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.