“My little girl’s had a high fever for six days, a rash, red eyes and cracked lips — the calpol isn’t touching it”

KAWASAKI DISEASE is a medium-vessel vasculitis of young children. NICE NG143: be aware of it in any child with FEVER lasting 5 DAYS or longer — 4 features are not required (the "≥4 of 5" rule is the AHA 2017 research definition, international); the features are bilateral NON-purulent conjunctivitis; mucosal changes (red/cracked lips, strawberry tongue); cervical lymphadenopathy; polymorphous rash; and extremity changes (palm/sole erythema-oedema, later peeling). It is a CLINICAL diagnosis with no single confirmatory test (inflammatory markers and later thrombocytosis support it), and clinicians must be alert to INCOMPLETE/ATYPICAL Kawasaki — especially in INFANTS, who present atypically and are at higher coronary risk — keeping a low referral threshold. The critical reason for early recognition is the risk of CORONARY ARTERY ANEURYSMS (a leading cause of acquired paediatric heart disease), substantially reduced by prompt treatment, so a prolonged-fever child with these features must not be dismissed as "just a virus". The action is an URGENT same-day paediatric referral/admission after an NG143 traffic-light and NICE NG254 sepsis assessment (on video, heart rate, capillary refill and hydration cannot be judged; any red or high-risk feature means emergency transfer): treatment is IV immunoglobulin plus aspirin, ideally within the first ~10 days, with echocardiography — primary care’s role is recognition and urgent referral. Aspirin is a specialist exception to the under-16 rule (BNFC): parents must not give it at home; antipyretics are for distress only and not given together (NG143). Consider and exclude mimics (measles, scarlet fever, other viral exanthems, toxin-mediated illness, drug reactions), but persistent high fever ≥5 days with the mucocutaneous cluster warrants paediatric assessment regardless. Validate the worried parent repeatedly told "it’s just a virus", recognise the pattern, and refer urgently the same day.