snarling dog

By Edward P. Buchanan, MD

It is estimated that over 4 million people are bitten by dogs yearly (1). Nearly 800,000 of these injuries require hospital visits, and close to one half of these patients are children

Although most people are treated in the emergency department and sent home, there are a few unfortunate people who require inpatient hospital stays and reconstructive surgery. The majority of these patients are children. The tragedy is that these injuries can be prevented with proper education.

Why Do Dogs Bite?

Dogs can bite for a number of reasons. This is important for pet owners to understand prior to introducing a dog into an environment with young children. Dogs are considered pack animals and much of their behavior is based on these instincts.

Because of their size relative to young children, they may consider themselves superior. They may try to exert this instinct by displaying protective behavior toward a territory, possession, or person.

Children, younger ones under the age of five in particular, oftentimes do not understand the concept of boundaries when it comes to animals or humans. This becomes most evident when it relates to dogs that are familiar to the child, such as household dogs or dogs belonging to close friends. The combination of an overprotective dog and a child who does not understand boundaries can lead to a big problem.

The vast majority of dog bites that occur in children are from dogs that are familiar with the child (34). Therefore, a dog may bite if it is provoked by a child who, for example, pulls its tail, fur, or ears.

If a child gets too close to a dog and startles it, the dog may attack. Dogs can bite for less common reasons, such as being sick or injured. If a dog views a child as prey because he or she is running, this may also provoke an attack.

Most injuries that occur to children involve their head, neck and facial regions (4). This is most likely due to the proximity of a child’s face to a dog’s mouth. These are the types of injuries that will require extensive surgery and possibly future reconstructive procedures.

Preventing an Attack

The positive role dogs play in a child’s life are not always appreciated. Furthermore, the powerful influence they have within the family dynamic is irreplaceable. To ensure these strong bonds, keeping your family and dog safe is paramount. This can be accomplished by educating pet owners about high-risk scenarios that should be avoided.

One of the most important factors to consider when it comes to dogs and children interacting is the age of the child. Children younger than about four or five have a hard time understanding certain guidelines when it comes to animals.

Some groups suggest to avoid bringing a dog into the family setting until children are at least school age. This will give children the time to understand the importance of respecting the dog’s space.

If a dog is introduced before this time, either by the family or family friends, the pet owner and parents need to be more vigilant when it comes to the interactions that may occur. The pet owner and the parents are responsible at this point, since neither the child nor the animal can fully control the situation.

Children that are school age can be taught proper techniques to avoid a negative interaction with dogs. Some of these include:

  • Avoid approaching unfamiliar dogs
  • Never scream at or run from a dog
  • Never play with a dog without adult supervision
  • Do not disturb a dog that is eating, sleeping or tending to puppies
  • If a dog approachs, do not run away
  • Always let a dog sniff you before petting it

After a Bite

If an adult or child is bitten, it is important to seek treatment by professionals who are skilled with these types of injuries. The vast majority of dog bites usually don’t need to be seen by a medical professional, especially if there was no skin disruption. If, however, the skin was punctured, caregivers should seek medical attention, since dogs have bacteria that live in their mouths that will enter the wounds.

These bacteria can lead to infections days after the injury. If these are untreated, these infections can spread to other parts of the body. Most dog bites that result in skin damage should at least be seen in the emergency room, so they can be cleaned and a short course of antibiotics started.

Dog bites can cause both physical and emotional damage. Seeking treatment by professionals who are comfortable with these specific problems is highly recommended.


The physical damage that can result from dog bites can range from minor to severe. Minor injuries usually require a brief visit to the doctor with instructions regarding wound care. Doctors recommend follow up for scar therapy if the injury is on a sensitive area of the body.

More severe injuries usually involve the head, neck and face. These injuries may require repair in the emergency room or even in the operating room, if they are very complicated. Furthermore, injuries to the face can involve underlying structures, such as nerves, muscles and bones. If these are affected, longer follow up is necessary to ensure proper functioning when the skin heals.

Reconstructive operations to repair nerves, muscles and bones may be needed immediately or in a delayed fashion if the injuries are very severe. If a child has sustained a significant dog bite, it will be important for that child to be treated at a major pediatric center, so that all of their reconstructive needs can be addressed.


The emotional damage caused by dog bites has been well-documented and can last a lifetime (56). Many times the impressions made during these episodes will affect the way people think about dogs for the rest of their lives.

It is important for these victims to understand and control their feelings after an attack. Dogs can be a positive addition to an individual’s life or to the family dynamic. Living in fear of dogs after a tragic event will prevent these important bonds from ever being formed. All dog bite patients should be evaluated for emotional trauma so that they can cope with these unfortunate accidents.

Edward P. Buchanan, MD, is a pediatric plastic and reconstructive surgeon at Texas Children’s Hospital and Assistant Professor at Baylor College of Medicine’s Division of Plastic Surgery in Houston, Texas.

Is your child fearful of dogs? Tell us why in the comments below.


  1. Dog­bite­related fatalities—United States, 1995–1996.. MMWR Morb Mortal Wkly Rep. 1997;46:463–7
  2. Weiss, HB, Freidman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. 1998;279:51-53.
  3. Kahn A, Bauche P, Lamoureux J. Dog Bites Research Team. Child victim of dog bites treated in emergency deopartments: a prospective study. Eur J Pediatr. 2003; 162: 254-258
  4. Brogan TV, Bratton SL, Dowd MD, Hegenbarth MA. Severe dog bites in children. Pediatrics. 1995; 96: 947-950
  5. Gandi RR, Liebman MA, Stafford BL, Stafford PW. Dog bite injuries in children: a preliminary study. AM SUrg. 1999:65: 863-864.
  6. Presutti RJ. Prvention and treatment of dog bites. Am Fam Physician. 2001; 63:1567-1572

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