[Dog bites in children]

Education of children and adolescents for the prevention of dog bite injuries

BACKGROUND

Dog bites can have dramatic consequences for children and adolescents. Educating young people on how to interact with dogs could contribute to reducing dog bite injuries.

OBJECTIVES

To determine the effectiveness of educational interventions that target children and adolescents in reducing dog bite injuries and their consequences.

SEARCH STRATEGY

We searched the following databases: The Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library Issue 3, 2008), CAB Abstracts, Zetoc, SIGLE, MEDLINE, EMBASE, ERIC, PsycInfo, SPECTR, CINAHL, National Research Register, LILACs, African Healthline, Science Citation Index, Social Science Citation Index, CurrentClinicalTrials.Gov, Centrewatch, Controlledtrials.com, Vetgate and the WHO database. We checked the bibliographies of relevant reviews and trials and also contacted experts in the field. The searches were carried out to 18 July 2008.

SELECTION CRITERIA

We included randomised controlled trials and controlled before-after studies that evaluated the effectiveness of educational interventions, in populations under 20 years old, for preventing dog bites.

DATA COLLECTION AND ANALYSIS

Two review authors selected eligible studies based on information from the title and abstract. Two review authors decided on the inclusion of eligible trials and extracted data from the trial reports. We contacted authors of eligible studies to obtain more information.

MAIN RESULTS

Two studies met the inclusion criteria. No study looked at our main outcome: dog bite rates. The included studies were randomised controlled trials conducted in kindergarten and primary schools. Their methodology was of moderate quality. One study showed that the intervention group showed less 'inappropriate behaviour' when observed in the presence of a dog after a 30-minute educational intervention. Another study showed an increase in knowledge and in caution after an information programme.

AUTHORS' CONCLUSIONS

There is no direct evidence that educational programmes can reduce dog bite rates in children and adolescents. Educating children who are less than 10 years old in school settings could improve their knowledge, attitude and behaviour towards dogs. Educating children and adolescents in settings other than schools should also be evaluated. There is a need for high quality studies that measure dog bite rates as an outcome. To date, evidence does not suggest that educating children and adolescents is effective as a unique public health strategy to reduce dog bite injuries and their consequences.

Tragic case of a dog bite in a young child: the dog stands trial

The authors present the tragic case of an 18-month-old child who was bitten by a dog, causing amputation of the forearm and substantial damage to the cutaneous muscle on his back, shoulder, thorax, and neck. A free latissimus dorsi flap was performed to preserve the humerus from which the periosteum had been torn away. A series of cutaneous expansions were then undertaken to graft skin back onto the back, the armpit, and the shoulder stump, to allow for a mechanical prosthesis. A study of the literature on this subject proves that dog bites are more frequent and serious (sometimes even fatal) in young children than in adults. In view of the current legislation, it would seem that the public health authorities are doing little to resolve this distressing problem.

[Hand infections in children]

Subcuticular whitlow is the most frequent form of hand infections in children, mainly resulting from the penetration of a foreign body such as a thorn bush or onychophagy. Local antispesis, Dakin's fluid baths and eventually antibiotics directed toward Staphylococcus aureus are usually effective therapies. Extension to a subcutaneous whitflow needs surgery. Specific treatment must be used in case of fungal and herpetic whitlows. Paronychia tendinosa is a severe form of infection affecting flexor tendons sheaths with a high risk of sequelae; it requires an emergency surgical excision and i.v. anti-Staphylococcus aureus antibiotics therapy. Hand bites need particular attention and systematic surgical advice.