How Do Dog Bites Affect Children Psychologically?

What you need to know

• Dog bites can cause significant psychological trauma in children, including post-traumatic stress disorder (PTSD) and dog phobias.
• Common symptoms after a dog bite include nightmares, anxiety, and avoidance behaviors.
• Psychological impacts of dog bites on children are often overlooked and undertreated.

Background on Dog Bites in Children

Dog bites are a major public health concern, affecting tens of millions of people annually worldwide. Children are particularly vulnerable to dog attacks and their consequences. In the UK, for example, hospital admissions for dog bites in children 14 and under occur at a rate of about 14.4 per 100,000 population per year.

Several factors make children more susceptible to dog bites:

1. Smaller physical size
2. Tendency to underestimate risks
3. More impulsive behavior
4. Leaning-in behavior with animals (especially in young children)

Most child dog bite victims are bitten inside the home by dogs they know. Children aged 5-9 have the highest rates of dog bite injuries. Younger children tend to have more bites to the face and head regions, which can lead to more severe injuries.

While the physical impacts of dog bites are well-documented, the psychological effects have received less attention. This review aimed to explore the current evidence on the psychological impact of dog bites in children and adolescents.

Psychological Effects of Dog Bites on Children

The research reveals that dog bites can have significant and long-lasting psychological effects on children. Some of the most common consequences include:

Post-Traumatic Stress Disorder (PTSD)

Several studies found that PTSD is a frequent outcome for children who experience dog bites. Prevalence rates varied across studies, but in some cases, over 50% of children developed PTSD symptoms after a dog attack. PTSD was typically diagnosed through screening questionnaires or by meeting criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Factors that increased the likelihood of developing PTSD included:

• More physically severe injuries
• Multiple bites
• Facial injuries

Acute Stress Disorder (ASD)

Some children developed Acute Stress Disorder shortly after the dog bite incident. ASD can be an early indicator of PTSD.

Dog Phobias and Avoidance

Many children developed intense fear or phobias of dogs after being bitten. This often led to avoidance behaviors, such as:

• Refusing to go near dogs
• Avoiding outdoor activities
• Difficulty playing outside

Sleep Disturbances and Nightmares

Sleep problems were commonly reported, including:

• Difficulty falling asleep
• Nightmares about dogs or the attack
• Bed-wetting (in some cases)

Other Symptoms

Additional psychological effects observed in some children included:

• Increased anxiety
• Hypervigilance
• Anger or aggression
• Withdrawal or depression
• Panic attacks
• Selective mutism (in rare cases)
• Fear of hospitals or medical procedures
• Traumatic memories or flashbacks

Impact on Parents and Families

The psychological effects of dog bites extend beyond the child victim. Parents and other family members can also experience significant distress. Some common parental reactions included:

• Feeling shaken or traumatized
• Guilt over not preventing the attack
• Increased fear for their child’s safety
• Worry about permanent scars or disfigurement
• Development of PTSD symptoms (in some cases)

One study found that mothers’ PTSD symptoms were associated with higher PTSD scores in their children, suggesting a potential link between parent and child trauma responses.

Gaps in Assessment and Treatment

Despite the clear psychological impact of dog bites on children, the review found that psychological assessment and treatment were often overlooked or under-provided. Several issues contribute to this gap:

1. Emergency department focus on physical injuries
2. Lack of standardized psychological screening for dog bite victims
3. Unclear follow-up procedures for assessing longer-term psychological effects
4. Limited referrals to mental health professionals

In some studies, no children received psychological services after a dog bite, even when parents felt it would be helpful. This highlights a significant unmet need in the care of pediatric dog bite victims.

Treatment Approaches

When psychological treatment was provided, cognitive-behavioral therapy (CBT) was the most commonly used approach, particularly for treating dog phobias. CBT often involves some form of graded exposure to dogs to help children overcome their fears.

However, using real dogs in therapy presents ethical and practical challenges, including:

• Ensuring safety for both child and animal
• Controlling the intensity of exposure
• Finding suitable dogs for therapy sessions

To address these issues, some researchers have proposed using virtual reality (VR) as an alternative to in-vivo exposure therapy. VR allows for more controlled and gradual exposure to dog-related stimuli in a safe environment. Early studies on VR therapy for dog phobias in children have shown promising results, but more research is needed to confirm its efficacy.

Prevention and Education

The review highlighted the need for better prevention strategies and education about dog bites. Suggestions included:

1. Offering educational programs to parents and children about dog bite risks and severity
2. Teaching children how to safely interact with dogs
3. Raising awareness about the potential psychological consequences of dog bites

Conclusions

• Dog bites can have significant and long-lasting psychological effects on children, including PTSD, phobias, and anxiety.
• The psychological impact of dog bites is often overlooked in emergency care settings, leading to inadequate assessment and treatment.
• More research is needed on effective treatments for dog bite-related psychological trauma, including the potential use of virtual reality therapy.
• Prevention efforts should focus on educating both children and parents about dog safety and the potential consequences of dog bites.

This review underscores the importance of considering both the physical and psychological impacts of dog bites in children. By improving assessment, treatment, and prevention strategies, we can better support young victims and their families in overcoming the trauma associated with dog attacks.