A5V4d

Feverish illness in children
The AHA criteria suggested that the diagnosis of Kawasaki disease can be made in children with a
history of fever for at least 5 days, plus at least four of the following five signs:
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changes in the extremities, such as erythema of the palms and soles and oedema of the
hands and feet
polymorphous exanthema
bilateral bulbar conjunctival injection without exudates
erythema of the lips, tongue and oral cavity
cervical lymphadenopathy of 1.5 cm in diameter or greater, which is usually unilateral.
Incomplete (atypical) Kawasaki disease is diagnosed with fewer than the suggested criteria above
and is seen in younger patients who are more likely to have coronary artery aneurysms if left
untreated.
GDG translation
The GDG felt it was important to highlight the need to rule out Kawasaki disease in children who have
had fever for 5 days or more. Therefore a fever for 5 days or more is an ‘amber’ sign. The GDG
highlighted the fact that Kawasaki disease, especially in the under 1 year age group, can be present
without all of the features listed in recommendation 32.
Recommendations
Number Recommendation
Assessment of risk of serious illness
8 Assess children with feverish illness for the presence or absence of symptoms
and signs that can be used to predict the risk of serious illness using the traffic
light system (see table 5.2). [2013]
9 When assessing children with learning disabilities, take the individual child’s
learning disability into account when interpreting the traffic light table. [new
2013]
10 Recognise that children with any of the following symptoms or signs are in a
high-risk group for serious illness:
pale/mottled/ashen/blue skin, lips or tongue
no response to social cues *
appearing ill to a healthcare professional
does not wake or if roused does not stay awake
weak, high-pitched or continuous cry
grunting
respiratory rate greater than 60 breaths per minute
moderate or severe chest indrawing
reduced skin turgor
bulging fontanelle. [new 2013]
* A child’s response to social interaction with a parent or health care professional, such as response to their name, smiling
and/or giggling.