If you are in a hurry
- Kawasaki disease was first described in Japan and mainly affects infants and young children aged 4 and under
- The 6 signs are: fever, redness in the whites of both eyes, red lips or tongue, a rash (including redness at the BCG vaccination site), changes in the hands and feet, and swollen neck glands
- If your child is limp, has a poor color, or has trouble breathing, see a doctor right away, even at night or on a holiday. If your child does not respond or is struggling badly to breathe, call 119 (Japan’s emergency number)
Hello. I am Shunichi Gamo, MD, PhD, a board-certified pulmonologist and the director of Sendai Airport North Clinic.
When I see children at the fever clinic, parents sometimes tell me that besides the fever, “the eyes are red,” “the lips are bright red,” or “spots have come out on the body.” In those cases, there is one illness we always keep in mind: Kawasaki disease.
Let me give you the answer first. If a child’s fever comes with changes in the eyes, lips, skin rash, hands and feet, or neck, please see a doctor early, no matter how many days the fever has lasted. That is because Kawasaki disease is an illness in which the earlier treatment starts, the better the chance of preventing aneurysms (bulges) from remaining in the heart’s blood vessels.
In this article, based on published papers and materials from medical societies, I explain what Kawasaki disease is, the 6 signs used as a guide to diagnosis, why early treatment matters, and how to keep a photo record at home.
At our fever clinic we give you the result of the PCR test (a test that copies the virus’s genetic material so it can be detected) the same day.
From October 4, 2026, our fever clinic is also open on Sundays and holidays
10:00 to 15:00 (no lunch break). No appointment is needed; you register by checking in on the day. We tell you the PCR result the same day. On Sundays and holidays we run the fever clinic only, with no general outpatient care and no IV drips. We are closed on Sunday, October 25. From November, we are generally open every Sunday and on holidays. Notice about the Sunday and holiday fever clinic
Shunichi Gamo, MD, PhD
Director, Sendai International Airport North Clinic
Born and raised locally, he attended Yuriage Elementary School and Yuriage Junior High School in Natori City. After graduating from Tohoku University School of Medicine, he worked at Sendai Open Hospital and Kesennuma City Hospital, and then at Tohoku University Hospital. In April 2021, in the middle of the COVID-19 pandemic, he opened Sendai International Airport North Clinic. Holding to a fever clinic that never turns patients away, he cared for well over 20,000 patients with fever in the two years before COVID-19 was moved to Class 5 under Japan’s infectious disease law.
Society memberships and board certifications
Certified Member and Board Certified Fellow, Japanese Society of Internal Medicine
Board Certified Pulmonologist, Japanese Respiratory Society
Board Certified Allergist, Japanese Society of Allergology
Board Certified Specialist, Japanese Society of Anti-Aging Medicine
PhD in Medicine (Tohoku University)
[Conclusion] The 6 signs of Kawasaki disease to look for along with the fever
The “Diagnostic Guidelines for Kawasaki Disease, 6th revised edition” (2019), compiled by the Japanese Society of Kawasaki Disease and others, lists the following 6 main symptoms[1]. Put into words you can see at home, they are roughly these.
- [Fever]
There is a fever (it does not matter which day of the fever it is) - [Whites of the eyes]
The whites of both eyes are red (bulbar conjunctival injection) - [Lips and mouth]
The lips are bright red, the tongue is red and bumpy like a strawberry (“strawberry tongue”), or the throat and inside of the mouth are red - [Rash]
A red rash appears on the body, arms or legs. The spot where the BCG vaccine (a tuberculosis vaccination) was given may also turn red - [Hands and feet]
The hands and feet are swollen, tight and hard, and the palms and soles are red. As the illness starts to clear, the skin on the fingertips peels - [Neck]
The lymph nodes in the neck are swollen (swelling without pus)
If 5 or more of the 6 appear during the course of the illness, Kawasaki disease is diagnosed[1]. Even with 4, it is diagnosed if other illnesses have been ruled out and a heart ultrasound shows changes in the coronary arteries (the blood vessels that supply the heart muscle)[1].
Even with 3 or 4, “incomplete Kawasaki disease” is diagnosed if other illnesses have been ruled out and the heart and blood test results fit[1]. Even with 2 or fewer, after other illnesses have been thoroughly checked, the possibility of incomplete Kawasaki disease is to be considered[1].
In other words, there is no need to wait at home for all the signs to appear. It is fine to see a doctor as soon as you notice a few of them along with the fever.
What kind of illness is Kawasaki disease?
Kawasaki disease was first reported in 1967 by a Japanese pediatrician, Dr. Tomisaku Kawasaki[2]. It is an illness in which inflammation occurs in the blood vessels throughout the body, and its cause is still unknown[1].
