What are the indications for referral to a specialist in cases of suspected Kawasaki Disease?

Indications for referral to a specialist in suspected Kawasaki disease include:

• Children with fever lasting 5 days or longer, especially if accompanied by features suggestive of Kawasaki disease such as bilateral conjunctival injection without exudate, erythema and cracking of lips, strawberry tongue, erythema of oral and pharyngeal mucosa, oedema and erythema of the hands and feet, polymorphous rash, or cervical lymphadenopathy should be referred for specialist assessment.
• Infants under 1 year of age presenting with fewer clinical features but suspected Kawasaki disease should be referred urgently due to their higher risk of coronary artery abnormalities.
• Children with suspected Kawasaki disease who have signs of serious illness or complications (e.g., signs of coronary artery involvement or persistent fever despite initial management) require specialist referral.

Referral should be made promptly to paediatric specialists for diagnosis confirmation, cardiac evaluation, and initiation of appropriate treatment to reduce the risk of coronary artery complications.

These recommendations are based on the NICE guideline on fever in under 5s, which highlights the importance of recognizing Kawasaki disease in children with prolonged fever and characteristic clinical features and the need for specialist involvement in management ¹,².