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This study focuses on the pattern of incidence, mechanisms, and circumstances of accident and injury in a series of pediatric patients who sustained dog bites. In our retrospective survey, the medical charts of all children who were younger than 17 years and sought medical attention after a dog bite between 1994 and 2003 were reviewed. To obtain the total number of each dog breed in the administrative district, we analyzed 5873 files from the community dog registers. For establishment of a risk index, the representation of a dog breed among the total canine population was divided by the frequency of dog bites from this breed. A total of 341 children (mean age: 5.9 years) were identified. The annual incidence of dog bites was 0.5 per 1000 children between 0 and 16 years of age. Incidence was highest in 1-year-old patients and decreased with increasing age. The relative risk for a dog attack by a German shepherd or a Doberman was approximately 5 times higher than that of a Labrador/retriever or cross-breed. The vast majority (82%) of the dogs were familiar to the children. Most (322; 94%) of the children had injuries to 1 body region; in the remaining 19 (6%) children, up to 3 body regions were injured. Of 357 injuries, the face, head, and neck region was the leading site affected (50%). Inpatient treatment was required in 93 (27%) patients. Dog bites in children are frequent and influenced by the breed-related behavior of dogs, dog owners, children, and parents. Therefore, prevention strategies should focus on public education and training of dogs and their owners. Children who are younger than 10 years represent the high-risk group for dog attacks.
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ARTICLE
Analysis of Dog Bites in Children Who Are Younger
Than 17 Years
Johannes Schalamon, MD, Herwig Ainoedhofer, Georg Singer, MD, Thomas Petnehazy, MD, Johannes Mayr, MD, PhD, Katalin Kiss, MD,
Michael E. Ho¨ llwarth, MD, PhD
Department of Pediatric Surgery, Medical University of Graz, Graz, Austria
The authors have indicated they have no financial relationships relevant to this article to disclose.
ABSTRACT
OBJECTIVES. This study focuses on the pattern of incidence, mechanisms, and circum-
stances of accident and injury in a series of pediatric patients who sustained dog
bites.
METHODS. In our retrospective survey, the medical charts of all children who were
younger than 17 years and sought medical attention after a dog bite between 1994
and 2003 were reviewed. To obtain the total number of each dog breed in the
administrative district, we analyzed 5873 files from the community dog registers.
For establishment of a risk index, the representation of a dog breed among the
total canine population was divided by the frequency of dog bites from this breed.
RESULTS. A total of 341 children (mean age: 5.9 years) were identified. The annual
incidence of dog bites was 0.5 per 1000 children between 0 and 16 years of age.
Incidence was highest in 1-year-old patients and decreased with increasing age.
The relative risk for a dog attack by a German shepherd or a Doberman was 5
times higher than that of a Labrador/retriever or cross-breed. The vast majority
(82%) of the dogs were familiar to the children. Most (322; 94%) of the children
had injuries to 1 body region; in the remaining 19 (6%) children, up to 3 body
regions were injured. Of 357 injuries, the face, head, and neck region was the
leading site affected (50%). Inpatient treatment was required in 93 (27%) pa-
tients.
CONCLUSIONS. Dog bites in children are frequent and influenced by the breed-related
behavior of dogs, dog owners, children, and parents. Therefore, prevention strat-
egies should focus on public education and training of dogs and their owners.
Children who are younger than 10 years represent the high-risk group for dog
attacks.
www.pediatrics.org/cgi/doi/10.1542/
peds.2005-1451
doi:10.1542/peds.2005-1451
Key Words
child safety, dog bites, epidemiology,
prevention
Accepted for publication Sep 26, 2005
Address correspondence to Johannes
Schalamon, MD, Department of Pediatric
Surgery, Medical University of Graz,
Auenbruggerplatz 34, 8036 Graz, Austria. E-
mail: johannes.schalamon@meduni-graz.at
PEDIATRICS (ISSN Numbers: Print, 0031-4005;
Online, 1098-4275). Copyright © 2006 by the
American Academy of Pediatrics
e374 SCHALAMON, et al
by guest on January 12, 2016Downloaded from
I
N MANY FAMILIES, dogs play an important role as
guards, companions, and friends. Unfortunately, this
partnership is not without problems. In recent years, it
has become more and more apparent that dog bites are
a serious and often underestimated public health prob-
lem.
1
In the United States, an overall incidence of 1.3:
1000 for dog bites that require medical treatment is
reported.
2
In particular, children tend to underestimate
the danger arising from dogs because they are more
careless and inexperienced than adults in their interac-
tion with dogs. This is confirmed by studies showing that
children are more likely than adults to sustain canine
bite wounds, with the highest incidence being among 5-
to 9-year-old boys (6:1000 people).
2
The likelihood of a
child’s sustaining a dog bite in their lifetime is 50%.
3
The aesthetic and psychosociological consequences of
trauma caused by a dog bite reportedly burden the qual-
ity of life of the affected child and his or her family.
4
Hence, pediatric dog bites represent a serious medical
and public health issue. For developing proper preven-
tion strategies, it is important to understand the circum-
stances and characteristics of dog bites. The major objec-
tives of this study were to analyze the incidence, the
mechanisms of accident, and the injury pattern as well
as the required surgical treatment in a series of pediatric
patients who sustained dog bites. Therefore, we evalu-
ated retrospectively the charts of 341 children who
sought medical assistance in our department as a result
of dog-bite–related injuries.
METHODS
The Department of Pediatric Surgery at the Medical Uni-
versity of Graz is a level 1 trauma center that treats
11 000 children annually. The census population aged
0 to 16 years in the respective catchment area is 62 457.
Our retrospective survey included all children who were
younger than 17 years and sought medical attention
after a dog bite between 1994 and 2003. Patients’ charts
were analyzed for personal data, type of injury, and
clinical course. The standard medical treatment of dog
bites at our department consists of meticulous wound
cleaning and closure of gaping wounds. Surgical closure
was indicated when a firm wound closure without a
suture was not possible. In the case of deep lacerations,
wound drainage and/or systemic antibiotic treatment
with either amoxicillin/clavulanate or cefuroxime/met-
ronidazole was performed. Children with facial wounds
or deep lacerations that required surgical closure under
general anesthesia were admitted to the ward. A veter-
inarian’s certificate was requested from the identified
dog owners to exclude rabies. When the certificate could
not be obtained within 24 hours after the dog bite, the
child was assigned to rabies vaccination.
