How to avoid and treat dog bites

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Our canine friends are a great source of joy and companionship the majority of the time. In fact, dogs are one of the most common domesticated animals with more than 58 million families reporting they own a dog. Our species have bonded since the early ages and we developed a loving relationship with our furry friends. 

Even if your family doesn’t own a dog, your child will likely have some type of interaction with dogs. The assimilation of canines into more than half of U.S. households also creates opportunities for dog bite injuries, especially with young children.  

Dogs account for approximately 90% of animal-related bites. According to the American Academy of Family Physicians, most dog bite victims are children, and in 70% of reported cases, the animal was known (Ellis et al., 2014). In fact, boys between the ages of 5 and 9 have the highest dog bite rates which typically affect the head and neck. Each year, approximately 4 million Americans are bitten by dogs. Out of those, about 800,000 will go on to seek medical treatment. 

Throughout my pediatric surgical training, I have seen the effects of severe dog attacks including disability and the need for cosmetic revision. Beyond the physical impact a dog attack can have, there is also a psychological component that can impact a child for the rest of their life. Providing children with proper pet etiquette from an early age is one way to reduce the risk of dog-related injuries and foster loving, positive animal interactions.  

Pet etiquette tips 

The American Society for the Prevention of Cruelty to Animals and PetU are great online resources I found that offer helpful parental tips to prevent dog bites and promote healthy interaction between children and dogs. Here are some of the things I found:

A common theme in the literature is that animals act on instincts, therefore, it’s important to help children understand when a dog is feeling tired, frightened, overstimulated or territorial as these are times when they are more likely to become aggressive. Demonstrating proper pet interactions for your child is the best way for them to develop proper pet etiquette. If your family doesn’t own a dog or you have young children, you can use a stuffed animal to demonstrate the following pet etiquette tips.  

• Always ask an adult owner if your child can pet their dog. Extend a hand slowly for smelling, especially during the first interaction.
• Teach young children the difference between petting and patting. Children should gently pet dogs taking care not to poke, push, pull or tease pets. Children should stick to a dog’s shoulders, back or sides, taking care to avoid a dog’s head and nose. 
• Do not pet dogs behind a fence or in a car as dogs will often instinctively try to protect their home or space. 
• Assess the dog’s body language. A wagging tail with a relaxed body conveys the dog is at ease. Stiffness, growling, large eyes, tail between legs or flattened ears may indicate fear, anxiety or aggression. Aggressive dogs tend to make themselves look bigger while fearful dogs may make themselves look smaller. Teach children to respect these signals and understand what the dog is trying to communicate. 
• Move slowly around dogs. Loud noises, yelling and sudden movements may cause a dog to become startled or frightened. Limit interactions between children and dogs during anxiety provoking situations such as storms and fireworks. 
• Give territorial dogs space when eating, playing with their toys or tending to their pups. Teach children that dogs need their personal time too. 
• Avoid startling a dog awake. 
• Teach children that if they see a dog off-leash outside they should go inside immediately and tell an adult. They should not approach the dog. 
• If a loose dog approaches your child, they should not scream or run away. A child cannot outrun a dog. Instead, teach your child to avoid eye contact and stand very still until the animal goes away. Your child can put any objects they have on between themselves and the dog (backpack, jacket, bicycle, etc.) 
• If your child is knocked down by a dog, they should curl up in a ball with knees tucked into their stomach, fingers interlocked behind the neck to protect the neck and ears and chin tucked to chest. Your child should remain quiet until the dog goes away. This is the least threatening position a child can place themselves in. 
• Involve children in the daily care of your dog. This will teach them respect for the animal and will instill in your dog dependency on your child for food. 

Treatment 

If your child does sustain a dog bite injury, there are several things you should know regarding proper care and treatment. 

• A dog’s mouth is full of bacteria and their bite is considered contaminated.
• Immediately irrigate the wound with soap and a large amount of clean water. Take this opportunity to examine the extent of the injury and look for foreign material like teeth fragments, gravel, etc. If bleeding, wrap area with clean towel and hold pressure. If bleeding continues over 15 minutes seek medical care. 
• Taking a picture of the wound will help to monitor wound progression and will help providers if medical treatment is needed. 
• Elevate and rest the area involved to help reduce swelling. 
• According to UpToDate, parents should seek medical treatment for their child if: 
  • The animal bite broke the skin and bleeding does not stop after applying pressure for 15 minutes 
  • There’s concern there may be a broken bone or other serious injury
  •  The child has other medical conditions including diabetes, liver disease, cancer, HIV-infection or is taking immunosuppressive medication 
  • You notice signs of infection including spreading redness around the bite, warmth around bite, pus-like discharge, fevers and worsening pain. Up to 15-20% of dog bites become infected. Deep bites, hand wounds and crush injuries are more likely compared to scratches or tears. In some severe cases, children may need a hospital admission and IV antibiotics. 
  • If the wound appears to be worsening
  • If there is a concern of rabies infection. A bite by an unprovoked dog with an unknown rabies vaccination history will likely require the rabies vaccination series. If the dog’s owner can reliably confirm rabies vaccination and the dog can be watched for the next 10 days, then your child may be able to avoid vaccination. 
  • If it is longer than five years since your child’s last tetanus vaccination or you cannot remember when your child’s last tetanus vaccination took place. 
• A collection of infections may develop called an abscess. Surgical incision and drainage may be required for proper treatment followed by antibiotics. 

REFERENCES

1. “Facts + Statistics: Pet Statistics.” III, The Insurance Information Institute, www.iii.org/fact-statistic/facts-statistics-pet-statistics.
2. Presutti, R. John. “Prevention and Treatment of Dog Bites.” American Family Physician, 15 Apr.2001, www.aafp.org/afp/2001/0415/p1567.html.
3. Ellis, Robert, and Carrie Ellis. “Dog and Cat Bites.” American Family Physician, 15 Aug. 2014, www.aafp.org/afp/2014/0815/p239.html.
4. Baddour, Larry M, and Marvin Harper. “Patient Education: Animal and Human Bites.”Edited by Allan B Wolfson et al., UpToDate, 8 May 2019,  www.uptodate.com/contents/animal-bites-dogs-cats-and-other-animals-evaluation-and-management?search=dog%20bite&source=search_result&selectedTitle=1~38&usage_type=default&display_rank=1.
5. “Dog Bite Prevention.” ASPCA, www.aspca.org/pet-care/dog-care/dog-bite-prevention.
6. “Pet University.” Pet U, Pet University Https://Pet-U.net/Wp-Content/Uploads/2016/10/Petu-Marker-New-1.Png, 14 Mar. 2018, pet-u.net/2018/03/training-dog-and-kids-proper-dog-etiquette-for-kids/.