Reference — Pediatrics
Kawasaki Disease & RSV Bronchiolitis Reference
Two high-yield pediatric illnesses that don’t fit the rash-and-vaccine pattern: Kawasaki, a vasculitis that threatens the coronary arteries and breaks the no-aspirin rule, and RSV bronchiolitis, the wheezy infant whose care is suction and hydration, not antibiotics.
Educational use only. IVIG, aspirin dosing, oxygen targets, and prophylaxis eligibility follow provider orders and current pediatric guidelines. Aspirin in children is reserved for specific conditions like Kawasaki under direction — never routine. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Kawasaki Disease — The Coronary Threat
Kawasaki is an acute vasculitis of medium-sized arteries in young children — and its danger is the coronary artery aneurysm. Untreated, a meaningful fraction develop coronary changes; prompt treatment cuts that risk sharply. The diagnosis is clinical, anchored on prolonged high fever plus the CRASH features.
| CRASH | Feature |
|---|---|
| C | Conjunctivitis — bilateral, nonexudative (no discharge) |
| R | Rash — polymorphous, often on the trunk and perineum |
| A | Adenopathy — cervical lymph node, usually unilateral and ≥1.5 cm |
| S | Strawberry tongue and cracked red lips (oral mucosal changes) |
| H | Hands and feet — edema, redness, then later peeling (desquamation) |
| Burn | Fever ≥5 days, high and unresponsive to antipyretics |
Kawasaki — Treatment & Nursing Care
IVIG is the cornerstone — given to reduce coronary aneurysm risk; monitor for infusion reactions and assess cardiac status. Defer live vaccines (MMR, varicella) for about 11 months after IVIG.
High-dose aspirin during the acute febrile phase, then low-dose for its antiplatelet effect — Kawasaki is the classic pediatric exception to the no-aspirin rule. Teach families to watch for Reye-syndrome signs if the child develops a viral illness (flu/varicella) while on aspirin.
Comfort the irritable child (Kawasaki children are notably miserable), give meticulous skin and mouth care, monitor strict I&O and cardiac status, and follow the echocardiogram surveillance plan.
RSV Bronchiolitis — The Wheezy Infant
RSV inflames the small airways (bronchioles), the leading cause of bronchiolitis and infant hospitalization. Picture: a baby with copious nasal secretions, cough, wheezing/crackles, tachypnea, retractions, nasal flaring, and feeding difficulty from the work of breathing. The youngest infants can present with apnea.
Care is supportive: nasal suctioning (bulb/saline before feeds), hydration (small frequent feeds or IV fluids), supplemental oxygen for hypoxemia, upright positioning, and cardiorespiratory monitoring. Antibiotics don’t help a viral illness; routine bronchodilators and steroids are generally not recommended. RSV spreads by contact and droplet — strict hand hygiene and contact precautions.
Prophylaxis: a long-acting monoclonal antibody given as a single dose — nirsevimab (or, since 2025, clesrovimab as an alternative for infants under 8 months) — is now the preferred RSV prevention for infants entering their first season (nirsevimab also covers high-risk children in a second season), having replaced monthly palivizumab (which CDC notes is no longer available as of December 2025). The maternal RSV vaccine (Abrysvo, given at 32–36 weeks gestation) is the other strategy; generally an infant needs either maternal vaccination OR an infant antibody, not both. It is prevention, not treatment.
NCLEX Pearls
- ✦Kawasaki's danger is coronary artery aneurysm; IVIG plus aspirin is the treatment, and an echocardiogram follows the heart.
- ✦Kawasaki is THE pediatric exception to the no-aspirin rule — high-dose then low-dose, under direction.
- ✦Hold live vaccines (MMR, varicella) for ~11 months after IVIG.
- ✦RSV bronchiolitis care is suction + hydration + oxygen — supportive; antibiotics don't treat a virus.
- ✦RSV prophylaxis is PREVENTION, not treatment — nirsevimab (one long-acting monoclonal dose) is now the primary product for infants' first season, having replaced monthly palivizumab; the maternal RSV vaccine is the alternative.
- ✦Apnea can be the presenting sign of RSV in the youngest infants — monitor closely.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →