It invariably happens to almost everyone. An overzealous toddler bites a friend. A scared dog bites an intrusive child. A curious boy catches a mouse and gets bitten. Many parents are naturally worried when this happens. Is my child going to catch rabies or some other strange disease? How do I keep the bite from getting infected? Should I go to the ER or page my doctor urgently?
Here is Dr. Sears guide to both animal and human bites. This will help you decide what to do immediately, when to call the doctor, and what treatment protocol, if any, is commonly prescribed.
As soon as possible, preferably within 8 hours, do the following:
- Gently wipe away any dirt.
- Irrigate the wound. Go to a drug store and buy a large bottle of sterile saline and a large syringe. Flush the wound with at least 16 ounces of the saline using the syringe. Use as much force with the syringe as the child will allow. If it is too painful, apply an antibiotic ointment that also contains an anesthetic ointment. This may ease the pain.
- Apply an antibiotic ointment.
- Use the guidelines below to determine whether further medical attention is necessary.
Here are some situations that require you seek medical attention the same day.
- Any large bite that results in a large tear that looks as if it requires stitches.
- Any bite on the hand, finger, foot or toe (unless it is just a little scrape).
- Any bite on the face (unless it is just a little scrape).
- Any deep puncture bite (those from long, thin teeth, such as a deep cat bite).
- These have the highest chance of becoming infected.
- If only bite marks are made, but the skin is not broken and no bleeding is apparent, then no special treatment is necessary.
- If the skin is broken and/or bleeding, then an antibiotic by mouth should be started within 8 hours to prevent infection, especially bites to the hand, foot, or face.
- These have much less of a chance of becoming infected.
- Small nips or scrapes from a dog bite usually don’t require any special treatment.
- Bites that tear the skin and cause bleeding on the hand, foot, or face should be treated with an antibiotic by mouth. Dog bites to other body parts don’t always require an antibiotic by mouth; doctors and researchers differ on this issue.
- Dog (and cat) bites sometimes cause one particular bacterial infection called Pasteurella that causes rapid onset (during the first 24 to 28 hours) of redness, swelling, and severe pain that seem out of proportion to the initial injury. This may also cause fever in the child. Call your doctor if these signs occur.
- These have about a 50% chance of becoming infected because they tend to be deep puncture wounds (although they may look small).
- Virtually all cat bites should be treated with an antibiotic by mouth, especially bites on the hands, feet, or face. For just a small nip or scrape, antibiotics are usually not necessary. The antibiotic works best if started within 8 hours.
- Cat (and dog) bites sometimes cause one particular bacterial infection called Pasteurella that causes rapid onset (during the first 24 to 28 hours) of redness, swelling, and severe pain that seem out of proportion to the initial injury. This may also cause fever in the child. Call your doctor is these signs occur.
There are many other animal bites that can occur, but the only other ones that may require antibiotics by mouth are reptile bites (lizards, turtles, etc.). Most of the other animal bites listed below under rabies don’t actually need antibiotics by mouth. They may, however, require rabies shots or a tetanus shot. See below.
If your child has had a tetanus shot within the past 7 years, then he does not need a booster. If it has been 7 years or more, then a booster is recommended. This only applies to bites that tear or deeply puncture the skin, not minor nips or scrapes. If a bite occurs in the evening, the tetanus shot can wait until the next day.
This is a virus that, if it invades and causes an infection, is virtually always fatal. There are only about 1 or 2 fatal cases each year in the U.S. thanks to the use of rabies vaccination and immune globulin treatments given when a human is bitten by a rabid animal. Here is a list of animals known to be at risk of carrying rabies:
Animals that pose the highest risk:
Animals that pose less risk:
- Immunized dogs
- Immunized cats
- Immunized ferrets
Animals that pose virtually no risk:
- Guinea pigs
The decision whether or not to give your child the series of rabies shots after being bitten by one of the high or low risk animals above depends on a variety of factors. If your child has been bitten by one of the animals in the bottom list, then he does not need a rabies shot. The local public health department will have information about the risk of rabies in your local area and can help you and your doctor decide if rabies shots are needed. If an animal has bitten your child, ask the owner (if available) if the pet has had all its shots. Get proof of this if possible. Then call your local public health department to ask for instructions. Clean the wound as instructed above. Call your doctor if the guidelines above warrant any antibiotics. If a tetanus shot is needed, make an appointment to see your doctor.