The diagnostic guidelines say it “occurs mainly in infants and young children aged 4 and under”[1]. In nationwide surveys in Japan, 15,032 people were diagnosed with Kawasaki disease in 2023 and 14,809 in 2024[3].
The median age of patients (the value of the person in the middle when everyone is lined up from youngest to oldest) was 2 years, and the middle half of all patients were aged 1 to 4[3]. Over the past 50 years, the number of children under 5 has fallen by 61.6%, yet the incidence rate (the proportion of people in a given population who newly develop the disease) has risen 16.1-fold[3].
In fact, it is by no means a rare illness. Children aged 5 and over can also get it[3], and a relapse after recovery is seen in 3 to 4%[1].
What the 6 signs look like
| Sign | What you may notice at home |
|---|---|
| Redness of the whites of the eyes | The whites of both eyes are red, not just one eye |
| Lips and mouth | Bright red lips. A red, bumpy tongue like a strawberry. The inside of the mouth and the throat are red too |
| Rash | A red rash of various shapes. The BCG site may turn red or form a scab |
| Hands and feet | The hands and feet are swollen, tight and hard. The palms, soles and fingertips are red |
| Neck | The side of the neck is puffy and swollen |
| As it clears | The skin peels from the fingertips like a thin membrane (membranous desquamation) |
Swollen lymph nodes in the neck are seen in only about 65% of young children, but in about 90% of children aged 3 and over, and they are often the first symptom[1]. In other words, some cases of Kawasaki disease begin with “a swollen neck and a fever.”
“It isn’t Kawasaki disease unless the fever lasts 5 days” is an old idea
In the earlier guidelines (5th revised edition, 2002), the fever had to “last 5 days or more.” In the 6th revised edition of 2019, this condition on the number of days was dropped, and the number of days of fever no longer matters[1].
According to the explanation of the revision, about 10% of patients were already starting treatment by the third day of fever, and about 35% by the fourth day[1]. The thinking that “it is not Kawasaki disease because 5 days have not passed” no longer matched current treatment.
So at home, too, there is no need to think “let’s wait 5 days before seeing a doctor.”
Redness at the BCG site
In the 6th revised edition, redness at the site where BCG was given was formally added to the rash item[1]. In Japan, BCG is a routine vaccination given before age 1, and this change is seen in children up to about a year after vaccination[1].
In a study of 17,181 people diagnosed with Kawasaki disease across Japan in 2005 to 2006, 44% (7,549 people) had redness or a scab at the BCG site[4]. These children were reported to have gone to the hospital and started treatment earlier[4].
If a baby with a fever has redness at the BCG site, it is an important clue to Kawasaki disease. Please take a photo and see a doctor.
Why we want to find Kawasaki disease early [coronary artery aneurysms and immunoglobulin]
The biggest concern with Kawasaki disease is that inflammation of the coronary arteries can form bulges (coronary artery aneurysms). If an aneurysm remains, heart tests and treatment have to continue for a long time.
The mainstay of treatment to prevent this is immunoglobulin (an IV drip medicine made from antibodies in blood).
In a randomized controlled trial at several US hospitals (a study that assigns treatments by chance and compares them), children who received aspirin (an oral medicine) alone were compared with children who also received immunoglobulin[5]. Seven weeks later, coronary artery abnormalities were present in 14 of 79 children (18%) with aspirin alone and in 3 of 79 (4%) in the group that also received immunoglobulin[5].
In that trial the drip was spread over 4 days. According to the explanation of the 6th revised edition, in Japan today more than 90% of patients are treated with a method in which a large dose is given in a single drip[1].
In a nationwide Japanese survey (2021 to 2022, 21,930 people), almost everyone received immunoglobulin treatment[6]. Even so, about 25% did not respond to the first treatment, and 2.3% had lasting heart aftereffects one month after onset[6].
The earlier treatment starts, the better, and when it does not work well, additional treatment is needed. For this reason, Kawasaki disease is treated at a hospital with a pediatric department that can admit patients.
Dr. GamoIt is fine to think “it may just be a cold.” If you notice a worrying change along with the fever, that alone is reason enough to see a doctor.
When to see a doctor if you are worried about Kawasaki disease [when and where]
[See a doctor now, or call 119] Signs you must not wait on
If even one of the following applies, see a doctor without waiting for morning, even at night or on a holiday. If a seizure lasts 5 minutes or longer, your child does not respond when called, or breathing looks very hard, call 119 (Japan’s emergency number) without hesitation.