All children and/or their parents were interviewed
and completed a questionnaire that contained the fol-
lowing items: dog ownership, the circumstances of the
accident, and long-term consequences for patients or
dogs. The dog breed was taken from the veterinarian
report.
To gain information about the local distribution of
dog breeds, we analyzed 5873 files from the community
dog registers (Fig 1) and added the information to a
Microsoft Excel database that contained the data of the
attacking dogs. For analysis, the 18 most popular breeds,
accounting for 90% of all dogs, were considered, thereby
excluding 31 breed populations with 64 dogs each. For
calculation of the risk index, the representation of a dog
breed among the total dog population was divided by the
representation of this breed among all registered dog
bites.
All children were followed up until wound healing
and revisited 3 to 4 weeks after wound healing to doc-
ument short-term results. Late follow-up was performed
in 317 (93%) of the 341 children 2 to 11 years (mean:
7.2 years) after the dog attack. Seventeen of the remain-
ing 24 children were contacted by telephone but de-
clined to participate because of complete healing; 7 chil-
dren could not be located.
Statistics
The
2
test was used to determine the statistical signifi-
cance between groups. All computations were per-
formed using the statistical software package SPSS
11.0.1 for Windows (SPSS, Inc, Chicago, IL). P .05 was
considered significant.
FIGURE 1
Local dog breed distribution as collected from the local community dog register. A total
of 5873 files were analyzed, and 31 breeds with 64 dogs each were excluded.
PEDIATRICS Volume 117, Number 3, March 2006 e375
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RESULTS
In this study, 341 children (174 boys, 167 girls) who
were aged between 8 days and 16 years (mean age: 5.9
years) were included. In the respective catchment area,
dog bites accounted for 0.31% of all trauma-related
hospital visits. The annual incidence of dog bites was 0.5
per 1000 children between 0 and 16 years of age. The
highest incidence was found in 1-year-old children, with
the incidence decreasing thereafter with age (Fig 2). A
total of 73% of all affected children were younger than
10 years. A seasonal fluctuation was detected: a majority
of the children were injured in the summer months, and
peak incidence occurred during August. There was an
almost equal distribution of dog attacks between the
days of the week.
The vast majority (73%) of the dogs were familiar to
the children, whereas in only 15% of the cases, the dog
owner was considered as unfamiliar. A total of 12% of
the affected patients could not specify the dog ownership
(Table 1). In 75% of all known circumstances that led to
the injury, the child interfered with the dog (Table 2).
A majority (n 322; 94%) of the children had inju-
ries to just 1 body region; in the remaining 19 (6%)
children, up to 3 body regions were injured. Of 357
injuries, the face, head, and neck region was the leading
body part affected (50%), followed by upper (28%) and
lower extremities (18%). Injuries to the trunk/chest
were less common (4%). A total of 290 (85%) children
sustained deep wounds; 51 (15%) children presented
with superficial scratches and minor lacerations. Chil-
dren with injuries to the head and neck were signifi-
cantly younger compared with the total study popula-
tion (mean age: 4.1 year; P .01).
According to the local veterinary guidelines, 198
(58%) of the biting dogs were classified as large (44 cm
of acromial height), 94 (28%) dogs were small; and the
size of 49 (14%) dogs was unknown. In 305 (89%) of
341 dog attacks, the exact breed of the dog could be
determined. The breed-related proportion of dog attacks
is shown in Table 3. Bites from German shepherds and
Dobermans accounted for 37% of all dog bites despite
that these breeds account for only for 13.1% of the dog
population. The relative risk for a dog attack by a Ger-
man shepherd or a Doberman was 5 times higher that
that associated with a Labrador/retriever or cross-breeds.
Children who were younger than 5 years sustained sig-
nificantly more attacks by small dogs compared with
older children (P .04).
Treatment
A total of 337 (99%) children presented within the first
24 hours after the dog bite. The remaining 4 children
sought medical advice 24 to 72 hours after the attack
with signs of wound infection subsequent to initial
treatment at home. A total of 219 children visited the
emergency department directly from the scene of the
accident; 118 children were referred from general prac-
titioners. In the emergency department, all children
were examined by pediatric surgeons.
Inpatient treatment was required for 93 (27%) pa-
tients. The mean hospital stay of these children was 4.9
days (range: 1–13 days). Surgical procedures for wound
adaptation were performed in 89 (26%) of 341 children,
with 32 patients requiring wound drainage. The major-
ity (n 77, 87%) of these 89 children required general
anesthesia for wound repair. Twenty-two children with
soft tissue injuries of the extremities and 2 additional
children with finger fractures had splint or cast immo-
bilization. For 6 children, an ophthalmologist was con-
sulted as a result of eye injuries.
Complications
Complications occurred in 40 (12%) children. Thirty-
four (10%) children had wound infections, 27 of whom
received primary antibiotic treatment. Delayed wound
healing without clear signs of infection was recorded in
FIGURE 2
Distribution of child age in 341 pediatric cases of dog
bites.
TABLE 1 Distribution of Dog Owners in a Series of 341 Children
Who Sustained a Dog Bite
Owner % (n)
Household member 24 (83)
Friend 20 (68)
Stranger 15 (51)
Neighbor 15 (50)
Relatives 14 (49)
Unknown 12 (40)
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5 (1%) children with major primary soft tissue lacera-
tions. Two of these 5 children sustained hypertrophic
scars. In 1 additional child with a finger fracture, a
rereduction was required as a result of a secondary frac-
ture displacement.
Late Problems
Five children complained of nightmares after the dog
attack; fear of dogs remained with another 34 children.
The 2 children with hypertrophic scars were underwent
surgery for scar revision. Two dogs were euthanized as a
consequence of repeated aggressive behavior.
