[Interesting cases in clinical practice concerning Kawasaki syndrome and child abuse]

Typical cases and families are reported to inform the reader about two new or newly recognized conditions of infants and young children, Kawasaki syndrome and child abuse. Although such patients have usually to be cared for in hospitals, it is the responsibility of the general practitioner to suspect the diagnosis in a very early phase and to refer the child immediately. Kawasaki syndrome, also called mucocutaneous lymph node syndrome, is an acute disease of infants and young children with yet unknown cause. The main symptoms are high fever, conjunctivitis, red and dry lips, palmar and plantar erythema, skin rashes and cervical lymphadenopathies. The danger of the disease is the occurrence of coronary arteritis, leading to coronary aneurysms and thrombosis. Treatment with high-dose immunoglobulins and acetylsalicylic acid is usually successful. Child abuse may lead to very different pathological manifestations. The incidence of these conditions and their recognition have markedly increased within the last 20 years, partially because of increased awareness by doctors and social workers, partially because of decreasing patience of parents and caretakers towards crying and "difficult' children. The intensity of injuries is escalating in single patients and in families. Every child who raises a suspicion of maltreatment should immediately be referred to a children's hospital, where a local multidisciplinary child protecting group will take care of it and decide on therapeutic, social and/or legal steps to prevent further injuries.