Studies have identified cat bites, puncture and crush wounds, bites of the hand, and wounds occurring more than 12 hours prior to medical management as potential risk factors for the development of wound infections [1, 3, 4]. Centers for Disease Control and Prevention. If your child has received a bite, wash your hands with antibacterial soap before tending to the bite. Injuries associated with dog bites and dog attacks were sustained most frequently by 5-9 year olds (28.5%). Use of this site is subject to our terms of use and privacy policy. American Academy of Pediatrics, Healthychildren.org. The doctor would then clean the wound by means of irrigation to prevent infection.Following this, he would also remove dead tissues, blood clots and any other foreign particles. Copyright © 2021 by The College of Family Physicians of Canada, Sign In to Email Alerts with your Email Address. The first-line choice of antibiotic is amoxicillin-clavulanate. As there is a paucity of evidence for or against it, antimicrobial prophylaxis is suggested for patients who have undergone primary closure of the wound; who have sustained moderate or severe bite wounds (especially if there is evidence of edema or crush injury, devitalized tissue, or full-thickness wounds involving tendons, ligaments, and joints); for those with puncture wounds, facial bites, hand or foot bites, and genital area bites; or those who are immunocompromised or asplenic.11,16,20, First-line antimicrobial prophylaxis for high-risk dog wounds in healthy patients is amoxicillin-clavulanate for 3 to 5 days, which is based on in vitro sensitivity data and expert opinion.16,20,21 Alternatively, ampicillin-sulbactam might be given intravenously if the patient is unable to take oral antibiotics. They determined that antibiotics would be cost effective if the rate of wound infection was 5% and antibiotics decreased the risk by greater than 3%, suggesting a role for prophylaxis of high-risk dog bite wounds. It is important to find out if the dog's rabies vaccinations are current. Top Dog Bite Treatment Related Articles Amoxicillin vs. It is important to sponge away visible dirt, per- NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. But if the wound is on your child’s face, sutures may be in order to prevent scarring. If you know whose dog it is, make sure to ask the owner whether Rover’s shots are up-to-date. If the patient is allergic to penicillin, first-line treatment is an extended-spectrum cephalosporin or trimethoprim-sulfamethoxazole plus clindamycin.12. In younger children, the most frequently affected areas are the head, face, and neck.10,11 As the child grows, bites to the extremities are most common.2, The incidence of dog bites peaks during the spring and summer seasons; they are often unprovoked, and frequently occur at home with a dog that is familiar to the child.1,4, The management of dog bites remains a topic of controversy. The most important way to keep your child safe around a dog: Supervision! We invite you to submit them to the PRETx program by fax at 604 875–2414; they will be addressed in future Child Health Updates. To earn credits, go to www.cfp.ca and click on the Mainpro link. One study found that facial bites predominated (70 percent) in children up to 7 years old, and bites to extremities occurred in 72 percent of children older than 7 years. avoid stroking or petting unfamiliar dogs – when greeting a dog for the first time, let it sniff you … If so, which antibiotic should be used and for how long? Use a clean towel or gauze to apply pressure to the bite if it … Wounds sustained from dog bites tend to be polymicrobial, with a median of 5 bacteria in a culture. Dog bites account for 0.3% to 1.5% of all pediatric presentations for medical attention, 1,2 and almost 50% of children have sustained dog bites. When children get too close to a dog suddenly and startle it, the animal might react by attacking. Children's Health. Although bites should be regarded as preventable injuries, mistakes will happen and therefore education should extend to what a child and caregiver should do during a dog bite incident in order to reduce injury severity, in addition to post-bite action such as psychological support.74 75 Following a bite, the owner should be helped to identify why the bite occurred, especially if a dog has … Do you have questions about the effects of drugs, chemicals, radiation, or infections in children? Dr Sabhaney is a member and Dr Goldman is Director of the PRETx program. The statistics are quite clear about who the targets of these dog bites are most likely to be. The face, hands, arms, and legs are the most common sites for animal bites. Here's how to give your child first aid for dog bites and keep him from provoking a pooch in the first place. Complications from dog bites include wound infection, cellulitis, osteomyelitis, septic arthritis, sepsis, meningitis, endocarditis, pneumonia, and death.13 Rates of infection are estimated to range from 1% to 30%, the lowest among all mammalian bites.14 With local wound care, the rate of infection drops substantially. Dog bites are a frequent reason for children to be brought for medical attention. A dog can bite if … Pasteurella species (specifically Pasteurella canis) is most commonly isolated, and other common bacteria include streptococci, staphylococci, and Fusobacterium and Bacteroides species.15. La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro d’octobre 2012 à la page e548. Wounds should