DISCUSSION
The present report covers dog bites over a 10-year pe-
riod. Taking into consideration that 50% of all dog
bites are reported to doctors or police,
4
it can be esti-
mated that there is an annual incidence of 1:1000 chil-
dren who sustain dog bites. Despite significant morbidity
related to dog bites, only a small number of fatal dog
attacks on children have been reported previously. For
example, Reuhl et al
5
described 20 fatal dog attacks in a
10-year period in Germany, Switzerland, and Austria,
with half of the victims being children who were
younger than 8 years (median: 2 years, 7 months).
Death was caused either by multiple trauma or by inju-
ries to the head and neck. In agreement with previous
publications,
6–8
our data showed that the most common
area targeted by dogs was above the shoulders, reflecting
the closer proximity of the child’s head to the attacking
dog. Fortunately, none of the children included in this
report died, although the face, head, and neck region
was primarily affected and 6% of our patients sustained
multiple injuries.
Injuries to the face, head, and neck area occur more
frequently in younger children. Scarring is a common
consequence related to dog bites, and the resulting emo-
tional distress should not be underestimated, particularly
for face wounds. As Schmitt
9
stated, “A child attacked by
a dog and bitten above the shoulders is equivalent to an
unarmed adult sustaining a bear bite. The human emo-
tional coping is overwhelmed.” Eleven percent (n 39)
of the children in our series reported prolonged emo-
tional distress, including nightmares and subsequent
augmented fear of dogs. The number of unreported cases
of emotional distress likely is much higher than re-
ported. Therefore, treatment strategies should include
early psychological support considering the different
trauma processing and coping strategies in children and
their families. More assistance that focuses on these
subjects will be required in the future.
We propose that the individual behavior of the at-
tacking dog or the dog breed may be directly related to
the severity of injuries. Voelker
1
stated that certain
breeds are more aggressive than others. In addition,
Gershman et al
16
found male and unneutered dogs more
likely to be aggressive compared with female and neu-
tered dogs. In several countries, certain dog breeds are
considered “fighting dogs” and are subject to legal regu-
lations. In Germany, these breeds include mastiff, bull
mastiff, bulldog, bullterrier, pit-bull, Tosa-Inu, and oth-
ers. Media reports that have focused on aggressive be-
havior of fighting dogs and special training for dogs to
make them more violent have led to an increased public
awareness. This may explain why we did not identify
any of these fighting dog breeds to be likely to attack
more frequently than average. On the basis of the dog
population in our catchment area, German shepherds
and Dobermans were the most aggressive breeds. These
findings are similar to other reports (Table 4). However,
every breed poses the threat of dog bites; any dog may
attack. Our data show that not only a proper education
of dog owners and behavioral training of dogs are re-
quired for “high-risk” breeds; rather, legislation should
regulate training of all dogs and dog owners and leashing
TABLE 2 External Circumstances of Dog Bites
Circumstance %
Playing with/near dog 28
Passing the dog (walking) 14
Cuddling the dog 10
Feeding the dog 8
Passing the dog (cycling) 4
Disturbance of dog while eating 4
Surprising the dog 2
Pulling the dog’s tail 2
Interfering during dog fight 2
Unknown 26
TABLE 3 Incidence of Dog Attacks According to Breed in a Total
Study Population of 341 Children Aged 0 to 16 Years
Dog Breed Dog
Bites
Dog Bites,
%
Dog Population,
%
Risk
Index
German shepherd 105 34 12 2.83
Doberman 8 3 1.1 2.71
Spitz 5 2 1.1 1.81
Pekingese 10 3 1.9 1.56
Dachshund 22 7 5.2 1.35
Schnauzer 5 2 1.5 1.33
Collie 10 3 2.3 1.30
Hound dog 15 5 3.9 1.29
Poodle 10 3 3.1 0.98
Rottweiler 3 1 1.1 0.92
Beagle 3 1 1.2 0.80
Terrier 15 5 8.1 0.61
Bernese dog 3 1 1.7 0.58
Labrador/retriever 11 4 8.2 0.49
Cross-breed 39 13 28 0.46
Spaniel 5 2 6.5 0.31
Shi Tzu 1 0.3 1.2 0.26
Maltese 0 0.0 1.1 0.00
The data about the distribution of the dog population was collected from the local community
dog register. Therisk index was calculated by dividing the representation of a dog breed among
the total dog population by the representation of this breed among all evaluated dog bites.
PEDIATRICS Volume 117, Number 3, March 2006 e377
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of dogs when using public areas. Improved skills of dog
owners and better training of the dogs may have pre-
vented several of the reported attacks. Concordant with
the findings of other authors,
2,4
a peak incidence of dog
attacks was noted during the summer months. This may
be explained by the fact that on warm, summer days,
children as well as dogs are more active and tend to play
outside, increasing the possibility of encountering each
other. Running past dogs or startling the dog can trigger
a possible attack.
A majority (73%) of the attacking dogs in the present
report were familiar to the children. However, only 33%
of these familiar dogs were “household members.” Fur-
thermore, the children interfered with the dog in a ma-
jority of the cases. In addition to well-known situations
such as disturbing a dog while eating or pulling its tail,
running or cycling past the dog without direct contact
provoked several attacks. Children likely feel comfort-
able with dogs that they know and therefore may reduce
distance and lose respect, not realizing that this attitude
may not be reciprocated. Small dogs attacked small chil-
dren significantly more frequently than older children,
presumably because small dogs are more likely to feel
superior to little children.
Borud and Friedman
10
discussed possible prevention
strategies in their report about dog bites in New York
City. They recommended behavioral modification, espe-
cially of children, when interacting with a dog. Despite
being helpful in adolescents, this approach may fail in
younger children. This is important as the incidence of
dog bites in the present report was highest in 1-year-old
children. Because of the accumulation of dog bites in
younger children, we agree with Thompson et al
17
that
parents should postpone purchase of a dog until children
are of school age. Throughout evolution, dogs have lived
in packs with a specific order of dominance. In view of
this rigorous hierarchal system in a pack, dogs may
regard newborns as well as toddlers as subordinate.
