Children Have an Increased Risk of Periorbital Dog Bite Injuries

Management of Soft Tissue Injuries in Children-A Comprehensive Review

Airway injury, Ocular injury and neurovascular tissue damage, burns is all a spectrum of pediatric soft tissue injury complex. Soft tissue injuries to the head and neck area in children are challenging to manage, because these injuries significantly affect the child's overall health and development. Management of such injuries requires a multidisciplinary approach involving surgical and nonsurgical interventions and close collaboration among health care professionals, parents, and caregivers. This article reviews the various causes of injuries, specific considerations for each region of the head and neck, and approaches to the surgical management of soft tissue injuries in pediatric patients, including surgical and adjuvant therapies. Specific anatomic regions reviewed include the scalp/forehead, periorbital region, nose, cheeks, lips, ears, and neck/airway.Laceration repair in the growing pediatric populations may require revisions in the future. Facial soft tissue injuries are prone to poor cosmesis as in many occasions as may be constrained by available surgical specialists, thus proper multispecialty team approach along with surgical alignment and symmetry should be considered comprehensively.

Legal epidemiology of paediatric dog bite injuries

BACKGROUND

Dog bite injuries cause over 100 000 paediatric emergency department visits annually. Our objective was to analyse associations between regional dog ownership laws and incidence of paediatric dog bites.

METHODS

This observational study used an online search to locate local dog-related policies within Ohio cities. Data collected by Ohio Partners For Kids from 2011 through 2020 regarding claims for paediatric dog bite injuries were used to compare areas with and without located policies and the incidence of injury.

RESULTS

Our cohort consisted of 6175 paediatric patients with dog bite injury encounters. A majority were white (79.1%), male (55.0%), 0-5 years old (39.2%) and did not require hospital admission (98.1%). Seventy-nine of 303 cities (26.1%) had city-specific policies related to dogs. Overall, the presence of dog-related policies was associated with lower incidence of dog bite injury claims (p=0.01). Specifically, metropolitan areas and the Central Ohio region had a significantly lower incidence when dog-related policies were present (324.85 per 100 000 children per year when present vs 398.56 when absent; p<0.05; 304.87 per 100 000 children per year when present vs 411.43 when absent; p<0.05).

CONCLUSIONS

The presence of city-specific dog-related policies is associated with lower incidence of paediatric dog bite injury claims, suggesting that local policy impacts this important public health issue. There are limited dog-related policies addressing dog bite prevention, with inconsistencies in breadth and depth. Creating consistent, practical requirements among policies with vigorous enforcement could ameliorate public health concerns from paediatric dog bite injuries.

Are children and dogs best friends? A scoping review to explore the positive and negative effects of child-dog interactions

Personal wellbeing is greatly influenced by our childhood and adolescence, and the relationships formed during those phases of our development. The human-dog bond represents a significant relationship that started thousands of years ago. There is a higher prevalence of dog ownership around the world, especially in households including children. This has resulted in a growing number of researchers studying our interactions with dogs and an expanding evidence base from the exploration of child-dog interactions. We review the potential effects of child-dog interactions on the physical, mental, and social wellbeing of both species. A search of the SCOPUS database identified documents published between January 1980 and April 2022. Filtering for key inclusion criteria, duplicate removals, and inspecting the references of these documents for additional sources, we reviewed a total of 393 documents, 88% of which were scientific articles. We were able to define the numerous ways in which children and dogs interact, be it neutral (e.g., sharing a common area), positive (e.g., petting), or negative (e.g., biting). Then, we found evidence for an association between childhood interaction with dogs and an array of benefits such as increased physical activities, a reduction of stress, and the development of empathy. Nonetheless, several detrimental outcomes have also been identified for both humans and dogs. Children are the most at-risk population regarding dog bites and dog-borne zoonoses, which may lead to injuries/illness, a subsequent fear of dogs, or even death. Moreover, pet bereavement is generally inevitable when living with a canine companion and should not be trivialized. With a canine focus, children sometimes take part in caretaking behaviors toward them, such as feeding or going for walks. These represent opportunities for dogs to relieve themselves outside, but also to exercise and socialize. By contrast, a lack of physical activity can lead to the onset of obesity in both dogs and children. Dogs may present greater levels of stress when in the presence of children. Finally, the welfare of assistance, therapy, and free-roaming dogs who may interact with children remains underexplored. Overall, it appears that the benefits of child-dog interactions outweigh the risks for children but not for dogs; determination of the effects on both species, positive as well as negative, still requires further development. We call for longitudinal studies and cross-cultural research in the future to better understand the impact of child-dog interactions. Our review is important for people in and outside of the scientific community, to pediatricians, veterinarians, and current or future dog owners seeking to extend their knowledge, and to inform future research of scientists studying dogs and human-animal interactions.

