Study of children bitten by dogs
Research type
Research Study
Full title
Longitudinal study of children attending Alder Hey Children's Hospital for dog bites
IRAS ID
276013
Contact name
Carri Westgarth
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
2 years, 0 months, 0 days
Research summary
Research Summary
To provide public health intervention it is essential to understand the contexts and patterns of dog bites to children in Merseyside, the possible causes and if victims go on to need psychological intervention. The project will use a survey to be completed following hospital intake and follow-up at 2 and 6 months, which will also be linked to medical treatment records. This longitudinal data will be collected at Alder Hey Children’s Hospital for approximately 150 children to 6 month follow up. The survey will assess the context of the dog bite, including demographics of the victim, owner and the dog, socioeconomic factors and the circumstances of the bite, in order to inform prevention intervention design. It will also assess the treatment needs of dog bites to children; physical interventions (such as surgery) required and psychological impact using the previously validated Children's Revised Impact of Event Scale (Perrin, Meiser-Stedman & Smith, 2005) as it is unknown what proportion of child victims are psychologically impacted.
Summary Results
This study was conducted researchers from the University of Liverpool in collaboration with Alder Hey Children's Hospital. It received funding from the University of Liverpool Translational Research Access Programme.
Dog bites are a common injury to children that experts believe are often preventable. Earlier research suggests that children often provoke dogs by hugging/kissing them or disturbing them whilst sleeping or eating. This is the basis of educational campaigns to prevent bites, which also recommend adult supervision.
This project studied the contexts of dog bites to children attending Alder Hey Children's Hospital over a one-year period. It also studied the psychological effects of being bitten by a dog, as there is little information about this.
All children and their families who presented with a dog bite at the hospital in the year 2021 were encouraged to join the study. This involved completing three online questionnaires, one just after the bite, one after 2 months, and one at 6 months after the bite. In addition, some brief questions about the incident were collected as standard procedure in the medical notes, entered by the medical person treating the patient. The written text about the bite incident were used to create common groups.
195 dog bites were recorded in the year 2021. They were most commonly seen in the Emergency Department (85%) or Plastics (13%). Only 7 children and their parents volunteered to complete the additional surveys. Six completed the first survey; three of these completed survey two and four completed survey 3. Only one participant completed all three surveys but all six had at least one follow-up measure sometime after the incident.
The most common age of child was 4 years old (12%) and equal numbers of males and females were bitten. Children were most commonly bitten in the face/head (52%), and discharged with antibiotics and no further treatment (51%).45 different breeds were named but for 21% the breed was not recorded. French Bulldog (14%), Shih Tzu (10%) and Jack Russell Terrier (6%) were the most common breeds,. When the age of the dog was recorded (44% of records), 29% of dogs were under 1 year old.
The majority of bites occurred in the patient's own home (47%) by their own dog (44%). Bites most commonly happened when the child was interacting with the dog (51%). Other bites occurred when the child accidentally disturbed the dog (7%), was cycling/running/playing near the dog (7%) and walking past or sitting near the dog (6%). In 9% of bites where this information was available, the dog was either in its bed or sleeping. For 4% of bites the dog was mentioned to be old or in pain, although this is likely a low estimate. For 19% of incidents there was not enough information given to know why the bite might have happened.
Where there was information on the interaction, bites occurred in various circumstances including during playing with the dog (29%), stroking the dog (25%), hugging/kissing the dog (14%), or around food (8%). In 42% of situations the victim approached the dog, 31% the dog approached the victim, and 26% unknown.
In 13% of cases there was no adult supervision, 14% were supervised by an adult and witnessed, 5% supervised and not witnessed, and 70% not known if an adult was supervising the child and dog. Worryingly, 9% of dogs were known to have shown aggression to people before, and for 50% this was unknown. Regarding what would happen to prevent future bites, 43% had no change to the management/fate of the dog planned and for 33% this was reported as unknown.
One of the six children who completed the additional survey, two were reported during a follow-up time point to have received counselling about the bite. Using an 8-question survey about impact of traumatic events, 3/5 children met the criteria for post-traumatic stress disorder shortly after the incident and 4/6 during their follow-up. One described suffering from extreme anxiety and nightmares during a follow-up survey and two others described being wary of dogs.This study has shown us that hospital notes are generally insufficient to assess the context of the bite even if medical personnel are encouraged to ask questions and record this. However, recruitment of patients to more detailed research using surveys is also challenging.
Of particular concern is the finding that in most cases no changes around the dog were planned post-bite, making likelihood of further incidents high. Bites were also happening despite adult supervision of the child and dog. Future interventions to try to reduce dog bites to children should target all breeds and also add safety whilst playing with dogs. Psychological screening and treatment of children after a dog bite is also recommended given our findings showed this was common in our small sample.
REC name
Wales REC 5
REC reference
20/WA/0125
Date of REC Opinion
23 Apr 2020
REC opinion
Favourable Opinion