Got a pandemic puppy? Learn how to prevent dog bites

The surge in pet adoptions during the pandemic brought much-needed joy to many families, but doctors are worrying about a downside as well: more dog bites.

A commentary published in October in The Journal of Pediatrics noted an almost threefold increase in children with dog bites coming into the pediatric emergency room at Children’s Hospital Colorado after the stay-at-home order went into effect.

The lead author, Dr Cinnamon Dixon, a medical officer in the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development said: “If someone were to tell me they were going to get a new dog during Covid, I would first and foremost want to make sure that family is prepared to have a new entity in their household, a new family member.”

Dixon said that as a pediatric emergency room doctor, taking care of children who get bitten had been a priority for her. Still, she said, from the stories she heard, she often felt “that dogs are victims in this as well.”

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Brooke Goff, a partner in the personal-injury law firm the Goff Law Group in Hartford, Connecticut, said, “We’re definitely seeing a huge uptick in dog bite cases.”

Goff said that dog bites harm children in ways that go well beyond the physical damage. “It creates major emotional issues and PTSD,” she said. “If you’ve ever spoken to a dog bite victim as an adult that was bitten as a child, they are deathly afraid of dogs.”

Dog bites are “an underrepresented public health problem” in the United States, said Dixon, the daughter of a veterinarian who grew up around animals. The Centers for Disease Control and Prevention’s best estimates from old research put the number of dog bites at 4.5 million a year. There are more than 300,000 nonfatal emergency department visits a year related to dog bites, and among children, the greatest incidence is in school age children, ages 5-9, but the most severe injuries are among infants and young children, presumably because they are less mobile, and lower to the ground, with their heads and faces closer to the dogs.

Dr Robert McLoughlin, a general surgery resident at the University of Massachusetts Medical School in Worcester, was the first author on a 2020 study of hospitalizations for pediatric dog bite injuries in the United States. He said that his research grew out of an interest in pediatric surgery and pediatric injury prevention. “I had seen a lot of cases of toddlers with head and neck injuries,” he said.

The study showed that younger children, ages 1-4 and 5-10, were much more likely to need hospitalisation than those over 11. In the youngest children, most injuries are to the head and neck, and beyond the age of 6, extremity wounds (arms, legs, hands) become increasingly prevalent and predominant after the age of 11, McLoughlin said.

The bites that require hospitalization and surgical repair are the most serious injuries, such as toddlers bitten in the face and neck, where many critical structures can be damaged, including eyes and ears, and there can be devastating cosmetic damage done as well. But hand injuries can also have a very lasting impact and need expert repair.

For dog bite prevention, Dixon said, “The No. 1 strategy remains supervision.” Children should learn to leave dogs alone when they are eating, when they are sleeping with a favourite toy and when they are caring for their puppies. They should not reach out to unfamiliar dogs. And dog owners should keep their dogs healthy and should socialize and train them from an early age.

“It’s important we take responsibility for our animals,” said Goff, who has a dog named Daisy that she brings with her to the office. “Most dogs don’t bite to attack, they bite because they’re scared or provoked.”

Goff also emphasised that from the point of view of liability, anyone who owns a dog should have insurance coverage. In her state, Connecticut, a strict liability state, “I don’t have to prove anybody was at fault,” she said, and the dog owner is responsible for the damages. “If you can afford the dog, you can afford the insurance,” she said.

She said that it’s important as well that dog bites be reported because of the need to track dogs who bite multiple times, but reassured those who were worried that a dog might be destroyed that, at least in Connecticut, unless there is a catastrophic or fatal injury, “our forgiveness about animals extends quite heavily.”

When dogs do show aggressive behaviour, Dixon said, owners should seek expert help from a veterinarian or “a behavioural expert in canine aggression — ideally before something bad happens.”

Dr Judy Schaechter, a professor of paediatrics and public health at the University of Miami, said that given the increase in puppy buying during the Covid epidemic, “We’re now a year into this; puppies may be big, strong dogs at this point.” And with many parents juggling work from home with their children’s school issues, it can be difficult for them to supervise all the children (and pets) all the time.

Bites often occur, Schaechter said, “around playing and feeding behaviours.” Small children are particularly at risk, in part because they may be close to the dog’s food dish, or on the ground when food falls, and the dog may see the child as competition. “Any dog can bite, any breed can bite, and that can be horrific,” she said, but a medium or large dog, or a dog with a very strong jaw, “can quickly do a lot more damage.”

When Dixon saw children who had been bitten in the emergency room, “the most common story I would hear over and over,” she said, involved “resource guarding,” in which the child seemed to be encroaching on something that belonged to the dog. “The child was next to the dog’s food or had gone next to a dog’s toy or was playing with the dog and the dog jumped up and grabbed the arm instead of the bone,” she said.

McLoughlin sees opportunities for programs to address dog bite prevention, perhaps drawing lessons from programs that discuss “stranger danger.” It’s important to teach children not to approach strange dogs, he said, but also to help them interpret dogs’ behaviour, “to identify when a dog is saying leave me alone, give me some space.” He is interested in the possibility of taking dogs into schools in order to educate children about dogs they may encounter outside their homes, but emphasized that parents should be teaching even very young children about how to approach a dog — including that they should always ask the owner first.

Schaechter pointed to research on the benefits of having a dog in the family, from the joys of companionship and the lessons children learn from caring for a pet to the medical evidence that children may be at lower risk of allergy and asthma if they are exposed early to animals. The bond between children and their pets is the substance of so many books and movies, Schaechter said. “It’s real — but don’t let that be so romantic that a child ends up being hurt or scarred.”