COVID-19 pandemic and lockdown increase the frequency and severity of periorbital dog bite injuries in children

Objective

To determine whether the COVID-19 pandemic and lockdown increase the risk of head, neck, and face (HNF) dog bite injuries in children.

Methods

Using a retrospective cohort study design, the investigators enrolled a sample of children presenting with HNF dog bite injuries during 22 weeks before and 22 weeks during the COVID-19 pandemic in a German level 1 trauma center. The predictor variables were COVID-19 pandemic and lockdown. The outcome variables were grouped into demographic, anatomic, injury-related, and therapeutic. Appropriate statistics were computed, and statistical significance was set at P ≤ .05.

Results

The sample included 36 subjects (19.4% girls; 97.2% Caucasians; 50% isolated periorbital injuries; 61.1% during the lockdown; 16.7% after the lockdown) with an average age of 8 ± 3.3 years. Compared to the pre-COVID-19 period, pediatric HNF dog bite injuries increased ca. 5.5- and 1.5-fold during and after the lockdown, respectively. The COVID-19 pandemic was significantly associated with severe household injury from a pet dog, number of inpatients and treatments in the operating room, and prolonged hospitalization. Isolated periorbital injury was common during the COVID-19 pandemic (P = 0.04; relative risk [RR], 4.86; 95% confidence interval [95% CI], 0.76 to 31.12), especially during the lockdown (P = 0.02; RR, 4.36; 95% CI, 0.72 to 26.6).

Conclusion

During the COVID-19 pandemic, especially during the lockdown, there is an increasing tendency of frequency and severity of domestic HNF dog injuries in children, and periorbital region is the most injury-prone.

Pediatric dog bite injuries in the USA: a systematic review

Introduction

Dog bites are one of the leading causes of non-fatal emergency room visits in children. These injuries not only cause physical harm but can lead to long-term psychological stress. This study evaluated the current literature related to pediatric dog bite injuries to identify research gaps which should be prioritized to improve a major public health concern.

Methods

We performed a keyword search of PubMed, Scopus, and OVID Medline databases (January 1980– March 2020) for all published studies focused on dog bite injuries in the pediatric population (≤18 years of age) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results

Out of 1859 abstracts screened, 43 studies involving 86 880 patients were included. Twenty-nine studies were retrospective chart reviews characterizing the epidemiology of dog bites and their associated treatment outcomes; six were prospective cohort studies; two were cross-sectional studies; and six were experimental studies. Synthesized results demonstrate that children <9 years of age suffer the greatest burden of injuries, with children <6 years of age at higher risk of more severe injuries involving the head, neck, and face.

Conclusion

Studies analyzing the prevention or psychosocial consequences of dog bites injuries are needed.

Pediatric patients with dog bites presenting to US children's hospitals

Background

To characterize pediatric dog bite injuries presenting to US children’s hospitals and identify factors associated with clinically significant injuries.

Methods

We performed a multicenter observational study from 26 pediatric hospitals between July 1, 2010, and June 30, 2020, including patients ≤ 18 years with dog bites, consolidating together encounters from patients with multiple encounters within 30 days as a single episode of care. We characterized diagnoses and procedures performed in these patients. We used generalized linear mixed models to identify factors associated with a composite outcome that we term clinically significant injuries (defined as admission, operating room charge, sedation, fractures/dislocations, intracranial/eye injury, skin/soft tissue infection, or in-hospital mortality).

