Going To The Dogs

This week’s guest columnist is Dr. Alicia Ortiz, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Every case is different.  Sometimes it’s a puppy playing with a toddler, a lick-fest gone wrong.  Once it was a mother of a litter protecting her young from potential buyers.  We see lots of dog bites in the Pediatric Emergency Department, and they generally come in two flavors.  The first is toddlers getting too close, and geting bitten in the face or hand.  Older kids get bitten in the legs and butt as they run away from loose neighborhood dogs.  Almost a million people visit ERs per year for dog bites.  Sometimes dogs can kill. How can you keep your kids from being Rover’s next victim?

Data suggests that certain dog breeds make better family pets than others.  Poodles and retrievers tend to be safer than terriers, shepherds, and guard-dog breeds. When picking a dog, be sure it’s young, preferably under four months.  Puppies are easier to train, and to acclimate to your kids.  If they do bite, they do less damage.  Older dogs, particularly rescues, can be unpredictable towards kids, and cause worse wounds.  Spay/neuter new dogs- this makes them less aggressive.

“Humanizing” pets has become more prevalent with social media.  People love videos of dogs in costumes, seeming to “talk” to their owners.  And everyone loves seeing laughing babies flop around with a litter of tail-wagging puppies.  Unfortunately,  humanizing encourages dogs in a family to think they’re more important than they are.  Sleeping in bed with family members, feeding from the table, hugging and kissing, generally treating the dog as a child, doesn’t teach the dog it’s place- that the kids outrank it.  You should be the alpha, kids the beta, and dogs last in your family’s “pack” hierarchy.

Having dogs with little kids isn’t great either.  Young kids, instead of running around screaming with the dogs, hyping them up, should be more restrained.  They shouldn’t  pet or get face-to-face with new or unfamiliar dogs.  Trying to train little kids and new dogs simultaneously is just too much- it’s hard enough to get kids to behave by themselves!

The two-year old was best friends with the puppy.  They napped together, played together, watched cartoons together.  Then one second they were tugging on a rope, the next the boy came running to his parents screaming, his face covered in blood.

As we said above, toddlers typically get bitten in the face, since their faces are at dog level, and toddlers get too close while inspecting, hugging, or kissing the dog.  The other popular injury sites are limbs, in the hands when petting a wary pooch, or in the legs and butt while running from a neighborhood dog.

When kids come to the ER, we copiously wash out the wound to reduce the risk of infection, and assess it.  The first question: are stitches needed, like for disfiguring face bites, or gaping wounds elsewhere. Sometimes the wound is so bad that it will leave an ugly scar, no matter how skilled the ED doctor or plastic surgeon.  We don’t sew simple punctures- these heal with small scars, and suturing bites runs the risk of trapping infection inside.

Infection is the next determination.  Kids should be vaccinated, because dog bites can cause tetanus.  Dog mouths can also contaminate wounds with bacteria, so bites that break the skin need antibiotics.  We also worry about rabies.  Wounds through the skin warrant calling Animal Control. The Animal Control officer assesses the dog for rabies risk.  Even if pooch is vaccinated, or is mostly indoors, rabies is still possible.  When dogs go outside to potty, they can get bitten by rabid animals like bats or skunks, and you won’t know it.  And dog rabies vaccine isn’t 100% protective.

We don’t mess with rabies.  If there’s any risk to the child, like being bitten by a stray animal that can’t be found and assessed, we start the kid on rabies vaccine.  Because if a human contracts rabies, it’s 100% fatal. 

Yes, dogs are furry and cute.  Kids love them, and dogs and humans have been  companions for thousands of years.  But make an informed decision when getting a dog: choose the safest breed, and get it when your kids are older.  Aren’t baby humans more important than pooches?

Real Animals Are Not Cartoons

This week’s guest columnist is Dr. Crystal Davis, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Mom’s in the yard when her 5 year-old son Logan runs over. “Something bit me,” he cries, “it hurts!”  Blood drips down his arm.  He’s rushed inside and while mom washes the arm in the kitchen sink, the story comes out.  Logan was next door at his friend Tommy’s, when they saw some animals in the bushes. They went to get a closer look, and Logan got bitten. It was a small animal, that looked to Logan like a rat.

Just then Tommy’s mom calls to check on Logan, and that she saw ferrets in the bushes lately.  ”It was a ferret!” chimes in Logan, “One of the teachers at school has one in her classroom!”  A ferret and a bleeding bite wound, mom thinks, what do I do now? Go to the Emergency Room?  Call Animal Control?

Both are good ideas. Any time an animal bites and breaks the skin, the child is at risk for infections.  The bite can cause other problems too- disfiguring scars, tendon and nerve damage, and pain.  Your first step is doing just what Logan’s mom did- wash the wound. This rinses out harmful bacteria and viruses that might cause infection. Some bleeding is good- blood washes bacteria out too.  After a good washing, stop the bleeding with direct pressure.