Thus, they may feel the need to defend their own posi-
tion in the pack against this intruder, especially if a new
child enters the family while the dog is already an inte-
grated member. School-aged children can be trained
successfully in precautionary behavior when approach-
ing a dog. Chapman et al
11
conducted an educational
program in 8 Australian primary schools. Children who
had received the training displayed significantly greater
precautionary behavior than children in the untrained
group. Despite possible training programs for school-
aged children, it still seems to be more reasonable to
teach the dog owners and parents to pay attention when
children are close to dogs than to place the blame/
responsibility for a dog attack on the children. Table 5,
which includes the recommendations of Presutti
12
and
Voelker,
1
summarizes a code of behavior to prevent dog
bites.
CONCLUSIONS
Dog bites in children are more prevalent in certain dog
breeds. Specific circumstances such as breed-related be-
havior of dogs and behavior of dog owners, children, and
parents seem to increase the risks for dog bites. There-
fore, prevention strategies should focus on public edu-
cation and training of dogs and their owners. Children
who are younger than 10 years represent the high-risk
group for dog attacks.
TABLE 4 Review of Several Dog-Bite Reports Identifying the Dog
Breed That Caused the Most Incidents
Author Year No. of
Cases
Dog Breed That
Caused Most Incidents
Avner and Baker
13
1991 168 German shepherd
Greenhalgh et al
14
1991 159 German shepherd
a
Unshelm et al
15
1993 284 German shepherd
Gershman et al
16
1994 178 German shepherd
Thompson
17
1997 356 Doberman
a
Gandhi et al
18
1999 67 Pit bull
Reuhl et al
5
2001 20 (deaths) German shepherd
Kahn et al
4
2003 100 German shepherd
a
Mitchell et al
19
2003 44 Rottweiler
Schalamon et al 2004 341 German shepherd
a
In all studies that were based on dog population, German shepherd and Doberman are the
breeds that are most likely to be involved in dog-bite accidents.
a
Based on dog population.
TABLE 5 Code of Behavior When Handling a Dog
Dogs Humans
Dogs sniff as a means of communication. Before petting a dog, let it sniff you.
Dogs like to chase moving objects. Do not run past dogs.
Dogs run faster than humans. Do not try to outrun a dog.
Screaming may incite predatory behavior. Remain calm if a dog approaches.
The order of precedence needs to be in evidence. Do not hug or kiss a dog.
Direct eye contact may be interpreted as aggression. Avoid direct eye contact.
Dogs tend to attack extremities, face, and neck. If attacked, stand still (feet together) and protect neck and
face with arms and hands.
Lying on the ground provokes attacks. Stand up. If attacked while lying, keep face down and
cover the ears with the hands. Do not move.
Fighting dogs bite at anything that is near. Do not try to stop 2 fighting dogs.
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ACKNOWLEDGMENTS
We thank the Austrian Committee for Injury Prevention
in Childhood (Grosse Schuetzen Kleine, Safe Kids Aus-
tria) for assistance in data analysis. We thank Dr Karen
Stokes for assistance with manuscript preparation.
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DOI: 10.1542/peds.2005-1451
2006;117;e374Pediatrics
Johannes Mayr, Katalin Kiss and Michael E. Höllwarth
Johannes Schalamon, Herwig Ainoedhofer, Georg Singer, Thomas Petnehazy,
Analysis of Dog Bites in Children Who Are Younger Than 17 Years
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... As well as proper educational interventions for preventing bites (LAKESTANI and DONALDSON, 2015;MEINTS et al., 2018) and behavioural dog training (SCHALAMON et al., 2006), we believe it is important to identify the factors that increase the risk for bites. Additional knowledge about risk factors for dog bites may help improve existing preventive strategies. ...
... The profile of the attacking dogs was consistent with previous results (FLINT et al., 2017;SARCEY et al., 2017), comprising a male, adult dog that was large in size. German shepherds are often reported as the breed most commonly involved in biting incidents involving children (SCHALAMON et al., 2006;KHAN et al., 2020), as also seen in our sample. We also found a large number of reports about aggression by small breeds, which we presume might be due to such dogs attempting to exert their superiority over smaller children (SCHALAMON et al., 2006). ...
... German shepherds are often reported as the breed most commonly involved in biting incidents involving children (SCHALAMON et al., 2006;KHAN et al., 2020), as also seen in our sample. We also found a large number of reports about aggression by small breeds, which we presume might be due to such dogs attempting to exert their superiority over smaller children (SCHALAMON et al., 2006). ...
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Although children are the most frequent victims of dog bites, gaps remain in understanding of the factors that lead to biting incidents. Using a retrospective and victim self-report questionnaire, risk factors for dog bites with respect to younger and older children in Slovenia are examined. The results showed that younger children were more commonly bitten in a non-public place, outside or inside a house when the owner was absent. They had approached and interacted with a dog they knew, which had a history of aggression and had displayed tense or aggressive behaviour before the bite. Older children were mainly bitten outside in a public space, when the owner was not there. They were approached and bitten by an unknown dog while running or cycling, while entering the dog's personal space, or it was completely unprovoked. The dog involved had a history of aggression and before the bite the victims had neither interacted nor attempted to interact with the dog. These results suggest that the risk factors for dog bites involving children might be age-related calling for due attention and further assessment.
... Wegen ihrer geringen Körpergröße können sie in das Beuteschema von Hunden passen [7]. Größere, beißkräftige Hunderassen, wie Schäferhunde, Rottweiler oder Retriever -die regelmäßig die Beißstatistiken anführen -, verursachen überwiegend schwere Verletzungen an Kopf, Nacken und Hals von Kindern im Vorschulalter [3,7,23,24,27,32,36,37]. Ältere und größere Kinder werden eher in Arme, Hände und Beine gebissen [11,30]. ...
... Die Bandbreite an Verletzungen reicht von oberflächlichen Quetsch-Riss-Wunden, Kratz-oder Schürfdefekten bis zu Abrissverletzungen und/ oder großflächigen Substanzdefekten [3,20]. Das Infektionsrisiko ist abhängig von der Art der Verletzung und der individuellen Infektionsdisposition des/der Gebissenen: Tiefe, verschmutzte Wunden mit großflächiger Gewebszerstörung, Verletzungen im Gesicht und/oder an den Extremitäten sowie Gewebe mit reduzierter Durchblutung bergen ein hohes Risiko, sich zu infizieren [28,30]. Das Risiko einer Wundinfektion nach Hundebissverletzungen wird je nach Quelle mit 3-18 % bzw. ...