Results

68,833 episodes were included (median age 6.6 years [interquartile range 3.5–10.4 years], 55.5% male) from 67,781 patients. We identified 16,502 patients (24.0%) with clinically significant injuries, including 6653 (9.7%) admitted, 5080 (7.4%) managed in the operating room, 11,685 (17.0%) requiring sedation, 493 (0.7%) with a skull fracture, 32 (0.0%) with a fracture in the neck or trunk, 389 (0.6%) with a fracture of the upper limb, 51 (0.1%) with a fracture in the lower limb, 15 (0.0%) with dislocations, 66 (0.1%) with an intracranial injury and 164 (0.2%) with an injury to the eyeball, 3708 (5.4%) with skin/soft tissue infections, and 5 (0.0%) with in-hospital mortality. In multivariable analysis, younger age (0–4 years, 5–9 years, and 10–14 years relative to 15–18 years), weekday injuries, and an income in the second and third quartiles (relative to the lowest quartile) had higher odds of clinically significant injuries. Black patients (relative to White), Hispanic/Latino ethnicity, and private insurance status (relative to public insurance) had lower odds of clinically important injuries. When evaluating individual components within the composite outcome, most followed broader trends.

Conclusion

Dog bites are an important mechanism of injury encountered in children’s hospitals. Using a composite outcome measure, we identified younger, White, non-Hispanic children at higher risk of clinically significant injuries. Findings with respect to race and ethnicity and dog bite injuries warrant further investigation. Results can be used to identify populations for targeted prevention efforts to reduce severe dog bite injuries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-021-00349-3.

Rabies epidemiology, prevention and control in Nigeria: Scoping progress towards elimination

Background

Human rabies remains a significant public health problem in Africa with outbreaks reported in most countries. In Nigeria–the most populous country in Africa–rabies causes a significant public health burden partly due to perennial obstacles to implementing a national prevention and control program.

Methods

We conducted a scoping review using standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify and select published articles from Nigeria during 1978–2020 reporting on rabies virus infections (human, canine, livestock, and wildlife), canine bites, knowledge, attitudes and practices (KAP) surveys on rabies and canine ecology studies. We extracted information on study location, year and additional details of each study such as rabies prevalence, general characteristics of offending dogs, dog vaccination status and health-seeking behaviours.

Findings

Between 1978 and 2020, 90 published articles met our inclusion criteria. The prevalence of rabies virus antigen detection varied between 3% and 28%, with more studies in the north. Most bites were unprovoked from dog bite studies (36.4%-97%), by dogs with low vaccination rates (12–38%). A more significant proportion of biting dogs were owned (31–90%). Laboratory confirmation for biting was available for only a small proportion of studies (6%; n = 2/32). Of the dogs surveyed during ecology studies, indigenous dogs accounted for the majority (62–98%), used mostly for security purposes (52–98%), with the vaccination rate between 15% and 38% in most states. Studies conducted in areas distant from rabies diagnostic facilities accounted for more human rabies cases and fewer dog rabies cases.

Conclusion

Significant improvements are necessary to achieve the elimination of human rabies mediated via dogs by 2030.

Rabies remains one of the deadliest zoonoses known to humanity since antiquity, resulting in tens of thousands of human deaths each year, mostly in African and Asian countries. Mass dog vaccination, enhanced surveillance, improved access to Pre-exposure prophylaxis(PrE) and (Post-exposure prophylaxis(PEP) to at-risk groups, enforcement of responsible dog ownership and public education are keystones to rabies prevention and control. Since the first reported case in Nigeria during 1912, rabies has continued to take its toll on human and animal lives. However, gross underreporting due to a frail health care infrastructure, deficient reporting systems, and misdiagnosis with neurological diseases further complicated by socio-cultural practices have resulted in a lack of empirical data to support rabies prioritization, per the global target of 2030. We used the standard PRISMA guidelines to select Nigerian rabies studies between 1978 and 2020. Rabies risk, coupled with welfare concerns identified in this study, demonstrates the need for continued advocacy towards legislation prohibiting the dog trade in Nigeria and elsewhere. The high-risk community groups identified in this review (i.e., children, butchers, and adult males) need to be educated on response to dog bite exposure to reduce the impact of this invariable fatal but preventable disease. Moreover, there is a need for mandatory dog vaccination and implementation of a national rabies program to attain the World Health Organization (WHO) recommended vaccination coverage of at least 70%. We unravel the need to establish rabies diagnostic centres in the country’s six geopolitical zones. Local inclusion of dog bite occurrence by Disease Surveillance and Notification Officers (DSNOs), with related community surveillance tools, can help in rabies/dog surveillance. In addition, there is a need for investment into pathogen discovery by enhancing laboratory-based surveillance for wildlife rabies, understanding its potential role in Nigeria and the need for quantitative research to understand the various risk factors for disease perpetuation.

