“Who let the dogs out?” may not be a relevant question when it comes to dog bites, pediatric emergency medicine physician Douglas Baker reported at Johns Hopkins Children’s Center’s annual Pediatric Trends conference in mid-April. That’s because in most dog-bite cases, the perpetrator is the family pet or a neighbor’s pet.

“Almost all of the biters are well known to the victim,” Baker said.

Dog bites, though stable in incidence in recent years, are a persistent and serious problem for pediatricians, added Baker, noting that up to 10 percent require sutures, 5 to 10 percent result in infections, 30 percent incur disability, and 50 percent result in scarring. While few, less than 1 percent, some are fatal. What are the circumstances in which dog-bites, especially the lethal ones, occur?

Citing one study, Baker noted that of 109 dog bite-related deaths between 1989 and 1994, 18 were children under 1 year of age—11 of whom were infants sleeping in a crib or bed. There were 44 deaths for children ages 1 to 9. In most cases, the dog was unrestrained on the owner’s property. The breeds most commonly involved? Pit Bulls accounted for 24 of the deaths, Rottweilers 16 and German Shepherds 10 (Pediatrics, 1996;97:891-5).

But all dogs have the potential to bite, added Baker, and under similar—and preventable—circumstances. Dogs often bite when they’re guarding a resource like a food bowl or bone, in response to punishment, when being disturbed from sleep, and in response to a loud noise (Injury Prevention 2007;13:348-351).

“With these type of triggers,” Baker said, “primary care physicians have a very ripe opportunity to raise awareness among patients and families about behavior around dogs to help them avoid this type of injury.”

While the causes of bites are largely known, Baker said, there may be some misperceptions about the clinical management of the injuries they incur, especially when it comes to repairing open dog-bite wounds.

“In some cases you may seal an infection,” Baker said. “In bite-wound care it’s all about cleaning the wound really well, in some cases with debridement, to stay away from a secondary infection.”

Baker also warns pediatricians to be wary of early—sometimes false—signs of an infection, which may prompt liberal use of antibiotics. He noted that it typically takes 12 or more hours after an injury for clinical signs of infection to develop.

“In the first eight to 10 hours in most cases,” Baker said, “what looks like an infection is probably the physical response to the injury.”

Bite wound infections are generally polymicrobial, Baker added, so antibiotic therapy should cover a variety of types of pathogens. Other important management considerations include a determination of the patient’s tetanus vaccine status, and the use of rabies prophylaxis. For more information, see the dog-bite prevention tips from the American Academy of Pediatrics.