... Bissverletzte Kinder wurden ausschließlich konsiliarisch mitbegutachtet. Dies entspricht auch den Ergebnissen anderer Studien, denen zufolge sich Bissopfer abhängig von der Schwere der Verletzungen medizinische Hilfe suchen, Kinder jedoch deutlich niedrigschwelliger medizinisch vorgestellt werden [11,30]. Die Befunde der untersuchten Kinder und Jugendlichen fanden sich überwiegend an der oberen Körperhälfte -insbesondere am Kopf -und waren -übereinstimmend mit vergleichbaren Studien -schwerwiegender als die der untersuchten Erwachsenen [9,15]. ...
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Zusammenfassung Insbesondere jüngere Kinder sind aufgrund ihrer geringen Körpergröße gefährdet, Opfer von Hundeangriffen zu werden. Ein solcher Beißvorfall kann verschiedene Strafbestände erfüllen. Um möglichen rechtlichen Ansprüchen genügen zu können, sollten die Verletzungen rechtsmedizinisch und damit gerichtfest dokumentiert werden. Es empfiehlt sich daher eine enge Zusammenarbeit von behandelnden ChirurgInnen und RechtsmedizinerInnen. Es wurde eine retrospektive Analyse der klinisch-rechtsmedizinisch bearbeiteten Fälle von Hundebissverletzungen bei Kindern und Erwachsenen an der Universitätsmedizin Rostock unter verschiedenen Aspekten durchgeführt. Erwachsene Verletzte wurden überwiegend an der unteren Extremität verletzt. Die untersuchten Kinder wurden überwiegend die Kopf‑, Hals- und Gesichtsregion sowie die obere Extremität gebissen. Die Verletzungsschwere reichte von Hautrötungen bis zu schweren Substanzdefekten mit Verlust von Körperstrukturen. Der beißende Hund war in gut der Hälfte der Fälle bekannt. Um Beißangriffe durch Hunde auf Kinder zu vermeiden, sollten Eltern sowie auch Kinder unbedingt im Umgang mit Hunden geschult werden.
... Unaesthetic soft-tissue and skeletal injuries, scars and disfigurements are outcome of such incidents [1]. It is estimated that 50% of population in the United States experience an animal or human bite wound at least once in their lifetime, and 45% of children had been bitten during their lifetimes [2][3][4]. These types of injuries are ever-growing burden for public health, especially in developing and third world countries. ...
... Amongst bites caused by domestic animals, dog bites account 80-90% [5,6], whereas cat bites account for 5% and 15% [7,8], as second common cause. Children are especially susceptible to dog bite injuries of the head and neck region [4,[9][10][11][12]. The kind of wounds afflicted span from insignificant scratches to fatal injuries and/or infections [13]. ...
... The prime characteristic features of eligible studies are summarized in Tables I-III. The time span assessed in the studies ranged from 1985 to 2017 [4,9,11,. Majority of the included studies in the review were retrospective studies except 4 studies (2 were prospective studies [11,25] and 2 were cross-sectional questionnaire-based surveys [38,43]). ...
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Objectives: To assess the scientific literature pertaining the risk factors for injuries among victims of animal bite injuries. Data and sources: A systematic review of scientific literature published until May 2020 was carried out in the following databases: PubMed, Cochrane Library, Google Scholar and Journals@ovid. Study selection: A total of 924 records were found, of which 29 articles fulfilled the inclusion criteria and were analyzed. There was a male preponderance in most of the studies with male/female ratio ranging from 0.75:1 to 2.1:1. The age range varies from 0 to 19 years with the mean age varying from 3.6 to 8 years. Pitbulls, Rottweiler's, German shepherds, Bull terriers, Labradors and Dobermans were breeds with higher risk of attack. The animals were familiar to the victim (own, friends, neighbors) in 27–98% instances. Most cases of animal bite injuries were recorded during Summer and Spring months. Head and neck followed by extremities was found to be most inflicted area. Conclusions: The sociodemographic characteristics of victim as well as the biting animal affect the circumstances leading to biting episode. However, the results should be interpreted with caution due to the high heterogeneity among studies and moderate quality evidence.
... Children, especially toddlers, are capable of unpredictable behaviors and can be prone to risk-taking (Davis et al., 2012). Most dog bites happen when a child is left alone with a dog without adult supervision (Schalamon et al., 2006). Boys seem at a higher risk of being bitten than girls (Schalamon et al., 2006;Dwyer, Douglas & van As, 2007;Messam et al., 2018;Zangari et al., 2021). ...
... Most dog bites happen when a child is left alone with a dog without adult supervision (Schalamon et al., 2006). Boys seem at a higher risk of being bitten than girls (Schalamon et al., 2006;Dwyer, Douglas & van As, 2007;Messam et al., 2018;Zangari et al., 2021). The nature of human-dog interactions may differ based on gender and therefore play an etiological role in the differences of dog bite frequency between males and females (Overall & Love, 2001 (Shuler et al., 2008;Casey et al., 2014). ...