be cleaned and debrided to minimize risk of infection. Treatment with prophylactic antibiotics for three to seven days is appropriate for dog bite wounds, unless the risk of infection is low or the wound is superficial.4,5,7 If frank cellulitis is evident, a 10- to 14-day course of treatment is more appropriate.9 Amoxicillin-clavulanate potassium (Augmentin) is the antibiotic of choice for a dog bite. Before individuals can seek medical help it is necessary that they thoroughly wash the wound with tap water and cover it with a sterile dressing.. Although most dog bites are easily treatable, there are severe instances professional medical treatment may be necessary when the bite is especially deep or profound. Each year in the United Sta… People may be able to use at-home treatments to prevent a dog bite from becoming infected. 3 Dog bites occur more frequently in young children 4,5 and have a higher risk of resulting in serious injury or death, 6,7 usually from exsanguination. Inpatient treatment was required in 93 (27%) patients. If a dog bites you, take these steps right away: Wash the wound.Use mild soap, and run warm tap water over it for five to 10 minutes. If you are prescribed antibiotics with a view to preventing infection, three days of treatment should be enough. Some dog bites need antibiotics, particularly if they are deep puncture wounds. You don’t know the dog that bit your child (in which case, a rabies shot may be in order). https://www.whattoexpect.com/.../treating-dog-bites-in-children.aspx Dog bite injuries to a child's face are not an infrequent occurrence. For treatment of an infected dog or cat bite, prescribe co-amoxiclav for 5 days. Biting is a worse-case scenario reaction, but it's still important to know first aid for dog bites in children (and how to ease your tot's subsequent fear of dogs). And since even the most intelligent pooch can’t exactly say, “Excuse me, but that hurts,” it may respond to being provoked by lashing out with its teeth. Call your child's healthcare provider for help in reporting the attack and to decide if more treatment … All patients were treated with a course of antibiotics (amoxicillin-clavulanic acid was given to all except for 2). © 2021 Everyday Health, Inc. This report describes the treatment and outcomes of dog bites of the face, scalp, and neck based on a case series of 107 children over a 10-year period.The average children's age was 5.9 years. Little evidence exists to support the routine use of antibiotics. A sick or injured dog might bite. It is critically important that your child be assessed to see if trauma counseling is indicated. Two of the dog bite studies included in the Cummings meta-analysis were not included in the Cochrane review. One of the common questions after a dog bite is whether antibiotic prophylaxis is beneficial. Injuries occurred most often in the summer, 37.7%, and most frequently between the hours of 4 and 8 p.m., (32.7%). Child Health Update is produced by the Pediatric Research in Emergency Therapeutics (PRETx) program (www.pretx.org) at the BC Children’s Hospital in Vancouver, BC. They may require primary and revisional surgery. Dogs can bite anybody. Many children suffer from emotional stress or even Post Traumatic Stress Disorder after a dog bite. A randomized controlled trial studied the infection rate at which prophylactic antibiotics were cost effective.19 Two of 46 patients (4%) receiving placebo developed wound infections, and none of the patients receiving 3 days of amoxicillin-clavulanate developed infection (absolute risk reduction 4%, 95% CI -1% to 4.5%). 7 steps to treating a dog bite. This article is eligible for Mainpro-M1 credits. Dog bites. Exotic Animals as Pets — Are They Right for Your Toddler? Treatment for Dog and Cat Bites and Scratches, reviewed by our medical review board and team of experts. Young children should always be supervised around animals. Dog bites account for 0.3% to 1.5% of all pediatric presentations for medical attention,1,2 and almost 50% of children have sustained dog bites.3 Dog bites occur more frequently in young children4,5 and have a higher risk of resulting in serious injury or death,6,7 usually from exsanguination.8 In Canada between 1990 and 2007, 24 of 28 fatal dog bites occurred in children younger than 12 years of age.9, The location of injury due to dog bites is largely dependent on age. None of these studies have specifically evaluated risk factor… Visit a doctor immediately. Additionally, many municipalities have regulations for reporting dog bites and monitoring the dogs, which is often initiated by contact with a doctor. Losing a Pet — How to Help Your Toddler Deal With Death, What to Do if Your Tot Is Allergic to Pets. Deep wounds: If the dog has bitten on the skin, causing perforation and loss of blood, apply pressure with a clean, dry cloth to stop the bleeding. Dog bites are the most common bite injury. The child might pull the dog’s tail or fur playfully but this can provoke the animal to bite. Although some breeds of dogs have been identified as being more aggressive than other breeds, any dog may attack when threatened. Thank you for your interest in spreading the word on The College of Family Physicians of Canada. It is best to take your child to a doctor as soon as possible after a dog bite, minor or otherwise. Since most bites occur in children, be sure to teach children to be careful around animals and that an animal could hurt them. Treatment steps Wash the wound