Should Your Child See a Doctor?

Animal or Human Bites

Definition

  • Bite or claw wound from a pet, farm or wild animal
  • Bite from a human child or adult

First Aid Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

First Aid Advice for All Bites and Scratches: Wash all bite wounds and scratches with soap and warm water.

 Risk of bites 

  • Animal or human bites usually need to be seen because all of them are contaminated with saliva and prone to wound infection.

Types of wounds

  • Bruising: There is no break in the skin. No risk of infection.
  • Scrape (abrasion) or scratch: A superficial wound that doesn't go all the way through the skin. Low risk of infection. Preventive antibiotics are not indicated.
  • Laceration (cut): A wound that goes through the skin (dermis) to the fat or muscle tissue. Intermediate risk of infection. Most need to be seen. Wound cleansing and irrigation can help prevent infection by washing out the bacteria from the wound. Preventive antibiotics may be required.
  • Puncture wound: Intermediate risk of infection. Puncture wounds rfom cat bites are especially prone to getting infected; many physicians will prescribe preventive antibiotics for cat bites.

Types of bites 

  • Bites from Rabies-Prone Wild Animals: Rabies is a fatal disease. Bites or scratches from a bat, skunk, raccoon, fox, coyote, or large wild animal are especially dangerous. These animals can transmit rabies even if they have no symptoms. In the U.S., 90% of cases of rabies in humans is attributed to bats. Bats have transmitted rabies without a detectable bite mark.
  • Small Wild Animal Bites: Rodents such as mice, rats, moles, gophers, chipmunks, prairie dogs and rabbits fortunately are considered free of rabies. Squirrels rarely carry rabies, but have not transmitted it to humans.
  • Large Pet Animal Bites: Most bites from pets are from dogs or cats. Bites from domestic animals such as horses can be handled using these guidelines. Dogs and cats are free of rabies in most metro areas. Stray animals are always at risk for rabies until proven otherwise. Cats and dogs that are never allowed to roam freely outdoors are considered free of rabies. The main risk in pet bites is serious wound infection, not rabies. Cat bites become infected more often than dog bites. Claw wounds from cats are treated the same as bite wounds, since the claws may be contaminated with saliva.
  • Small Indoor Pet Animal Bites: Small indoor pets (gerbils, hamsters, guinea pigs, white mice, etc.) are at no risk for rabies. Tiny puncture wounds from these small animals also don't need to be seen. They carry a small risk for wound infections.
  • Human Bites: Most human bites occur during fights, especially in teenagers. Sometimes a fist is cut when it strikes a tooth. Human bites are more likely to become infected than animal bites. Bites on the hands are at increased risk of complications. Many toddler bites are safe because they don't break the skin.

Dogs and Cats and the Risk of Rabies  

  • Indoor versus Outdoor Pets: Dogs and cats that are never allowed to roam freely outdoors are considered free of rabies. Outdoor pets who are [1] stray, sick or unvaccinated AND [2] living in communities where rabies occurs in pets are considered at risk for Rabies in the U.S. and Canada.
  • Metropolitan versus Rural Location: Dogs and cats in most metropolitan areas in the U.S. and Canada are free of rabies (Exception: towns along the border with Mexico). Dogs and cats in rural areas have a higher risk of rabies.
  • Provoked versus Unprovoked Bite: An unprovoked attack by a domestic animal increases the likelihood that an animal is rabid. Note that bites inflicted while a person is attempting to feed or handle a healthy animal are considered provoked.
  • Developing Countries versus U.S. and Canada: Dogs and cats in developing countries have a higher risk of rabies; rabies postexposure prophylaxis is indicated if a bite occurs in a developing country. International travelers need to remain alert.
  • Nurses and physicians must check with the local Public Health Department about the risk for rabies in their community.

First Aid Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

First Aid Advice for All Bites and Scratches: Wash all bite wounds and scratches immediately with soap and warm water.

When to Call Your Doctor for Animal or Human Bite

Call 911 If…

 
 
  • Your child has major bleeding that can't be stopped
  • Your child is not moving or too weak to stand

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Bleeding won't stop with 10 minutes of direct pressure (continue pressure until seen)
  • Any contact with an animal at risk for RABIES
  • Wild animal bite that breaks the skin
  • Pet animal (e.g., dog or cat) bite that breaks the skin (EXCEPTION: bruise or superficial scratches that don't go through the skin or tiny puncture wound)
  • Puncture wound (holes through skin) from CAT teeth or claws
  • Puncture wound of hand or face
  • Human bite that breaks the skin
  • Bite looks infected (redness or red streaks) or fever
  • Bat contact or exposure, even without a bite mark

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

 
  • You think your child needs to be seen
  • Last tetanus shot over 5 years ago

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

Parent Care at Home If

  • PET ANIMAL BITE: Tiny puncture wound or superficial scratches (EXCEPTION: cat puncture wound)
  • ANY BITE that didn't break the skin (bruise)

Home Care Advice for Animal or Human Bite

  1. Cleansing:
    • Wash all wounds immediately with soap and water for 5 minutes.
    • Also, flush vigorously under running water for a few minutes (Reason: can prevent many wound infections).
    • Scrub the wound enough to make it re-bleed a little. (Reason: to help with cleaning out the wound).
     
  2. Bleeding: For any bleeding, apply continuous pressure for 10 minutes.
  3. Antibiotic Ointment: For small cuts, apply an antibiotic ointment (e.g., Polysporin, Bacitracin) to the bite 3 times a day for three days. (No prescription needed.)
  4. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief.
  5. Bruises: Apply a cold pack or ice bag wrapped in a wet washcloth once for 20 minutes. (Reason: reduce bleeding, pain and swelling)
  6. Expected Course: Most scratches, scrapes and other minor bites heal up fine in 5 to 7 days.
  7. Call Your Doctor If:
    • Wound begins to look infected (pus, redness, red streaks)
    • Fever occurs
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

  1. American Academy of Pediatrics: Committee on Infectious Diseases. Wound Infections. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
  2. American Academy of Pediatrics: Committee on Infectious Diseases. Animal Bites. In Pickering L, ed. 2009 Red Book. 28th ed. Elk Grove Village, IL: 2009.
  3. Blanton JD, Hanlon CA, Rupprecht CE. Rabies surveillance in the United States during 2006. J Am Vet Med Assoc. 2007;231:540-556.
  4. Brogan T, et al. Severe dog bites in children. Pediatrics. 1995;96:947-950.
  5. Garcia VF. Animal bites and pasturella infections. Pediatr Rev. 1997;18:127-130.
  6. Leung AKC et al. Human bites in children. Pediatr Emerg Care. 1992;8:255.
  7. Litwin CM. Pet-transmitted infections: diagnosis by microbiologic and immunologic methods. Pediatr Infect Dis J. 2003; 22:768-777.
  8. Manning SE, et.al. Advisory Committee on Immunization Practices Centers for Disease Control and Prevention (CDC). Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008 May 23;57(RR-3):1-28.
  9. Ostdiek SA and Shackelford PG. Human bite wounds. Rep Pediatr Infect Dis. 1997;7(9):33-34.
  10. Steele MT, Ma OJ, Nakase J, et al. Epidemiology of animal exposures presenting to emergency departments. Acad Emerg Med. 2007;14(5):398-403.  

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/13/2010 6:09:35 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.