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. 2024 Oct 7;11(10):1218. doi: 10.3390/children11101218

Table 1.

Summary of eligible studies on the psychological effects of dog bites in chronological order. Included are case reports, experimental studies, pilot, prospective, cross-sectional and retrospective studies.

Author(s) Year Type Objective Methods Results Conclusions
Gislason & Call, 1982 [28] CR. To describe the effects of dog bite trauma on 3 children Clinical observation In the post-traumatic state, ↑ short-lived symptoms and personality changes characterized by over-caution, constriction of thought, inhibition of action and impairment of the ability to experience gratification (reward) Authors consider a double trauma, i.e., the child’s personal trauma and its traumatic effect on the caretaking parent(s). These changes will be carried forward and generalise, constraining later personality formation
Spiegel, 2000 [25] PS. Evaluate the effectiveness of a school-based dog bite safety primary program for elementary school children in Maryland, US The pilot program was assessed through pre/post program questionnaires completed by 486 students The program demonstrated ↑ effectiveness in teaching children how to prevent potentially dangerous situations with dogs. Students showed ↑ awareness of risk and appropriate behaviours Dog bite safety programs in primary schools can be effective in promoting children’s safety. Further research is needed to monitor actual changes in children’s behaviour
Overall et al., 2001 [14] RS. To analyse demographics, epidemiology, injuries and risks associated with dog bites to humans Data on dog bite cases across a wide geographic area over a 5 year period collected by hospitals, veterinary clinics, and animal control services ↑ incidence of dog bites. Children < 10 years and adults aged 20–40 years (unexpectedly) were most affected victims. Common injuries: extremities, face and neck Significance of public education regarding safety around dogs and the importance of responsible pet management. Prevention strategies need to be refined
Anyfantakis et al., 2009 [29] CR. Case presentation: A 4-year-old girl admitted to the University Hospital of Crete for dog-bite related injuries developed selective mutism and acute PTSD Clinical observation This case highlights the need for greater awareness of the psychological effects of dog bites in children among healthcare providers and caregivers Childhood psychological distress following dog bites is not extensively documented. This case emphasises the importance of counselling, psychological support, follow-up care and parents being aware of post-traumatic psychiatric morbidity in children after physical trauma
Daniels at al., 2009 [30] CS. To examine hospital incidence, charges, and characteristics of dog bite injuries among children by age. An electronic hospital database used to identify patients < 18 years from 1999–2006 1347 children < 18 were treated for dog bites. Most were treated and discharged from the ED Injuries to the head/neck region ↑ the odds of requiring 23-h observation and age < 5 years ↑ the odds of being admitted as an inpatient
Meints & De Keuster, 2009 [31] ES. To evaluate the effectiveness of the ‘Blue Dog’ CD in teaching dog-bite prevention to children < 7 years 96 children aged 3–6 used ‘Blue Dog’ CD in 3 phases with half receiving verbal feedback and the others practice with parents; re-test after 2 weeks All age groups demonstrated ↑ safe choices post-training. Children < 6 years benefited from parental involvement, while verbal feedback did not impact effectiveness Children 3–6 learned safety messages from the “Test Yourself” module on the Blue Dog CD with older children performing better
Shields et al., 2009 [32] RS. To analyse dog bite-related fatalities in Kentucky, focusing on the role of forensic odontology in investigating these incidents 11 cases of dog bite-related fatalities in Kentucky (1991–2005). Postmortem examinations in 8 cases; forensic odontology in 4 cases Most fatalities involved multiple blunt and sharp force injuries (primarily head/neck). Common breed: Pit bulls. Common victims: children < 6 years The study emphasizes the importance of responsible dog ownership and prevention strategies to reduce dog bite-related fatalities
Reisner et al., 2011 [10] CS. To characterise the behavioural circumstances of dog bites Interview children ≤ 17 years presenting with dog bite injuries to The Children’s Hospital of Philadelphia (Penn., US) Older bitten children were unfamiliar with the dog and not interacting with them. Face bites predominated (70%) in the younger group (<7 years), bites to extremities predominated (72%) in the older group Recognition of the two distinctive behavioural and circumstantial subgroups of dog bites that emerged can lead to more effective prevention strategies
Dixon et al., 2012 [33] CS. To assess children’s knowledge about preventing dog bites and to understand parental desires for dog bite prevention education Participants: 5- to 15-year-olds and their parents or guardians who visited a paediatric ED for non-urgent complaints or dog bites 43% of children failed the knowledge test. Children and those with white parents had ↑ odds of passing the test. >70% of children did not receive dog bite prevention education; 88% of parents wished receiving education This study highlights poor knowledge about dog bite prevention, especially among younger children and among those with non-Caucasian parents
Fein et al., 2018 [9] CS, RS. This study aims to identify risk factors for paediatric dog bites using NTDB. Hypotheses: younger boys at ↑risk, with most bites occurring at home and resulting in moderate to severe injuries (particularly face/neck) 7.912 children, aged 0–17 years with ICD-9. Datasets from 2007 to 2014 were used and included patient’s gender, age, ICD-9 primary and location E-codes, AIS body region and AIS severity Age of the child predicted where the incident occurred, the severity of the injury and the body region affected, all with statistical significance. Additionally, the body region of the injury predicted its severity This study’s population risk factors profile suggests targeting educational initiatives on responsible dog ownership towards parents of young children as a preventive measure
Caffrey et al., 2019 [11] CS. To analyse factors contributing to dog bite severity using data from Calgary; Alberta, Canada Data from 2012–2017 on dog aggression accidents were obtained using the Chameleon customisable software. The Dunbar Scale applied to classify accident severity 2012–2017: 2723 accidents of chases or bites involving humans; severity: 51% low; 35% medium; 13.5% high. Accidents occurred on owner’s property, in off-leash parks or at home. Male older adults ↑ odds of moderate to severe bite Severe accidents are common at home and affect all age groups (children, youths, adults). Need for targeted education for both dog owners and the public to prevent bites, through supervision of children around dog and programs for older adults
Parente et al., 2021 [34] RS. To evaluate whether stress upon domestic dogs resulted in an increase of dog bites in the paediatric population From records of patients admitted to paediatric EDs for dog bites 2014–2020, total mean dog bites for the years 2014–2019 and mean number per single month with 2020 data were compared From 2014–2019, 32% were from familiar dogs and 68% from foreign dogs. In 2020, there was a significant ↓ in bites from foreign dogs and an ↑ in bites from familiar dogs compared to the average for the previous period. ↑ anxiety and depression in both children, families and dogs due to the lockdown were put in relation to the ↑ incidence of dog bites in 2020 The number of family dog bites in children ↑ in 2020, especially during the lockdown period. Paediatricians had the task to educate parents during the pandemic on the importance of continuous child supervision during their interactions with dogs. Dog owners should manage their dog’s increasing anxiety

Abbreviations: AIS Abbreviated Injury Scale; CR, case report; CS, cross-sectional study; ED, Emergency Department; ES, Experimental Study; ICD-9, International Classification of Diseases 9th edition; NTDB, National Trauma Data Bank; PS, Pilot Study; PTSD, post-traumatic stress disorder; RS, retrospective study; US, United States of America; ↓, decreased, low; ↑, increased, high.

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