Call Animal Control.  The animal should be captured and quarantined to see if it has rabies.  This goes for pets, stray animals, and wild animals- any mammal can carry rabies, and rabies is deadly!

Then at the Emergency Room, the team can further clean the wound, assess for infection and damage, prescribe an antibiotic, and consider if rabies vaccine is necessary.  Though deep lacerations are usually stitched, this isn’t always the case with bites.  While face bites are often sutured to minimize scarring, wounds on hands, arms, legs, and feet are commonly left open to continue to drain.  Stitching those increases the risk of infection by trapping bacteria inside.  Finally, the child’s tetanus vaccine status is assessed. Tetanus is another deadly infection, and kids who aren’t up to date need a booster.

Preventing animal bites is the best way to avoid complications like above.  Consider what your child watches on TV and in movies concerning animals.  Most animals in kid shows talk, are friendly, and are really cute.  These shows inadvertently teach your kids that animals are pretty much all great.  So, they might think, why not play with every real animal they see?

Well, in real life wild animals are more like people in a big city- some are mean, some have nasty infections, some bite.  You wouldn’t want your kid going up to every stranger and touching them, would you?  Thus you need to teach them to be wary of animals too. Even a neighbor’s dog that you don’t know well may be skittish with strangers, and bite when confronted.

Caution with animals is particularly important given the nastiness of animal bite infections. The scariest of these is rabies.  Rabies is a fatal viral infection.  It infects the brains of animals, causing them to be very aggressive, and attack other animals and humans. Rabies is passed along in the biting animal’s saliva, and all infected animals eventually die. Likewise with humans, rabies just about always kills.  There have only been 13 known survivors in history, compared to 65,000 deaths worldwide per year.

So which kid needs rabies prophylaxis?  Factors include prevalence of rabies in your region, if the child’s skin was broken by a bite (bad) or paw scratch (less bad), and of course- could the offending animal be carrying rabies?

Domestic animals can have rabies- not all have had rabies vaccines.  Wild animals are at high risk of carrying rabies, particularly bats, raccoons, skunks, foxes, and coyotes. And these wild animals can bite and transmit the virus to pets.

So as we said above, if your child is bitten, call Animal Control.  They can help you and the doctor decide the risk of rabies.  In the best case, they can capture the animal, take it into quarantine, to see if it develops rabies.  If the animal turns rabid, your child can start the vaccines.  If the animal turns out to be safe, so is your child.

Mammal Bites

This week’s guest columnists are Drs. Marc Fernandez and April Weliever, Family Practice residents at the University Hospital and Clinics here in Lafayette.

We see it all the time in the Emergency Department: the family cat bit the toddler, “a wild raccoon bit our girl,” “the neighbor’s dog bit our boy,” the neighbor’s boy bit our boy!”  Dog and cat bites are the most common bites, usually from the family or neighbor’s pet. Sometimes kids will chomp other kids hard enough to warrant a visit to the ER.

Our country sees between 2 and 5 million ER visits per year for bites, costing the medical system about $1 billion dollars per year.  That’s a lot of meat-eaters!  And those are the ones that come for care- there’s many more that don’t come in, getting taken care of at home.  Most ER visits are for dog bites, followed by cat bites, then bites by rodents and other smaller, wild animals, and least of all, human bites.

What bites need the doctor?  The most obvious bites to bring in are those that break the skin-these all need assessment, because they’re at risk for infection.  Some bites that don’t break the skin may also need to be seen: crush injury that might damage bone, nerve, or tendon, or cause significant pain.  When bringing a child for care, there are other considerations: was it a pet or a wild animal?  Is the animal vaccinated?  Is the child vaccinated?

Before coming to the ER it’s good to clean the wound. Most bites kids get are on the arms, legs, hands, or face.  Running the wound under tap water is a great way to get some of the infection-causing bacteria out.  Gently scrub a wound that can’t be run under water (like on faces).  At the hospital we can numb wounds that need more extensive cleaning.

The next consideration is x-rays.  Most bites and scratches don’t need these.  However, sometimes an animal tooth can break off in a deep wound.  X-rays can find if there’s a bit of tooth that needs to be removed.

The most common story involves the neighbor’s dog.  The child goes out to play, walks by the neighbor’s property, and the dog runs out and bites.  These kids usually get it in the back of the leg, while running away from the dog.  The next most common story is the toddler or pre-school kid playing with the family pet.  She puts her face too close to the pet, the pet gets nervous, and snaps at the child.

