Fever Longer than 3 Days

     In previous articles about fever I have stated that the usual course of fever is about three days of day and night fever followed by two to three nights of fever without daytime fever and then all fever resolves.

     If daytime fever lasts longer than three days, the child needs to be examined. The cause could be a more severe infection such as a urinary tract infection, but parents need to be aware of another possible cause: Kawasaki disease.

     Kawasaki disease is not an infection but is a generalized inflammation in the body. The first sign of it is daytime fever that lasts longer than three to four days. It can also cause red eyes without discharge, generalized rash, swelling in the fingers and toes and a peculiar red discoloration of the lips. The real reason parents need to know about this disease is that it can cause a weakening of the arteries in the heart and severe permanent heart damage. This serious complication can be prevented if the child is treated early enough. The problem for parents and physicians is that many of the more classic symptoms may not appear right away which makes diagnosis difficult. The longer treatment is delayed, the greater the risk of heart disease. A study done at Children’s Hospital Colorado showed that heart vessel damage occurred in 21% of the children who had been sick for 5 days, 60% of children who had been sick for 7 days and 80% of children sick for 10 days.

   The important message for parents is that daytime fever from routine viral infections does not last longer than three days. Kawasaki disease may only present with prolonged fever, especially in younger infants and any child with a prolonged fever needs to be closely evaluated. If there is any evidence of Kawasaki disease, the child needs to be hospitalized right away and treated to prevent heart damage.