Preprint
Our wellbeing is greatly influenced by our childhood and adolescence, and the relationships that we form during those phases of our development. The human-dog bond started thousands of years ago. The higher prevalence of dog ownership around the world, especially in households including children along with the growing number of people studying dogs most likely explain the growing literature focusing on child-dog interactions. We review the potential effects of child-dog interactions on the physical, mental, and social wellbeing of both species. A scoping search of the SCOPUS database found several hundred documents meeting selection criteria. It allowed us to define the numerous ways in which children and dogs can interact, be it neutral (e.g., sharing a common area), positive (e.g., petting), or negative (e.g., biting). Then, we found evidence for an association between interacting with dogs during childhood and an array of health and mental benefits like stress relief and the development of empathy. Walking a dog and playing with one are perfect physical activity opportunities. Additionally, interacting with a dog can help lower stress and may have a role in the development of empathy. Nonetheless, a number of detrimental outcomes have also been identified in both humans and dogs. Children are the most at-risk population regarding dog bites and dog-borne zoonoses, which may lead to a subsequent fear of dogs or even death. Moreover, pet bereavement is generally inevitable when living with a canine companion and should not be trivialized. In terms of dogs, children sometimes take part in caretaking behaviors toward them which include going on walks. They are opportunities for dogs to relieve themselves outside, but also to exercise and socialize. In contrast, a lack of physical activity can lead to the onset of obesity. Dogs may present greater levels of stress when in the presence of children. Finally, the welfare of assistance, therapy, and free-roaming dogs remains underexplored. Overall, the study of the effects, positive as well as negative, on both species still requires further development. We call for more longitudinal studies and hope for cross-cultural research in the future in order to better understand the impact child-dog interactions might have.
... In our study, male children were bitten more frequently than female children, which is consistent with other research 37,56,57 . In general, children are 3-5 times more likely to be bitten than adults 58,59 . ...
... Mongrels and the German Shepherds were the most frequently reported dog breeds involved in the incidents in our study, which is similar to some previous studies 57,61,62 . However, this nding should be interpreted with caution. ...
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Most animal bites in humans are caused by domestic dogs, making dog bite-related injuries a serious public health and safety concern globally. However, till date there is no comprehensive research regarding the occurrence of dog bites, and incidence of exposure to rabies post-exposure prophylaxis in Poland. Thus, the main goal of the study was to examine incidents of dog bites in humans and the potential risk of rabies in Poland between 1994-2018. Our results showed that the mean annual dog bite incidence rate in Poland was 13 people per 100000 inhabitants, with ~5000 people vaccinated annually post exposure. Children were more likely to be bitten than adults, and males were more likely than females. People were more likely to be bitten by mongrels followed by German Shepherds. However, most of the bite incidents included dogs that were free-ranging or stray, highlighting the di culty in regulating the vaccination status of the dog and consequently the likelihood of people meeting a rabid animal. Therefore, we recommend increasing stray dog captureefforts to decrease the incidence of dog bites and potential exposure to rabies. Furthermore, o cial reporting of all cases of dog bites by associated stakeholders involved in data collection would be effective.
... In one retrospective study that evaluates hospital admissions for children with dog bite injuries, McLoughlin et al. reported that most patients (32.3%) were in middle childhood (6-11 years) [16]. Schalamon et al. reported that the incidence was highest in 1-year-old patients and decreased with increasing age [17]. In the study by Ramgopal and Macy, dog bites were seen most frequently among patients 0-4 years of age [18]. ...
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Objectives This study aimed to evaluate the clinical features, management, and outcomes of patients with animal bites presented to the pediatric emergency department in a tertiary center with animal bites. Methods Patients with ICD-10 code W54 (Contact with dog) and W55 (Contact with other mammals) between March 1st, 2017, and July 1st, 2021, were included in the study. Demographic characteristics of the patients, type of contacted animal, wound characteristics (muscle involvement, soft tissue defect, vascular injury, type of nerve injury, and Lackmann’s classification), wound care measurements, tetanus prophylaxis, administration of rabies immunoglobulin and antibiotics, location of the injury, existing fractures, suturing, splinting, surgical consultations and hospitalization status were recorded. Results Four hundred and nineteen incidents of animal bites (240 males and 179 females) occurred over a four-year period. 51% was due to dog bite; 47% was by cat. The median age was nine years (IQR: 5–14 years). Most bites (91.6%) involved only a single anatomical site. The extremities were the commonly involved part (right upper limb [35.3%], left upper limb [21.2%], right lower limb [12.6%], left lower limb [16%]). Head-neck and face injury ratio was 17.6%. Torso (5.7%) and genitalia (5.2%) were uncommonly involved. A consultation was requested from at least one surgical department for 8% of the patients. 97.1% of patients received rabies vaccine. Most attacks were trivial and did not require hospitalization. Conclusion Animal bites often cause minor injuries. However, multiple dog attacks can be seen related to a high number of stray animals in our country. Therefore, these patients may present major traumas. Surgical intervention and hospitalization may be required. Emergency physicians play an essential role in acute management and rabies prophylaxis in these patients.
Article
Gaining popularity, animal-assisted education is thought to enhance learning processes and children's development, inter alia. While previous research has focused on these potential positive effects for the pupils, animal welfare and human safety in the classroom are aspects that have hardly been examined so far. We performed a cross-sectional investigation at 54 Bavarian schools with one working dog each. Our aim was to describe the status quo and to identify problematic issues which may require measures for ensuring awareness and prevention. We attended one class for a single or double session, videotaped for subsequent behavior analysis of the dog, and the handler was asked to complete a questionnaire. The handlers were mainly female teachers with more than 2 years of work experience. The dogs' median age was 3.0 years, and 22 of them (40.7%) had received a specialized training before working at school. We visited mostly elementary schools (38.9%, n=21/54). According to survey data, the mean duration of a session was 3.3 ± 1.9 hours, and the dogs participated in classes on 8.7 ± 6.0 days per month. Based on video analysis, the dogs' behavior as well as any interaction of the pupils and of the teacher with the dog were given a score, resulting in a classification as "innocuous", "problematic" or "critical". Half of all sessions were categorized as "problematic" and about a quarter as "innocuous" and "critical", respectively. Common "problematic" interactions included contact with several pupils at the same time (in 64.8% of classes), whereas common "critical" interactions included hugging / kissing the dog (in 18.5% of classes). Common "problematic" canine behaviors, reflecting an urgent need for optimized procedures, were for instance withdrawal reactions (in 37.0% of dogs). "Passive submission of the dog - ducking / crouching" was a "critical" category determined in 11 dogs; furthermore, aggressive behavior toward a pupil and territorial behavior occurred once, respectively. Moderate correlations were found as follows: Classes with older pupils had fewer "problematic" / "critical" dogs and more "innocuous" dogs compared with elementary schools; also, fewer dogs were categorized as "problematic" / "critical" if a canine aptitude test / specialized training had been performed. In conclusion, this study raised some serious concerns about the dogs' welfare and the pupils' safety, highlighting the importance of national guidelines, including certification requirements.
