Complex Dog Bites in Children – Experience and Recommended Treatment

Dog bites are a common and potentially severe injury in children. Plastic surgeons at a pediatric trauma center outline their recommended approach to appropriate treatment and surgery for children with complex dog bites in Plastic and Reconstructive Surgery—Global Open®, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).

"Children with large dog bite injuries require more immediate care in a Level I pediatric trauma hospital in order to optimize their hospitalization course and eventual outcome," according to the report by ASPS Member Surgeon Kaveh Alizadeh, MD, and colleagues of New York Medical College in Valhalla, NY. Their experience highlights some important characteristics of complex dog bites in children, including the finding that pit bulls are the breed most commonly involved, particularly in more severe injuries.

Characteristics and Treatment Approach for Dog Bites in Children

The study included 108 children with complex dog bites seen at the authors' Level 1 Pediatric Trauma Center during 2012-14. The patients were 61 boys and 47 girls, aged 5 months to 18 years; most were in the preschool to grade school age range. Nearly 60 percent of children had injuries to the head and neck, while about 30 percent had injuries to the arm, hand or leg or foot.

Treatment included wound closure in the emergency room in about 39 percent of children; in most of these causes, consultation with plastic surgeons and other specialists was needed. Another 21 percent of patients required surgery in the operating room, sometimes with skin flaps or other reconstructive procedures.

About 27 percent of children were admitted to the hospital after initial treatment. Nine patients required extended hospitalization of four days or longer, most commonly because of infection.

Information on the breed of the biting dog was available in 56 cases. Pit bulls were the most common breed, accounting for 48 percent of injuries. Other common breeds included German shepherds, huskies and small terriers.

Surgery was required in about half of injuries caused by pit bulls, three times higher than the rate for other breeds. Of the nine children who required extended hospitalization, six were bitten by pit bulls.

"The penetrating and crushing nature of these bites can lead to lifelong deformities," Dr. Alizadeh said.

Based on their experience, the researchers outline a set of guidelines for treatment of complex dog bites in children. They divide the injuries into four groups, with treatment guided by the severity of injury. In the two most severe categories (complex lacerations or complete tissue loss), hospital admission and surgery are recommended.

Dr. Alizadeh notes some limitations of their study, including the lack of information on dog breed in about half of cases. They also note that their trauma center likely sees more patients with complex injuries caused by larger biting dogs.

In addition to potentially severe injuries requiring medical attention, the authors point out that children are at risk of psychological and emotional aftereffects of dog bites. Dr. Alizadeh said, "It is of utmost importance to seek care at medical centers that have available trauma, surgery and psychological support services."

Plastic and Reconstructive Surgery—Global Open® is published by Wolters Kluwer.