In one of the most comprehensive studies of its kind, a CHOC-led team of researchers concluded that dog bites continue to be prevalent in the pediatric population, with children ages 1 to 5 most at risk and pit bulls likely to inflict the most severe injuries, while German shepherds are responsible for the highest number of injuries.
The study, a collaboration between CHOC’s trauma and plastic surgery departments, as well as researchers from other institutions, looked at nearly 1,000 CHOC patients who were identified as victims of a dog bite from 2013 to 2018.
While many studies have identified trends in pediatric dog-bite injuries and interventions, this study is one of the first to stratify injury severity based on the type of surgical treatment required, said Dr. Raj Vyas, chief of plastic surgery at CHOC and co-author.
“This study is a nice indicator of who might need surgery after suffering a dog bite, and that’s important because often when parents come to the ER, they want a plastic surgeon to treat their child’s wounds, but that only needs to be done less than 20 percent of the time,” Dr. Vyas said.
Indeed, the study, published in November 2021 in the Western Journal of Emergency Medicine, found that repair by a surgical specialist was required only 17.1 percent of the time.
A child’s head and neck are most vulnerable
Most bites – 61.7% – were inflicted on the head and neck, followed by 20.6% on the hands or arms, and 13% on the feet or legs, the study found.
In other key conclusions, children are bitten most frequently by a dog living in their home (33.4%), and the relative risk of a pediatric patient being bitten in a low-income area was 2.24-fold greater than the baseline risk of being bitten in the county.
In contrast, the relative risk of a pediatric patient being bitten in a high-income area was 0.46.
Researchers called this disparity “significant” and said the combination of inadequate resources for child supervision and large-breed dogs without robust training may account for the increased incidence of pediatric dog-bite injury in low-income households.
Practical applications
Dr. Ted Heyming, chair of emergency medicine at CHOC and co-author of the study, said delineating injury patterns in the high-risk pediatric population could lead to more streamlined care and guide future prevention efforts.
“This study can help inform public policy decisions when it comes to dogs that are more prone to bite kids,” Dr. Heyming said.
He added that the study could lead to more in-depth research on the topic.
“Injury prevention work is critical at CHOC,” Dr. Heyming said, “and this study could lead to how CHOC could potentially work more closely with the county to help prevent dog bites.”
Dog bites by breed
Nearly 200 kids came to CHOC each year between 2013-18 to be treated for dog bites.
Among cases where the breed of dog responsible was known, the study found that the dog breed most associated with severe bites was the pit bull (relative risk vs. German shepherd 8.53, relative risk vs. unknown, 3.28).
Researchers found a significant association between breed and the requirement for surgical treatment by a specialist.
The likelihood that the patient had been bitten by a pit bull increased as the level of intervention increased from no repair (6.0%) to repair in the operating room (25.8%).
Pit bull bites were found to be significantly larger, deeper, and/or more complex than the average dog bites included in the study.
Many studies have reported similar results of pit bull-related aggression, and the breed has been considered a public health risk, with several countries and U.S. cities having introduced breed-specific bans.
But the researchers said rather than breed-specific laws, efforts to decrease the frequency of pediatric dog-bite injury should focus on identifying the precipitating factors.
“Clinicians should be educated to include as part of their history questions about whether the dog was partitioned from the child,” the report said, “in addition to questions about the age, gender, breed and level of training of the dog.”
Study participants
An interdisciplinary team worked on the study.
“Support for this study largely came from our chief scientific officer at CHOC,” noted Dr. Vyas, referring to Dr. Terence Sanger.
Elizabeth Wallace, MPH, a clinical research coordinator in CHOC Research Institute, was a key leader of the study, Dr. Yvas said.
John Schomberg, PhD, a biostatistician in the department of nursing, was instrumental in data collection and analysis, Dr. Vyas added.
Others who participated in the peer-reviewed study were Dr. Yigit Guner, a pediatric surgeon at CHOC; UC Riverside School of Medicine students Sawyer Schuljak and Jonathan Phan; and UC Irvine Department of Plastic Surgery medical student Ekaterina Tiourin.
Why youngsters get bit
Because of mandates during the COVID-19 pandemic that had kids spending more time at home, the number of dog bite injuries is expected to surge when the years 2000-2022 and beyond are looked at, according to the study, “Surgical Treatment of Pediatric Dog-bite Wounds: A 5-year Retrospective Review.”
The risk for dog bites decreases as age increases, said the study, which comes on the heels of another Orange County study on dog bites in the adult population.
“Dogs may perceive the behavior of young children as threatening,” the researchers noted in their report. “Infants, toddlers, and preschool children are less cautious, tend to explore their environments with their hands and mouths, and exhibit unpredictable behaviors, such as suddenly kissing, biting, grabbing, and climbing upon a dog.”
Because of its proximity to the floor, the head and neck region of a child is particularly susceptible to dog-bite injury, the study concluded. In adults, the extremities are most susceptible.
“What I’ve seen is any dog can impact any kid,” Dr. Vyas said. “The common story every parent says when their kid comes in with a dog bite is, ‘Oh, you know, the dog was minding its own business and the kid was just tormenting the dog; the kid kept hitting it in the face and eventually the poor dog had to react and fight back.’ It’s rarely the dog’s fault.”
Dr. Vyas has a 1-year-old son and another son due soon.
“We’ll think of getting a dog when my kids are older and more in charge,” he said.
Learn about pediatric research and clinical trials at CHOC