Chapter
Craniomaxillofacial trauma in children is an increasing, debilitating and preventable entity in pediatric health care in America. There has been a shift of trauma incidence to the younger population due to increased independence of children and risk-taking behaviour among youth, particularly in adolescence, which puts children at risk of significant injury. Children require updated immunization status, and it is vital to have responsible caregivers who can partner with the surgeon and participate in trauma care and recovery.Children require rapid intervention in trauma care, including facial injuries, to preserve tissue health and optimal results. Facial injuries are generally age-dependent in that cranio-orbital injuries are seen more in the very young, while midface and lower face injuries are seen more frequently in the older and adolescent child. Particular attention to soft tissue management of the eye, nasal and ear regions, including neurovascular entities, requires preservation of tissue, focused repair, support of repaired structures and scar management modalities in order to obtain a good result in form and function. Fracture management in the very young has undergone recent change with the advent of absorbable fixation materials and techniques as well as the increased appreciation for skeletal response to trauma, particularly for long-term facial development. It is important to recognize that jaw function in young children must be preserved and allowed during the healing period, and long-term growth assessed by regular follow-up with documentation.Adolescent fracture management mirrors that of adults, but nuances must be understood to achieve optimal results. Follow-up for growth perturbations should be documented into the early adult years, especially for mandibular condylar fractures and nasal trauma.KeywordsPediatricFacial traumaAdvanced trauma life supportSoft tissue injuriesHard tissue (bony) fracturesInjury-related growth disturbances
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As a result of a perceived increase in pit bull injuries, all children who presented to The Children's Hospital of Philadelphia during 1989 for evaluation of dog bite injuries were prospectively studied. Epidemiologic information was collected from parents, either at the time of visit or by phone on the following day. A total of 168 children were enrolled; the mean age was 8 years. Males outnumbered females 1.5:1. Most (61%) injuries occurred in or around the home and involved dogs known to the patient (77%). Types of injuries included abrasions (33%), punctures (29%), and lacerations (38%). Thirteen bites had associated complications; nine developed infection. Twelve (7%) children required admission to the hospital. More than 12 different purebreeds or cross-breeds were identified as perpetrators, including German shepherds (n = 35), pit bulls (n = 33), rottweilers (n = 9), and Dobermans (n = 7). Most (54%) animals were contained (ie, leashed, fenced, in-house) at the time of injury. Fewer (46%) were provoked prior to biting. Significantly more pit bull injuries (94% vs 43%, P less than .001) were the consequence of unprovoked attacks and involved freely roaming animals (67% vs 41%, P less than .01). Children aged 5 or younger were more likely to provoke animals prior to injury than were older children (69% vs 36%, P less than .001). It is recommended that families with young children be the target of pet safety education and that measures be sought that would lead to early identification of a potentially dangerous dog and restrict ownership.
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Dog bites cause an estimated 585,000 injuries resulting in the need for medical attention yearly and children are the most frequent victims. This study sought to determine dog-specific factors independently associated with a dog biting a nonhousehold member. A matched case-control design comprising 178 pairs of dogs was used. Cases were selected from dogs reported to Denver Animal Control in 1991 for a first-bite episode of a nonhousehold member in which the victim received medical treatment. Controls were neighborhood-matched dogs with no history of biting a nonhousehold member, selected by modified random-digit dialing based on the first five digits of the case dog owner's phone number. Case and control dog owners were interviewed by telephone. Children aged 12 years and younger were the victims in 51% of cases. Compared with controls, biting dogs were more likely to be German Shepherd (adjusted odds ratio (ORa) = 16.4, 95% confidence interval (CI) 3.8 to 71.4) or Chow Chow (ORa = 4.0, 95% CI 1.2 to 13.7) predominant breeds, male (ORa = 6.2, 95% CI 2.5 to 15.1), unneutered (ORa = 2.6, 95% CI 1.1 to 6.3), residing in a house with > or = 1 children (ORa = 3.5, 95% CI 1.6 to 7.5), and chained while in the yard (ORa = 2.8, 95% CI 1.0 to 8.1). Pediatricians should advise parents that failure to neuter a dog and selection of male dogs and certain breeds such as German Shepherd and Chow Chow may increase the risk of their dog biting a nonhousehold member, who often may be a child. The potential preventability of this frequent public health problem deserves further attention.
Article
Context.— Dog bites that result in injuries occur frequently, but how frequently dog bite injuries necessitate medical attention at a hospital or hospital admission is unknown.Objective.— To describe the incidence and characteristics of dog bite injuries treated in US emergency departments (EDs).Design.— Emergency department survey from the National Center for Health Statistics National Hospital Ambulatory Medical Care Survey for 1992 to 1994.Patients.— National probability sample of patients visiting EDs.Main Outcome Measure.— Incidence of dog bites treated in EDs, defined as a cause of injury recorded as the E-code E906.0.Results.— The 3-year annualized, adjusted, and weighted estimate of new dog bite–related injury visits to US EDs was 333687, a rate of 12.9 per 10000 persons (95% confidence interval [CI], 10.5-15.4). This represents approximately 914 new dog bite injuries requiring ED visits per day. The median age of patients bitten was 15 years, with children, especially boys aged 5 to 9 years, having the highest incidence rate (60.7 per 10000 persons for boys aged 5 to 9 years). Children seen in EDs were more likely than older persons to be bitten on the face, neck, and head (73% vs 30%). We estimated that for each US dog bite fatality there are about 670 hospitalizations and 16000 ED visits.Conclusions.— Dog bite injuries are an important source of injury in the US population, especially among children. Improved surveillance and prevention of dog bite–related injuries, particularly among children, are needed.