with soap and warm water. However, given the baseline infection rate of 16%, 100 patients would need to be treated to prevent 7 infections.16 Furthermore, there was considerable heterogeneity among antibiotics used across the studies. Most dog bite victims are children. However, prophylaxis did substantially lower the rate of infection in dog bites of the hand from 28% to 2% (odds ratio 0.10, 95% CI 0.01 to 0.86, number needed to treat = 4).17, A recent retrospective review of 87 children suffering facial dog bites of varying severity evaluated the rate of wound infections, scar revision, and other wound complications after primary closure with sutures. What's more, little kids are more likely than grown-ups to be on the receiving end of a canine's canines. Analysis of nonfatal dog bites in children, Dog bites in Canadian children: a five-year review of severity and emergency department management, Pediatric dog bite injuries: a 5-year review of the experience at the Children’s Hospital of Philadelphia, Analysis of dog bites in children who are younger than 17 years, A comparison of dog bite injuries in younger and older children treated in a pediatric emergency department, Red book: 2009 report of the Committee on Infectious Diseases, Management of lacerations in the emergency department, Bacteriologic analysis of infected dog and cat bites, Antibiotics to prevent infections in patients with dog bite wounds: a meta-analysis of randomized trials, Antibiotic prophylaxis for mammalian bites, Primary repair of facial dog bite injuries in children, Randomized controlled trial of prophylactic antibiotics for dog bites with refined cost model, La prise en charge des morsures de chien chez les enfants, Managing type 2 diabetes in primary care during COVID-19, Effectiveness of dermoscopy in skin cancer diagnosis, Continuous positive airway pressure for obstructive sleep apnea in children, Fluid management in children with diabetic ketoacidosis, http://www.cfpc.ca/Canadianfamilyphysician/, Copyright© the College of Family Physicians of Canada. Beyond that, you can start teaching her a few basic rules: From the What to Expect editorial team and Heidi Murkoff, author of What to Expect the Second Year. For patients who are allergic to penicillin, doxycycline (Vibramycin) is an acceptable alternative, except for children younger than eight years and pregnant women. Please whitelist our site to get all the best deals and offers from our partners. They account for 80-90% of presentations. The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. The annual incidence of dog bites requiring emergency department treatment is 12.9 per 10 000 persons, with children aged 5-9 (particularly boys) having an incidence of 60.7 per 10 000 persons aged 5-9 years. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff. Should she be treated with antibiotics? Cleaning minor wounds immediately is often sufficient. Wash the bite carefully with soap and water. Most injuries occurred at the victim's own home, 34.2% or other home, 30.3%. Published Child Health Updates are available on the Canadian Family Physician website (www.cfp.ca). Apply pressure if the wound is bleeding. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine. A large percentage of dog bite victims are children. Similar conservative care should be offered for wounds that are more than 8 hours old; however, primary wound closure is not recommended.12. If the bite occurred on a sensitive area of the body like the face or thigh, or if the … Of 357 injuries, the face, head, and neck region was the leading site affected (50%). All dog bites carry a r … The wound looks very deep or is on your child’s face (according to the Centers for Disease Control and Prevention, nearly two-thirds of animal-induced injuries among children four and younger are to the head or neck region). Find advice, support and good company (and some stuff just for fun). Dog bites in children are frequent and influenced by the breed-related behavior of dogs, dog owners, children, and parents. Dogs bite more than 4 million people every year, and one out of five of those bites requires medical attention. Cover with a sterile bandage. Cummings performed a meta-analysis of 8 randomized trials (of which 6 were placebo-controlled, double-blinded studies) assessing the use of prophylactic antibiotics among 786 patients who sustained dog bites. Question A 4-year-old girl was playing with her neighbour’s dog. The dog became excited and bit the girl on the forearm, leaving a puncture wound. Amoxicillin and penicillin are penicillin-type antibiotics used to treat various bacterial... Capnocytophaga canimorsus. Courtney Trempe Memorial Fund for Dog Bite Victim Support The Courtney fund was created to honour the memory of 8-year old Courtney Trempe who was killed by a neighbour's dog in 1998. Watch for signs of infection. Of all injuries related to dog bites and dog attacks, 57.9% were to males. First Aid for Dog Bites in Kids In a Cochrane review of 8 randomized controlled trials investigating antibiotic prophylaxis after mammalian bites, a subgroup analysis of 6 studies including dog bites reported no statistically significant reduction of local wound infection in the prophylaxis group (4%, 10 of 225 patients) as compared with the control group (5.5%, 13 of 238 patients) (odds ratio 0.74, 95% CI 0.30 to 1.85). None of the patients developed wound infections, nor required scar revision in follow-up.18. You should also call the doctor if, over