Consequences of COVID-19 Lockdown on Children and Their Pets: Dangerous Increase of Dog Bites among the Paediatric Population

Background: The SARS-CoV-2 pandemic has not only put our national health systems to the test, but it also notably hit the economy, the society and the psychology of the people. Our pets have been subjected to the pandemic related stress too. The aim of the study was to evaluate whether the stress induced on domestic dogs resulted in an increase of dog bites in the paediatric population. Methods: A retrospective study was conducted on all patients admitted to our paediatric emergency department for dog bite from January 2014 and December 2020. We compared the total mean dog bites of the years 2014–2019 and the mean number per single month with the respective 2020 data. The bites were divided between bites from family dogs and bites from stranger dogs. Continuous data were analysed using single sample t test while categorical values with chi-squared test, considering statistically significant a p value < 0.05. Results: From January 2014 to December 2019, we recorded a mean of 41 ± 5.9 dog bites (range: 30–46) of which a mean 13 ± 2.6 (range: 10–17) were due to family dogs (32%) and a mean of 28 ± 2.4 (range: 25–31) were due to stranger dogs (68%); the male-to-female ratio was 3:2 and 43% of the injuries concerned the head and face, 26% the lower limbs, 25% the upper limbs, 3% the genitalia and 3% the torso. From January 2020 to December 2020, 30 children were admitted for dog bites: 22 were from family dogs (73%) and 8 from stranger dogs (27%); the male-to-female ratio was 14:11 and 72% of the injuries concerned the head and face, 16% the upper limbs, 8% the lower limbs and 4% the torso. The 2020 data’s higher number of family dog bites compared with the mean of those in the 2014–2019 period was statistically significant (p < 0.01) such as the 2020 data’s lower number of stranger dog bites when compared with the mean number of stranger dog bites in the 2014–2019 period (p < 0.01). Between 2014 and 2019, a mean of 9 ± 2 (range: 6–12) of the wounds needed to be sutured (22%), while 32 ± 3 (range: 28–35) wounds were discharged after application of Steri Strips (78%). On the other hand, in 2020, 21 wounds needed to be sutured (70%), and 9 received just Steri Strips application (41%). The frequency distribution of the treatments required (stitches vs. Steri Strips) between the 2014 to 2019 period and the 2020 period was statistically significant (p < 0.0001). Conclusions: The number of family dog bites in children increased in 2020, especially during the lockdown period. Paediatricians should pay a lot of attention now more than ever to educate parents on the importance of always supervising children who are playing with dogs.

Consequences of COVID-19 Lockdown on Children and Their Pets: Dangerous Increase of Dog Bites among the Paediatric Population

BACKGROUND

The SARS-CoV-2 pandemic has not only put our national health systems to the test, but it also notably hit the economy, the society and the psychology of the people. Our pets have been subjected to the pandemic related stress too. The aim of the study was to evaluate whether the stress induced on domestic dogs resulted in an increase of dog bites in the paediatric population.

METHODS

A retrospective study was conducted on all patients admitted to our paediatric emergency department for dog bite from January 2014 and December 2020. We compared the total mean dog bites of the years 2014-2019 and the mean number per single month with the respective 2020 data. The bites were divided between bites from family dogs and bites from stranger dogs. Continuous data were analysed using single sample t test while categorical values with chi-squared test, considering statistically significant a p value < 0.05.

