seven to 10 days of the onset of illness will help reduce his risk of coronary complications. Treatment at Boston Children's Hospital aims to:
- reduce fever and inflammation
- control platelet activity
- make your child more comfortable
- protect the heart from damage
The standard treatment for Kawasaki disease is IVIG (intravenous immunoglobulin), given during the acute phase of the illness. IVIG has been shown to shorten the duration of the fever and decrease the risk of developing a coronary aneurysm. Because IVIG is given intravenously (through a vein), your child will need to stay in the hospital while the IVIG is given and until his fever goes away.
In addition, high doses of aspirin will help control your child’s fever until it has resolved, after which time the dose of aspirin is lowered. Lower-dose aspirin helps prevent blood clotting during this time.
Response vs. resistance to IVIG
Most children respond with reduced fever to their first treatment with IVIG. If your child’s fever continues, he may need a second dose. Some children are resistant to IVIG (i.e., continue to have fever despite IVIG treatment) and may be treated with additional therapies. The expert team at Children’s Kawasaki Disease Program has wide experience treating children with IVIG-resistant Kawasaki disease.
At home: caring for your child after Kawasaki disease
Expect your child to feel tired and irritable for a few weeks after he comes home. He may be able to go back to school/daycare after about a week but may not feel 100 percent better until about six to eight weeks after his illness. Monitor your child’s temperature at home and contact your health professional if the fever returns.
Your child may be prescribed low-dose aspirin to prevent clotting for as long as six to eight weeks after your child goes home. A child will need ongoing medication if he has coronary enlargement or aneurysms. Medications that affect clotting, such as aspirin, will cause easy bruising. While the child is on an anti-clotting medication, he should avoid activities that have a high risk of physical injury, and should take the usual precautions, such as wearing a seat belt in the car and a helmet when riding his bike.
Most children make a full recovery after Kawasaki disease. Follow-up appointments will be scheduled approximately one to two weeks after treatment, and again four to six weeks after treatment. At these visits, your child will have a cardiac ultrasound (echocardiogram) to assess his coronary artery size and heart and valve function.
At the same intervals, your child will also have blood work, which may include a complete blood count, platelet count, liver function tests and tests for inflammation in the blood.
Following Kawasaki disease, your child should receive periodic follow-up. The frequency of follow-up and the testing that’s ordered will be determined on an individual basis. The clinician will continue to monitor your child for coronary artery disease risk factors, such as high blood pressure and high cholesterol. Your child should be sure to eat a heart-healthy diet, exercise regularly and avoid smoking.
As he grows: your child’s long-term outlook after Kawasaki disease
If your child has no coronary artery changes. Kawasaki disease was first described in the late 60’s, so information about the longer-term complications of the illness is restricted to the first few decades of life. Within this time frame, children who never developed coronary aneurysms at any time in their early illness have not developed future coronary artery disease causing clinical symptoms.
However, we do like to make sure that children who’ve had Kawasaki disease do not have additional risk factors for coronary heart disease as they get older. Since the very long-term health risks from Kawasaki disease aren’t conclusively known, your child should be sure to eat a heart-healthy diet, exercise regularly and avoid smoking. At some point after the illness (about one year later), he should have a cholesterol profile checked as part of his routine well-child care.
Research at Children’s has also examined the psychosocial and physical functioning of children who’ve recovered from Kawasaki disease. We’ve found that children without aneurysms were similar in psychosocial and physical health to the general population.
If your child developed aneurysms. If your child developed an aneurysm(s) as a result of Kawasaki disease, he’ll need more frequent cardiac follow-up. The frequency of follow-up and cardiac testing is determined individually for each patient, depending on the extent of coronary injury.
Coronary arteries that are damaged may heal over time. In coronary arteries with large or giant coronary aneurysms, the healing process may result in tightness (stenosis) of the coronary artery, especially at the ends of the aneurysm. If a coronary artery blockage or stenosis occurs, the child is at risk for too little blood flow to the heart (myocardial ischemia) or a heart attack (myocardial infarction).
Testing is done at regular intervals to make sure that the heart muscle is getting enough blood flow. Testing may include periodic echocardiograms, stress tests, cardiac MRIs, cardiac CT scans and other imaging studies that assess heart function and blood flow to the heart. Cardiac catheterization may done in patients who still have significant coronary abnormalities one year after the initial illness, or if there are signs or symptoms that the heart isn’t getting enough oxygen.
Aneurysms may also occasionally occur in other arteries, such as those supplying the arms, legs or kidneys. These peripheral aneurysms rarely cause symptoms, and are generally seen only in patients who have giant coronary aneurysms.
Coping and support
At Children’s, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child’s—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about:
- getting to Children’s
- navigating the hospital experience
- resources that are available for your family
In particular, we understand that you may have a lot of questions if your child is diagnosed with Kawasaki disease. How will it affect my child long term? What do we do next? We can connect you with a number of resources to help you and your family through this difficult time, including:
patient education: From the hospital to recuperation, our doctors and nurses will be on hand to walk you through your child’s course and help answer any questions you may have. Upon your child’s discharge, they’ll also reach out to you by phone, continuing the care and support he received while at Children’s.
parent-to-parent: Want to talk with someone whose child has been treated for Kawasakidisease? We can often put you in touch with other families who’ve been through the same process that you and your child are facing, and who can share their experience.
faith-based support: If you’re in need of spiritual support, we’ll connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
- social work: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.
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