the next few days, you notice any signs of infection, such as redness, swelling, warmth, or pus. Apply antibiotic ointment to the injury every day to prevent infection. The physical and functional impairment of a child can be significant after a bite wound from a dog. Apply an antibacterial ointment to the wound. Erythromy… Apply a sterile bandage to the wound. Enter multiple addresses on separate lines or separate them with commas. For adults who are allergic to penicillin, prescribe metronidazole plus doxycycline for 5 days. The bacteria Capnocytophaga canimorsus is common in the mouths of cats, people, and dogs. And if you’re not sure that your child’s up-to-date on her tetanus shots, call your pediatrician even if the bite isn’t very deep and you were able to tend to it yourself with basic first aid for dog bites. For children the first-choice oral antibiotic for those aged 1 month and over: How to Make Children's Pets Part of Your Family. Try to keep the injured area elevated. 2  Any unidentified dog runs a minor risk of carrying rabies. Patients should be assessed for tetanus immunization status, and treated with immunization or immunoglobulins if necessary (Table 1).12 Necessity of rabies prophylaxis should be assessed on a case-by-case basis. As a result of the injury, she has presented to my office. Bite wounds should be cleaned, copiously irrigated with normal saline using a 20-mL or larger syringe or a 20-gauge catheter attached to … Gently press a clean cloth over the wound to stop the flow of blood. To a toddler or preschooler, what seems like an affectionate hug or curious tug can easily be experienced by a dog as a too-tight squeeze or a painful pull. Penicillin. To care for a dog bite injury at home: Place a clean towel over the injury to stop any bleeding. The fund is administered by Doggone Safe and provides support for child victims of dog attacks and their families. When a dog perceives a running child as prey, it can lead to biting. Appropriate tetanus and rabies prophylaxis as indicated should also be a part of caring for a patient who has sustained a dog bite, as well as local debridement and thorough cleaning of the wound. We do not capture any email address. Most dog bites are caused either by a family pet or a dog that belongs to someone you know. When a person receives a dog bite where the skin is broken, the risk of a serious infection can be reduced by cleaning the wound and getting appropriate health care treatment. Prompt treatment is the basis of appropriate care of dog bite. It is recommended that puncture wounds should not be closed, and that wounds on the hands and feet should be managed in consultation with an appropriate surgical specialist. An important goal in the management of animal bites is the prevention of subsequent infections. Seek help if … This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. This educational content is not medical or diagnostic advice. The mere fact that the child was taken to Mayo Clinic's Level I Pediatric Trauma Center in Rochester, Minnesota, demonstrated the severity of his injury, according to Denise B. Klinkner, M.D., M.Ed., Mayo Clinic pediatric surgeon and pediatric trauma medical director, noting the majority of dog bites are managed in the outpatient setting. Never leave a little kid alone with any pooch — even a beloved family pet. You can’t stop the bleeding after ten minutes of direct pressure. The relative risk of infection in those treated with prophylactic antibiotics as compared with controls was 0.56 (95% CI 0.38 to 0.82). At Mayo Clinic Hospital, Saint Marys Campus, where the child was treated, 21 patients have been admitted for dog bites over the last five years. Answer Initiation of prophylactic antibiotics is indicated if the dog bite has undergone primary closure; if there is a moderate or severe bite wound; for puncture wounds (especially if penetration of bone, tendon sheath, or joint), facial bites, bites to the hands or feet, or genital area bites; or wounds sustained by victims who are immunocompromised or asplenic. Almost one half of all dog bites involve an animal owned by the victim's family or neighbors. Your child may be prescribed a course of antibiotics. Antibiotic prophylaxis is recommended only in high-risk wounds. Doctors rarely use stitches to close up dog bites in children because this can increase the risk of infection. Antibiotics will also be prescribed if your wound has already become infected. CONCLUSIONS. The incidence of dog bites peaks during the spring and summer seasons; they are often unprovoked, and frequently occur at home with a dog that is familiar to the child.1,4 Treatment of bites The management of dog bites remains a topic of con-troversy. Two meta-analyses have reviewed the role of prophylactic antibiotics in the treatment of dog bites. Wound infections following an animal bite have been reported to occur in approximately 20% of dog bites and up to 80% of cat bites [1, 2]. It is important to sponge away visible dirt, perform copious irrigation, culture wounds (if they appear infected), and debride devitalized tissue. However, children under 5 are most at risk and are more likely to be bitten on the head, neck and face — around the lips, cheek or nose. If a child has a bite there is an alternative first-choice antibiotic called co-trimoxazole, but the other antibiotics used are the same. All result in permanent facial scars. However, people …
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