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.