Article
German shepherds are the most popular registered breed of dog in South Australia, but are also the most hazardous to children, biting more often and more severely. A study of the victims of dog bites presenting to the Emergency Department of the Adelaide Children's Hospital over an 18 month period revealed that, although many breeds were involved, only German shepherds were implicated more frequently than their prevalence in the community. Attacks occurred most often in a domestic setting involving a friendly dog that was known to the victim. Boys were more often bitten than girls and children aged 1-6 years most commonly involved. Injuries to the face and scalp were frequent and the usual ones to require admission for suture under general anaesthetic. Some scarring was a common sequel and resulting fear of dogs remained with some children. Most attacks were reported to be unprovoked and a previous biting history on the part of the dog was uncommon. Parents who are contemplating obtaining a dog for a family pet should be made aware of these facts and advised regarding the biting hazards and possible prevention. The German shepherd situation especially should be brought to their attention.
Article
In 1981, more than 3,200 Pennsylvania children, ages 4 to 18 years, were surveyed about their dog bite histories and attitudes toward animals. Dog bites were much more common than previously reported: 45 percent of children had been bitten during their lifetimes, and 15.5 percent had been bitten in 1980, more than 36 times the rate reported to health authorities. In 1980, the highest bite rate occurred among children 7-12 years old (20 percent). Children were bitten more frequently by the dogs owned by their neighbors, followed by their own dogs, than by strays or by dogs whose owners were not known. Boys were bitten twice as frequently as girls by neighbors' dogs and strays; the bite rates from family dogs were identical in boys and girls. Despite the high bite rates, being bitten was not significantly associated, in most groups of children studied, with a dislike of dogs. These positive attitudes toward dogs may lead to inadequate precautions against bites and to biases in the reporting of bites to health authorities.
Article
We evaluated children less than 16 years of age who had dog bite injuries that resulted in hospitalization or death to determine the typical characteristics of the children, the dogs, and the injuries suffered. Retrospective chart review. Three large city hospitals including Harborview Medical Center, Seattle, Washington; Children's Mercy Hospital, Kansas City, Missouri; and Mary Bridge Hospital, Tacoma, Washington. Charts were reviewed for patient demographic data and canine data. Hospitalization data included total length of stay, need for intensive care, Injury Severity Score, the nature and extent of the injuries, procedures performed, complications, and outcome. Forty cases were reviewed. Most children were boys (60%) and were white (87%). The median age was 50 months. There were three deaths. Most dogs were medium-sized or large breeds and were familiar to the victim. The average hospital stay was 6 days (SD = 5), and 12 (30%) patients required a stay in the intensive care unit. Injuries to the face, head, and neck area were most common (82%). Major surgical procedures included craniotomy, exploration of the neck or abdomen, ocular procedures, and repair of fractures. Severe dog bites in children occur most frequently in those younger than 5 years old and involve the head and neck. Large dogs that are familiar to the child are usually involved. Young children should be closely supervised when around any dog.
Article
Incidents with dogs present a public problem. In order to specify this, all recorded cases of dog bites in the city of Munich from 1986-1991 (n = 284) were registered. The range of injury of men and animal, the influence of breed, age and sex of the dog on the incident, the behaviour of the owner in the situation and the location were inquired. 207 people have been lightly wounded. 136 dogs have been injured. The most incidents occurred with German Shepherds, mixed breeds of German Shepherds, Boxers, Rottweilers, Doberman Pinschers, Great Danes and Bull terriers. Almost one third of the dogs have been involved in cases of recurrence. There has been a distinct influence of the owner on the behaviour of the dogs. The reaction of the owner has got significant influence of the kind, frequency and seriousness of the accident. The spectrum reaches from passive watching of the incidence to encouraging the dog to bite. Most owners did not absolve any kind of educational program with their dog. More than 50% of the dog owners were judged incompetent to lead their dog in an expert opinion and two third of the owners considered themselves unsuitable to lead a dog. Almost 90% of the dogs have not been on a leash. Most of the incidents took place in public places and only 9% happened in parks. A catalogue of possible measures to avoid such incidents will be presented.
Article
IT'S TIME to take some teeth out of a largely unrecognized yet preventable public health problem. Every year in the United States, almost 2% of the population is bitten by a dog. The Centers for Disease Control and Prevention (CDC) in Atlanta, Ga, estimates that of those 4.5 million bites, almost 800 000 are serious enough to require medical attention. In extreme cases, about 18 people die from dog bites every year (Pediatrics. 1996;97:891-895 and Injury Prev. 1996;2:52-54). In many instances, the bite is the result of a pet owner not fully understanding the responsibility involved in owning a dog. Some dog owners disregard leash laws; others may not think twice before leaving infants or young children alone with a dog. Sometimes, parents allow their children to freely approach an unfamiliar dog on the street. "We have to educate dog owners on their responsibilities," says Westwood, Kan, consultant Wayne Hunthausen
Article
To examine the impact of dog attacks by determining the incidence and risk factors for dog attacks. Injury surveillance data on dog attacks for a major metropolitan hospital were converted to incidence rates using 1991 census figures for the hospital catchment area and combined with data on community attitudes and experiences derived from a large community survey. Queen Elizabeth Hospital (tertiary referral hospital), Adelaide, South Australia, January 1990 to July 1993. 356 victims of dog attacks who presented to the emergency department and 3093 respondents to the 1992 South Australian Health Omnibus Survey. Rates of dog attack by age and sex of the victim, hospital presentation and admission; differences in the representation of various dog breeds in attacks. About 6500 people are injured in Adelaide each year as a result of dog attacks and about 810 seek hospital treatment (7.3 per 10,000 people per year). Children aged 0-4 years were attacked and required hospital treatment twice as often as adults aged 21-59 years, and men aged over 76 years twice as often as men aged 36-75 years. Males were more at risk of attack than females for all age groups. Hospital admission rates were five times higher for the elderly (95% confidence interval [CI], 2.3%-10.2%) and seven times higher for children 12 years and under (95% CI, 3.4%-15.1%) compared with people aged 13-59 years; 90% of children were admitted because of head and facial bites. The risk of attack from german shepherds, bull terriers, blue/red heelers, dobermans and rottwellers was four to five times higher than for other common breeds. The public health implications of dog attacks are significant and there needs to be increased awareness of the risks to young children. Potential interventions to reduce the incidence of dog attacks vary from strict controls on high-risk breeds to mandatory leashing to a "user pays" liability insurance proposal.