We talked above about which of those bites needs medical attention- broken skin or crush injuries.  Which bites needs stitches?  We usually close open wounds with stitches, but not always with animal bites. Animal bites are at high risk for infection, and the last thing you want is to sew those nasty bugs into your child’s skin.  For this reason we don’t stitch most bites- except face wounds that need them for cosmetic reasons, to minimize disfiguring scars.

All animal bites that break the skin get antibiotics.  This is especially true for deep wounds or puncture bites that might drive bacteria in to where they can’t be easily washed out. Also, the places kids get bitten (arms and legs) have poorer blood supplies to clean up infection.  And when kids get bitten on the face, wound infections can increase scarring, so those get antibiotics too.

Vaccine considerations are very important.  Animal bites are at risk for two deadly infections: rabies and tetanus.  If your child gets tetanus, he or she will get very sick, and have a high risk of dying.  If your child gets rabies, he or she WILL die.  Thus we always ensure that bitten kids are up-to-date on tetanus vaccination.  We also need to know the biting animal is rabies-free. Animal Control is called to find the offending animal, check its vaccine status, and quarantine it.  If the animal remains rabies-free after 10 days, it goes home.  If the animal can’t be found, the child needs rabies vaccination. 

By far the best way to treat mammal bites is prevention.  Children should be taught to stay away from wild animals, and give neighbor’s dogs a wide berth.  Toddlers should never play with family pets- neither toddlers nor animals have the skills to avoid confrontation. “Confrontation” meaning: one animal bites the other.

 

The Dark Side of Fluffy and Rover

It really wasn’t the boy’s fault.  He was playing in his yard when a stray dog wandered over. The dog jumped up and bit the boy on the side of his face. The dog fled and Animal Control couldn’t find it.  Rabies is in the area and there was no way to know if the dog was rabid without capturing and quarantining it. So we had to assume the worst, and start the boy on the rabies vaccines.  The vaccines aren’t so bad- no worse than regular vaccines.  But the rabies immunoglobin, a medicine to prevent the rabies virus spread, must be injected right into the wound.  It was not a good night for the boy or me.

Dog and cat bites make up plenty of pediatric ED visits.  Usually it’s a neighbor’s animal or the family pet at fault.  Occasionally it is a stray.  When a child gets bitten, there are lots of medical problems to address.  The most obvious worry is the wound itself.  Kids explore with their faces and hands and want to touch and look closely at any animal. If they get too close and the animal feels threatened, it protects itself by lashing out with tooth and claw. The resulting face wounds sometimes leave scars that even plastic surgery can’t hide. Then there is the worry about infection.

There are three infections that dogs and cats can transmit.  The biggest worry is rabies. Rabies is a virus that wild animals get by biting each other.  Rabies attacks the brain, makes the animal go mad and bite other animals (and thus pass the virus on), and then the animal dies.  It is very rare for any animal, or human, to survive rabies once the infection takes.  The next concerning infection is Pasteurella, a bacteria for which we give antibiotics.  The only face laceration I remember getting infected was from a dog bite, though the child was on antibiotics.  The third infection is Tetanus.  This is another good reason to be sure your kids are vaccinated because like rabies, tetanus often kills.

The newspapers recently ran a story from Oregon about a 22 pound cat named Lux who attacked his family.  The seven month old baby pulled Lux’s tail, so Lux swiped the baby in the forehead with his claw.  Then he got so aggressive that he trapped the parents in a bedroom until police arrived.  Even more concerning, the family is keeping the cat, getting it “therapy.”  Now, cats are carnivores, meat-eaters who are hard-wired to hunt, kill, and eat.  Some are nicer and more family friendly than others, but I doubt that any therapy will help Lux and a baby get along.

My point is not to give cats a bad rap as pets, but to illustrate safety issues.  The first thing is to not have a pet with a toddler.  Toddlers are explorers.  When they explore things they touch them, peer at them, and grab and pull on them.  Dogs and cats are often patient with such behavior, but not always. You can’t know when the ancient purpose buried in their DNA (defend, hunt, kill, eat) will come out with such treatment.  Wait until your kids are school age before getting a dog or cat.

Another safety concern is fencing for dogs- to keep them in, or out.  Fences keep your dogs and kids in and away from the neighbors. They also keep other neighbor’s dogs or strays out.  Also, pick a dog breed that is less aggressive.  Terriers, pit bulls, chows, and breeds like them are more aggressive and more difficult to train.  Poodles and retrievers tend to be safer with kids.  Veterinarians can help you pick a breed and tell what behavior to look for in an individual dog.  Finally, teach your children how to treat pets and other animals. Pets are not play-things or wrestling partners.  They need to be played with in appropriate ways, and need to be trained to do the same with your kids.

Feel free to get a pet: dogs, cats, and humans have been great companions for thousands of years.  However, dogs and cats have been hunters for even longer- treat that knowledge, and them, with respect.