- A baby under 3 months old has a temperature of 38°C or higher (please see a doctor even if the baby looks well)
- Your child is limp and slow to respond, does not wake up when you try to wake them, or does not make eye contact
- The face is pale, the lips look purplish, or the hands and feet are cold and mottled
- Breathing looks hard, is fast, or the chest or the hollow below the throat sucks in with each breath
- The belly is swollen tight and the vomiting will not stop
- A seizure lasts 5 minutes or longer, or consciousness does not return after it stops
- Your child cannot keep down any fluids, or has not passed urine for half a day or more
The guidelines also say that inflammation of the heart muscle, a drop in blood pressure, a state in which the bowel stops moving, and impaired consciousness are “highly urgent”[1].
[See a doctor the same day] When there are signs of Kawasaki disease
If there are no danger signs, but along with the fever you notice any of the 6 signs, please see a doctor the same day. If you notice it at night, it is fine to consult #8000 (the children’s medical phone consultation line, a national consultation number for children’s health) and then see a doctor first thing the next morning.
- A fever, and the whites of both eyes are red
- A fever, and the lips are bright red or the tongue looks like a strawberry
- A fever, and a rash has appeared or the BCG site is red
- A fever, and the hands and feet are swollen or the neck is swollen
- The fever does not fully go down, and other signs keep increasing day by day
When you visit, please say, “I am worried about Kawasaki disease.” Please also tell us the day you first noticed it and the signs you can see now.
What you can do at home [record the signs of Kawasaki disease with photos]
The signs of Kawasaki disease do not always appear at the same time. The guidelines also count symptoms seen “during the course of the illness”[1].
By the time of the examination, the rash may have disappeared, or the redness in the whites of the eyes may have faded. That is where a photo record on your smartphone helps.
- [What to photograph]
The whites of the eyes, lips and tongue, the rash, palms, soles and the tops of the hands and feet, neck swelling, and the BCG site - [How to photograph]
In a bright place, in natural light if possible. Where left and right can be compared, photograph both - [When]
As soon as you notice. Even if it fades before the visit, the photo stays as a record - [Notes]
The day the fever started, the highest temperature each day, the time you gave a fever reducer, how much your child could drink, and how often they passed urine - [As it clears]
Photograph the peeling skin on the fingertips too. It is a sign that appears as the illness clears (the recovery phase)
Make sure the photos show the date and time they were taken, and show us the photos on your smartphone when you visit. If a brother or sister has had Kawasaki disease before, please tell us that too. Among patients with Kawasaki disease, 1 to 2% are said to have a sibling who also had it[1].
What our clinic can do [an entry point to judge and connect you to a hospital]
As I wrote above, Kawasaki disease itself is treated at a hospital with a pediatric department that can admit patients. Our clinic is the entry point: we examine a child with a fever, judge whether Kawasaki disease is suspected, and refer the child to the hospital that is needed.
Our clinic has a policy of not refusing anyone who wants to come to the fever clinic (depending on the symptoms, we may direct you to a more suitable medical institution). We also see small children with fever.
| Day | Hours |
|---|---|
| Mon, Tue, Wed, Fri, Sat | 9:00 to 12:00 / 14:00 to 18:00 |
| Sundays and holidays (from October 4, 2026) | 10:00 to 15:00 (no lunch break, fever clinic only) |
| Thursday | Closed |
On Sundays and holidays, we are closed on Sunday, October 25, and from November we are generally open every Sunday and on holidays. For details, please see the Notice about the Sunday and holiday fever clinic.
How a visit works (no appointment needed)
You check in using the QR code at the fever clinic entrance (a square pattern that you scan with your smartphone camera). When your turn is near, we call you by SMS (a text message on a mobile phone) or by phone.
- Before you arrive, fill in the pre-visit questionnaire (optional; you can also fill it in when you check in at the entrance)
- Scan the QR code at the fever clinic entrance and check in by choosing “I have arrived, check me in” (required)
- On weekdays, once you have checked in, please wait in your car
- On Sundays and holidays, after you check in, we confirm your insurance card (My Number insurance card, certificate of eligibility, and so on) at the general outpatient entrance. Because general outpatient care is not offered on Sundays and holidays, please feel free to come in. After the confirmation, please wait in your car or similar
- When your turn is near, we call you by SMS or phone. Press the intercom at the fever clinic entrance and tell us your name
For the detailed steps, please see About the pre-visit questionnaire and same-day check-in for the fever clinic. Patients are generally seen in check-in order, but the order may change depending on how severe the symptoms are.
Please note that we cannot give IV drips on Sundays and holidays. If an IV drip is likely to be needed, for example because your child is limp and cannot take any fluids, please go to a medical institution that can give an IV drip.
Frequently asked questions
- The fever has only lasted 2 days. Is it not Kawasaki disease until 5 days have passed?