RESULTS

From January 2014 to December 2019, we recorded a mean of 41 ± 5.9 dog bites (range: 30-46) of which a mean 13 ± 2.6 (range: 10-17) were due to family dogs (32%) and a mean of 28 ± 2.4 (range: 25-31) were due to stranger dogs (68%); the male-to-female ratio was 3:2 and 43% of the injuries concerned the head and face, 26% the lower limbs, 25% the upper limbs, 3% the genitalia and 3% the torso. From January 2020 to December 2020, 30 children were admitted for dog bites: 22 were from family dogs (73%) and 8 from stranger dogs (27%); the male-to-female ratio was 14:11 and 72% of the injuries concerned the head and face, 16% the upper limbs, 8% the lower limbs and 4% the torso. The 2020 data's higher number of family dog bites compared with the mean of those in the 2014-2019 period was statistically significant (p < 0.01) such as the 2020 data's lower number of stranger dog bites when compared with the mean number of stranger dog bites in the 2014-2019 period (p < 0.01). Between 2014 and 2019, a mean of 9 ± 2 (range: 6-12) of the wounds needed to be sutured (22%), while 32 ± 3 (range: 28-35) wounds were discharged after application of Steri Strips (78%). On the other hand, in 2020, 21 wounds needed to be sutured (70%), and 9 received just Steri Strips application (41%). The frequency distribution of the treatments required (stitches vs. Steri Strips) between the 2014 to 2019 period and the 2020 period was statistically significant (p < 0.0001).

CONCLUSIONS

The number of family dog bites in children increased in 2020, especially during the lockdown period. Paediatricians should pay a lot of attention now more than ever to educate parents on the importance of always supervising children who are playing with dogs.

Expectations versus Reality: Long-Term Research on the Dog-Owner Relationship

Simple Summary

People who plan to own a dog have expectations about what this experience will be like and are initially in the motivational phase of dog-ownership. Their expectations about taking care of a dog and the benefits of this relationship determine if they will acquire a dog. Once they have acquired a dog, their expectations are tested against reality; they are then in the experience phase of dog-ownership. In this phase, the owner’s relationship with their dog develops, which may be pleasant and satisfying. However, when problems appear, the owner may experience dissatisfaction with their dog. In this study, 183 people who were planning to acquire a dog answered questions before and after acquisition of their dog. How their expectations and beliefs changed over time depended on whether the participants had experience with dogs (owning a dog presently, in the past, or never). In the first six months of ownership, especially for people with no prior experience with dogs, the owners had to adapt their expectations and beliefs. In the subsequent year, only a few differences based on dog ownership history were found. To conclude, the perceptions of dog ownership do change over time, but after testing such perceptions with reality, the perceptions become stable after six months.

Abstract

In the framework of the early prevention of problems in the owner–dog relationship, it is important to have a broad perspective on the development of this relationship over time, starting before people actually acquire a dog. People who currently (or previously) own(ed) a dog can rely on their experiences when considering a new dog, while this knowledge is unavailable to first time dog-owners. In this study, we explore how self-efficacy, social comparison, perceptions about the (dis)advantages of ownership and commitment to the dog (so-called social cognitive factors), problematic canine behaviors, perceived costs, and satisfaction with the dog change over time. We examine changes from the motivational phase of relationship development (before acquisition of the dog) into the experience phase (six and twelve months after acquisition of the dog). We explore if patterns are different in experienced (previous (n = 73) and current (n = 80)) versus unexperienced (first time (n = 30) dog owners. The respondents filled in three online questionnaires—once before and twice after acquisition of their dog. From T0 (before acquisition of the dog) to T1 (having the dog for six months) participants (especially those with no ownership experience) had to adjust their perceptions about dogs and dog ownership. Experiencing the relationship for an additional year (from T1 to T2) barely changed the social cognitive factors, satisfaction, and perceived costs. A small decline in problematic canine behaviors was present among the experienced dog owners between T1 and T2. To conclude, perceptions about dogs and dog ownership change over time, but after testing these perceptions with reality, they become stable after about six months.