What is the recommended treatment and parental guidance for a child with Kawasaki's disease?

Parental Guidance for Kawasaki Disease

Parents should be informed that their child requires immediate hospitalization for intravenous immunoglobulin (IVIG) treatment combined with high-dose aspirin to prevent potentially life-threatening coronary artery damage, and they must understand the critical importance of prompt treatment, medication adherence, and long-term cardiac follow-up. 1, 2

Understanding the Disease and Urgency

• Kawasaki disease is a serious acute vasculitis that, without treatment, causes coronary artery abnormalities in 15-25% of children, but this risk drops to approximately 5% with prompt IVIG therapy. 1
• Parents must understand that treatment should ideally begin within the first 10 days of fever onset to maximize protection against heart complications. 1, 2
• The disease primarily affects children under 5 years old, with infants under 1 year at paradoxically higher risk for coronary complications despite often having fewer classic symptoms. 1

Immediate Treatment Expectations

Hospital Phase

• The child will receive a single infusion of IVIG at 2 g/kg body weight combined with high-dose aspirin (80-100 mg/kg/day divided into four doses). 1, 2
• Parents should expect hospitalization for at least 2-3 days to monitor response to treatment and ensure fever resolution. 1
• Approximately 10-15% of children may not respond to the first IVIG dose and require a second infusion—this does not mean treatment has failed, but rather that their child needs additional therapy. 1, 3

Medication Management at Home

High-Dose Aspirin Phase:

• After discharge, continue high-dose aspirin until the child has been fever-free for 48-72 hours (typically 48-72 hours after defervescence or until day 14 of illness). 1
• Parents must give aspirin exactly four times daily at prescribed intervals to maintain anti-inflammatory effects. 1

Low-Dose Aspirin Phase:

• Once fever resolves, aspirin will be reduced to low-dose (3-5 mg/kg/day as a single daily dose) and continued for 6-8 weeks if no coronary abnormalities are detected, or indefinitely if coronary changes are present. 1, 2
• This low dose provides antiplatelet protection against blood clots in coronary arteries. 1

Critical Safety Instructions

Reye's Syndrome Prevention

• Parents must contact their physician immediately if their child develops symptoms of influenza or chickenpox (varicella) while taking aspirin, as this combination significantly increases the risk of Reye's syndrome, a potentially fatal condition. 1
• The child should receive annual influenza vaccination to reduce this risk. 1, 2
• Alternative antiplatelet medications may be substituted temporarily during influenza or varicella illness. 1

Medication Interactions

• Ibuprofen must be avoided in children taking aspirin because it antagonizes aspirin's protective antiplatelet effects. 1
• Parents should inform all healthcare providers (including dentists and emergency physicians) that their child is on aspirin therapy. 1

Vaccination Considerations

• Measles, mumps, rubella, and varicella vaccinations must be deferred for 11 months after high-dose IVIG administration because IVIG can interfere with vaccine effectiveness. 2, 4
• Influenza vaccination should be given annually and is particularly important for children on long-term aspirin therapy. 1, 2

Follow-Up Care and Monitoring

Cardiac Surveillance

• The child will require echocardiography at diagnosis, 2 weeks, and 6-8 weeks after illness onset to monitor for coronary artery changes. 1, 2, 4
• If coronary abnormalities develop, more frequent cardiac monitoring will be necessary, with the highest risk for complications occurring in the first 3 months (particularly days 15-45). 2, 4
• Parents should understand that some coronary changes may resolve over 1-2 years, particularly smaller fusiform aneurysms, but ongoing monitoring remains essential. 1

Activity Restrictions

• Children without coronary abnormalities can return to normal activities after 6-8 weeks when aspirin is discontinued. 1
• If coronary abnormalities are present, activity restrictions will be tailored to the severity of involvement and discussed with a pediatric cardiologist. 1

Warning Signs Requiring Immediate Medical Attention

Parents should seek emergency care if their child develops:

• Chest pain, shortness of breath, or unusual fatigue (potential signs of myocardial ischemia or infarction). 1, 5
• Recurrent fever beyond 36 hours after IVIG treatment (indicating IVIG resistance requiring additional therapy). 1, 3
• Signs of bleeding while on aspirin therapy (bruising, nosebleeds, blood in stool). 1

Long-Term Cardiovascular Health

• Even children without detectable coronary abnormalities may have subtle endothelial dysfunction, so parents should promote heart-healthy lifestyle habits including avoiding smoking, maintaining healthy diet, and regular exercise. 1
• Cardiovascular risk factor counseling should occur every 5 years throughout childhood and adolescence. 1
• Some children may require lifelong cardiac follow-up depending on the severity of coronary involvement. 1, 5

Common Pitfalls to Avoid

• Do not stop aspirin abruptly without physician guidance, even if the child appears completely well. 1
• Do not assume the diagnosis was wrong if the child requires a second IVIG dose—treatment resistance occurs in 10-20% of cases and is manageable. 3, 4
• Do not delay seeking care if fever recurs, as this may indicate inadequate disease control requiring escalation of therapy. 1, 3
• Do not give over-the-counter medications (especially ibuprofen) without consulting the treating physician first. 1

Prognosis Discussion

• With appropriate treatment, the vast majority of children recover completely without long-term cardiac complications. 1
• Giant coronary aneurysms (≥8 mm) carry the highest risk for long-term complications including thrombosis, stenosis, and myocardial infarction, but these occur in only about 1% of treated patients. 1, 5
• Kawasaki disease can recur (though rarely, in approximately 1-3% of cases), so parents should remain vigilant for similar symptoms in the future. 1