-
No. In the 6th revised edition of the diagnostic guidelines in 2019, the number of days of fever no longer matters. If, along with the fever, you notice redness in the whites of the eyes, red lips or tongue, a rash, swollen hands and feet, or a swollen neck, please see a doctor regardless of the number of days.
- The BCG site is red. Is it Kawasaki disease?
-
When there is a fever and the BCG site is red, it is an important clue to Kawasaki disease. In a Japanese survey, 44% of children with Kawasaki disease had this change[4]. Along with any other signs, take a photo and see a doctor the same day.
- The rash had disappeared by the time of the examination. Should I tell the doctor?
-
Yes, please do tell us. The signs of Kawasaki disease can appear at different times, and the diagnostic guidelines count symptoms seen during the course of the illness. If you have photos, the most reliable way is to show us the photos on your smartphone at the examination.
- If my child has had Kawasaki disease once, can it not happen again?
-
No. The diagnostic guidelines say a relapse is seen in 3 to 4%[1]. If a child who has had it before again has a fever and signs of Kawasaki disease, be sure to mention that when you see a doctor.
- Can I bring a child I am worried about for Kawasaki disease on a Sunday or holiday?
-
Yes. The Sunday and holiday fever clinic runs from 10:00 to 15:00. We are closed on Sunday, October 25, and from November we are generally open every Sunday and on holidays. No appointment is needed; we register you by same-day check-in only. We cannot give IV drips on Sundays and holidays. If Kawasaki disease is suspected, we refer you to a hospital with a pediatric department that can admit patients. If there are danger signs such as being limp, go straight to emergency care, even at night or on a holiday.
Summary [Suspect Kawasaki disease from a fever plus the 6 signs]
- Kawasaki disease was first described in Japan and mainly affects infants and young children aged 4 and under
- The 6 signs are: fever, redness in the whites of both eyes, red lips or tongue, a rash (including redness at the BCG vaccination site), changes in the hands and feet, and swollen neck glands
- Since the 6th revised edition in 2019, the number of days of fever no longer matters. It is fine to see a doctor without waiting 5 days
- Early immunoglobulin treatment is the key to preventing coronary artery aneurysms. Treatment is at a hospital with a pediatric department that can admit patients
- The signs do not always appear at the same time, so when you notice one, take a photo on your smartphone and show it at the visit
- If your child is limp, has a poor color, or has trouble breathing, see a doctor right away, even at night or on a holiday. If your child does not respond or is struggling badly to breathe, call 119 (Japan’s emergency number)
The feeling that “it’s not just the fever, somehow the eyes and lips are red too” is the best clue for finding Kawasaki disease early. Take photos, and please do not hesitate to consult us. Please leave the judgment and the referral to a hospital to us.
That’s all.
Disclaimer
This article is intended to provide general medical information and does not replace an examination, diagnosis or treatment by a doctor. The content is based on medical knowledge at the time of publication, but the right approach differs from person to person. If you are worried about your symptoms, please consult a medical institution.
References
- Kobayashi T, Ayusawa M, Suzuki H, Abe J, Ito S, Kato T, et al. Revision of diagnostic guidelines for Kawasaki disease (6th revised edition). Pediatr Int. 2020 Oct;62(10):1135-1138. doi:10.1111/ped.14326 PMID: 33001522
- Kawasaki T. [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children]. Arerugi. 1967 Mar;16(3):178-222. PMID: 6062087
- Ae R, Kosami K, Masuda H, Kato N, Kohro T, Seki M, et al. Epidemiology of Kawasaki Disease After the COVID-19 Pandemic in Japan 2023-2024. JAMA Netw Open. 2026 Aug;9(8):e2626910. doi:10.1001/jamanetworkopen.2026.26910 PMID: 42550508
- Takikawa H, Ae R, Matsubara Y, Matsubara D, Makino N, Kosami K, et al. Bacille Calmette-Guérin inoculation site changes and cardiac complications in patients with Kawasaki disease. Arch Dis Child. 2021 Jul;106(7):669-673. doi:10.1136/archdischild-2020-319543 PMID: 33303488
- Newburger JW, Takahashi M, Burns JC, Beiser AS, Chung KJ, Duffy CE, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med. 1986 Aug;315(6):341-7. doi:10.1056/NEJM198608073150601 PMID: 2426590
- Nakamura Y, Yashiro M, Yanagawa H. Epidemiology of Kawasaki disease in Japan in 2021-2022: Results of the 27th nationwide survey. Pediatr Int. 2025;67(1):e70007. doi:10.1111/ped.70007 PMID: 40189891
Related articles to read when you have a fever
For the Sunday and holiday fever clinic, see the Notice about the Sunday and holiday fever clinic. For how to come in, see About the pre-visit questionnaire and same-day check-in for the fever clinic.
