How should I manage a child with Kawasaki Disease who presents with persistent fever despite initial treatment?

Management of a child with Kawasaki disease who presents with persistent fever despite initial treatment:

• Recognise that persistent fever beyond 5 days with features of Kawasaki disease (such as bilateral conjunctival injection, erythema and cracking of lips, strawberry tongue, oedema and erythema of hands and feet, polymorphous rash, and cervical lymphadenopathy) warrants specialist paediatric assessment and management ¹.
• Initial treatment typically involves intravenous immunoglobulin (IVIG) and aspirin; if fever persists despite initial treatment, the child should be referred urgently to a paediatric specialist for further evaluation and management ¹.
• Children under 1 year may present with fewer clinical features but are at higher risk of coronary artery abnormalities, so persistent fever in this group requires particular vigilance and specialist input ¹.
• Ongoing monitoring for coronary artery abnormalities with echocardiography is essential in children with Kawasaki disease, especially if fever persists despite treatment ¹.
• Supportive care includes managing fever and distress with paracetamol or ibuprofen, but aspirin is contraindicated as an antipyretic in children under 16 years; antipyretics should be used only if the child is distressed, not solely to reduce temperature ².
• Persistent fever despite initial treatment may indicate resistance to IVIG, and additional treatments such as corticosteroids or other immunomodulatory therapies may be considered by paediatric specialists ¹.