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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Cartoon of a Postal Worker bitten by a dog

Animal Bites

I’m an animal lover. Really, all kinds. I’m not especially grossed out by snakes or spiders, and I was the very proud owner of a guinea pig named “Marshmallow” when I was a kid. I’m a sucker for all those cute, heartwarming, and hilarious animal videos on social media, and I have a fairly solid and rapid recall of what’s on Animal Planet or NatGeo Wild on any given night.

I also take care of lots of children who have sustained animal bites. From dogs to cats to bats to rats, I’ve seen too many to count.

One thing that really stands out for me is the ongoing confusion and lack of understanding about the following:

  1. Bites from which animals need rabies prevention/immunization
  2. Which types of bites are most at risk for infection
  3. How to manage and treat various bites

While nothing in medicine is 100%, I thought I’d try to clear up some of the confusion and create something digestible on the subject for easy reference should you find yourself on the wrong end of an animal’s mouth. And my entry wouldn’t be complete without some commentary about bite prevention.

Rabies

First point: NOT ALL ANIMAL BITES ARE AT RISK FOR RABIES. THIS MAY SURPRISE YOU.

Most people know that dogs and cats and even some wild animals like raccoons and foxes have the potential to carry rabies, which is universally fatal if contracted by a human, so it’s a big deal. Rabies is a virus that invades the brain and causes almost certain death. There is no treatment for rabies. All this is why we require our canine and feline pets to get the rabies vaccine—you know, because VACCINES WORK and all that.

What does surprise many people is that other animals like rodents—mice and rats—or those whose diet is plant based, are NOT considered high risk for rabies. On the other hand, BATS are considered high risk for rabies. In fact, rabies is common enough in bats that even if a bat flies over a person and does not bite them, they can be considered at risk, even without a bite at all.

Here are a few clinical examples that I’ve seen in my practice over the years:

  1. Bat flies into summer camp cottage with kids inside. No bite or definitive contact, but the bat was within 5-10 feet of the campers.RESULT: the 5 children inside received the rabies immunization series, just to be safe, because the bat could have shed some rabies in its saliva/secretions, and that could have reached the children. PLUS, the potential harm of getting rabies is so great that we err on the side of caution and play it safe given the exposure to this animal, so we give the immunization series.
  2. Parent brings child into acute care with several puncture wounds on the foot from a rat. No active bleeding.RESULT: Wound irrigated, cleaned and dressed. No rabies series needed. Why? Rats eat plants and the rabies virus is spread from animal to animal. Nothing to do with plants, and small rodents are NOT known to spread rabies to humans.

For dog and cat bites, it’s important to get a medical evaluation after a bite to determine the next step. Sometimes rabies immunoglobulin needs to be given directly into the wound and as a injection in addition to the rabies immunization series. For healthy animals acting normally, the rabies immunization series isn’t always indicated, but this is determined on a case by case basis and other considerations such as animal quarantine have to be considered when making a determination of management.

Infection

Second point: SOME ANIMAL BITES ARE MORE LIKELY TO GET INFECTED THAN OTHERS

This one is probably less surprising but bears repeating. The mouths of dogs and cats have plenty of germs… just like humans, and as such, are at high risk for infection. I have a very low threshold to treat dog and cat bites with prophylactic antibiotics. I had to put bites in BOLD there because many people get concerned that a scratch from one of these animals is likely to get infected. Possible? Yes. Likely? Less so. The deeper and more significant the wound, the higher the chances of infection become.

Notably, many dog and cat bites are small and round but can be deceptively deep punctures, which can also easily harbor infection. So, vigorous irrigation as a method to get rid of germs in the wound is critical, and sometimes these wounds need to be explored to get an appreciation of the depth and extent before a decision is made about giving antibiotics preventively. No one will ever balk at being conservative here.

That being said, very superficial abrasions can often be managed with a “wait and see” approach and don’t always need a week’s worth of oral antibiotics. Here’s where the art and science of medicine intersect yet again, and the clinical expertise and judgment of the healthcare professional will determine the best plan.

Caring for an animal bite

Third point: HOW SHOULD BITES BE TREATED/MANAGED?

Animal bites can be severe, especially dog bites. The tearing/ripping motion of the trauma itself can create significant open, irregular wounds. Our first thought may be to stitch up those wounds and align the edges as closely as possible, but in fact that’s the wrong move. Because the wounds tend to be so “dirty” (meaning lots of germs within), we tend to close the wound with loose stitches rather than tight ones, so that if the area becomes infected with cloudy infectious material (pus) accumulating in the space, it has an avenue to drain out, ultimately yielding better overall healing.

As mentioned above, irrigation and close observation are really key to minimizing the chances of infection. Many times the hands are the body parts that get bitten, and there are many small enclosed spaces in the hand anatomy, so if an infection gets into one of those spaces, compromise of blood flow and/or nerve compression can occur, so these wounds need to be observed very closely and reassessed by a medical professional right away if any increased swelling, redness, or drainage occur. For more on animal bite care, check out this swell video I created a few years back.

Preventing an animal bite

As with most injuries, prevention of animal bites in the first place is really the goal so that none of the 3 points above is even a factor. Beyond making sure your own pets have all of their required vaccinations, this is a quick reminder list of strategies to avoid dog bites, the most common types of bites seen:

  1. Never run to or away from a dog.
  2. Never grab a toy or food from a dog.
  3. Don’t squeeze a dog or pull its ears or tail.
  4. Always ask an owner if it’s ok to approach their dog.
  5. Don’t bother a dog with puppies.
  6. Don’t make eye contact with a dog you don’t know.

If you or your child gets bitten by an animal you don’t know, make sure you get the owner’s name, address, location where the bite occurred, and any information about the animal’s vaccination status. Then it’s always wise to seek medical care to make sure that there isn’t more to the injury than what initially meets the eye and to sort out any need to get animal control involved or to get started on the rabies vaccine series.

After all that, you can get back to your favorite animal show on TV knowing that you did all the right things to ensure the best possible outcome. Personally, I’m partial to the veterinarian programs and zoo shows that showcase the vets. People often say that pediatricians are like veterinarians in terms of having to figure out what’s wrong with their patients without them verbalizing it, but I always say—  the vets have it much harder. At least I’m only dealing with ONE SPECIES.

 

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