Biting in child care: What are the risks?

No parent wants to hear that their child has been bitten (or has bitten another child) while in child care, but it does happen. Young children are very active, and bites can happen by accident when they are playing. Some children may become aggressive or anxious, and may bite on purpose. The good news is that most bites are harmless and do not break the skin.

Is there a risk that the bite wound might become infected?

Wounds from human bites – especially by young children – don’t usually become infected with bacteria. Serious bites by children are unusual in child care centres.

Still, some parents are concerned about some of the more serious infections that are transmitted through blood, such as hepatitis B or C, and HIV (the virus that causes AIDS).

Hepatitis B

Hepatitis B is passed from person to person through blood and other bodily fluids. It can be passed through sexual intercourse, from mother to baby, and through sharing of needles and syringes. The virus is not passed by contact of saliva with normal skin.

Only a bite that breaks the skin can pass hepatitis B. A child with hepatitis B who bites another child and breaks the skin may expose the bitten child to hepatitis B infection. Also, a child who bites another child who has hepatitis B may be exposed to the virus if blood from the bitten child enters the biter’s mouth. In both cases, if your child has not been vaccinated against hepatitis B, she should be seen and treated by a doctor.

Hepatitis C

Hepatitis C is also passed from person to person through blood or other bodily fluids. It has occasionally been passed through severe bites between adults that caused a lot of bleeding. Hepatitis C infection is rare in young children, and bites by young children rarely cause bleeding. Hepatitis C infection from a bite by a young child is extremely unlikely and has never been reported.

HIV

HIV is passed through sexual intercourse, from mother to baby, or through blood when needles and syringes are shared. It has been passed through very traumatic bites by adults that caused a lot of bleeding into the mouth. The chance of transmitting HIV through a bite in the child care centre, even when the skin is broken, is extremely unlikely and has never been reported. Giving a child anti-HIV drugs after a bite is not recommended.

How are bite wounds cared for in a child care centre?

If a child is bitten by another child at the child care centre, here is what a child care practitioner should do:

• If the skin is not broken, clean the wound with soap and water. Apply a cold compress and gently soothe the child.

• If the skin is broken:

  • Let the wound bleed gently. Do not squeeze it.

  • Clean the wound carefully with soap and water.

  • Apply a mild antiseptic, such as hydrogen peroxide.

  • A caregiver should inform the parents of both children (the bitten and the biter).

  • Check to see whether the bitten child has been vaccinated against tetanus, and if he has had all of the recommended doses. If not, refer the child to a doctor or clinic for a tetanus vaccine.

  • Check whether the bitten child and the biter have been fully vaccinated against hepatitis B. If not, they should be referred right away to a doctor or clinic for hepatitis B vaccine.

  • Watch the wound over the next few days. If it gets red or begins to swell, the child should be seen by a doctor.

If the bite is very serious and the child bleeds a lot, talk to the child’s doctor right away.

• What can parents do?

  • Teach your child not to bite. Do not pretend to bite your child or let your child bite you in play. When your child is old enough to understand, teach her that biting hurts and can be dangerous to her and to whoever she bites.

  • If your child attends child care, have him vaccinated for hepatitis B. In some provinces, this vaccine is given to all babies, while in others, it is given to all children in elementary school. Talk to your doctor.

  • Children with hepatitis B, hepatitis C or HIV infection have the right to attend child care without discrimination (unfairness), and the right to privacy about their medical diagnoses. You do not have to tell the child care staff about these infections. If you choose to, the staff must keep this information private. If your child has hepatitis B, hepatitis C or HIV infection, discuss the best options for child care with your child’s doctor, as well as who to tell.

  For more information

  • A bite in the playroom: Managing human bites in child care settings, a position statement developed by the Infectious Diseases and Immunization Committee <www.cps.ca/english/publications/InfectiousDiseases.htm>.