Dog Bite Law

Types of bodily injuries 

• Abrasions
• Lacerations
• Punctures
• Tissue loss and avulsion
• Crush injuries
• Fractured bones
• Sprain / strain injuries
• Scars
• Infections such as rabies, cellulitis, C canimorsus infections

In an overview of 16 dog bite cases, there were 27 facial fractures, with 87 percent of the cases occurring in children under the age of 16. Sixty-nine percent of the cases involved fractures of bones around the eye, the nose, or the jaw. 

To rule out facial fractures, the authors agree that victims should undergo a computed tomographic (CT) scan in cases with a high degree of suspicion - when large breed dogs capable of crush-type injuries are involved. 

Death can result from infection. For example, C canimorsus infections are very rare but can be very dangerous. They can result in fever, malaise, myalgia, vomiting, diarrhea, abdominal pain, dyspnea, confusion, headache, and skin rash. Disseminated intravascular coagulation develops in many patients. (J Blackman, MD, "Man's Best Friend?", J Am Board Fam Pract 11(2):167-169, 1998.)

Treatment for bodily injuries 

It is important to find out when and if the victim had a tetanus shot. Such a shot may be administered if required or the date of the last shot cannot be determined. The dog may be known to be rabid. If so, the victim is treated preventatively for rabies. (Blackman JR. Animal bites. In: Rakel RE, Pedersen D, editor. Saunders Manual of Medical Practice. Philadelphia: WB Saunders, 1996; Wiley JF 2nd. Mammalian bites. Review of evaluation and management. Clin Pediatr Phila 1990; 29:283-7.)

Cultures and Gram stain are useless on a fresh wound, but they should be obtained for obviously infected wounds and victims who are already febrile or immunocompromised. [Kelleher AT, Gordon SM. Management of bite wounds and infection in primary care. Cleve Clin J Med 1997;64:137-41.]

Because dogs can develop a tremendous force when biting, x-ray studies might be necessary to determine underlying bone and joint injury. Fractured bones must be set. Nerve injuries must be repaired. 

Dog bites to the neck and face require special considerations. Most occur in children younger than 10 years, and severe brain injury and death are most common in this age group. Most deaths occur from hemorrhage from the great vessels of the neck. 

The nose, mouth, and parotid region is a primary target area for dog bites. [Morgan JP 3rd, Haug RH, Murphy MT. Management of facial dog bite injuries. J Oral Maxillofac Surg 1995;53:435-41.] Carotid artery injury with delayed cerebral infarction has been reported. [Meuli M, Glarner H. Delayed cerebral infarction after dog bites: case report. J Trauma 1994;37:848-9.] After a detailed exploration looking for damaged tissue (salivary duct, facial nerve, blood vessels), many wounds may be closed primarily. [Morgan JP 3rd, Haug RH, Murphy MT. Management of facial dog bite injuries. J Oral Maxillofac Surg 1995;53:435-41.]

Depending on the type of bite, the wounds may be closed. If the damage is not extensive, the wounds may be closed with tape or sutures. High-risk wounds should not be sutured but should receive antibiotic treatment. Low-risk wounds may be sutured and do not require antibiotic treatment unless infected. High-risk wounds include all human and cat bites; hand and foot wounds; wounds surgically debrided; puncture wounds; wounds involving joints, ligaments, tendons, and bones; bites with treatment delay exceeding 12 hours; and bites in immunocompromised patients. Low-risk wounds include bites involving the extremities, face, and body. (Blackman JR, "Man's Best Friend?", J Am Board Fam Pract 11(2):167-169, 1998.)

Heavily damaged tissue may have to be debrided -- cut away. Sometimes it can be reattached by grafting; other times it is replaced with skin from another area of the victim's body. More than one type of surgery may be required:

• Plastic/reconstructive surgery
• Orthopedic surgery

Scars 

Small scars may fade away. Otherwise, scars may be improved but never removed. Treatment includes:

• Dermabrasion (i.e., sanding down the scar)
• Pressure scar modification
• Surgical excision of scar
• Make-up 

Post traumatic stress disorder 

A dog bite victim might suffer from post traumatic stress disorder for months after the attack. It is unfair to allow this suffering to continue without proper treatment from a mental health practitioner (see treatment for emotional and social injuries, below).

Fear of dogs and the outdoors 

This may interfere with friendships and the quality of life. For example, a woman who lived in the countryside found that she no longer could take walks because she feared being attacked. This left her a "shut-in" for a period of months.

What the parents should watch out for 

• Infection. Do exactly what the doctor tells you to do. Dog bite infections are rare but can be very, very serious. Be sure to take your child to the doctor if he has a lot of pain, there is redness at the wound that is getting worse, or if you see streaks of redness heading away from the wound.

• Crush injury. The bigger, powerful dogs have tremendous crush power in their jaws. A crush injury causes scar tissue and compression of the nerves in the soft tissues -- and can also break bones. If your child complains of pain even after the wound heals, then you should take her to a doctor that has done a significant amount of work with dog bite victims and is familiar with crush injuries. If you detect any kind of disability -- such as favoring the hand or limb that was bitten, or weakness in it -- then your child might have a permanent problem, and should be seen by the appropriate physicians.

• Scars. Wounds can result in scars. Some people scar very badly. You should not think about resolving your child's cliam until the scars have matured to some degree. In cases where an attorney knows that there will be scars, we do not settle them until at least 9 months have passed since the date of the attack. Plastic surgeons who revise scars do not like rendering a long term prognosis about them until at least one year after the attack. When the victim is very young (i.e., under 5 years), the skin rejuvinates and therefore it is difficult to predict what the wound site will look like.

• Emotional injuries. Some children stop talking, or start wetting their beds. Some start hitting their siblings. Some cry and cling to their parents. Some do not want to go outside, or to school. Any unusual behavior may be a sign of emotional injury. This kind of trauma heals most of the time. However, your child might need the assistance of a counselor. See the next section for more information.

Emotional injuries in children 

"Trauma" includes emotional as well as physical experiences and injuries.  Emotional injuries are essentially a normal response to an extreme event.  Emotional injury involves the creation of emotional memories, which arise through a long lasting effect on structures deep within the brain.  The more direct exposure to the traumatic event, the higher the risk for emotional harm.

The "undifferentiated thinking" of children frequently leads them to derive "wrong" conclusions from traumatic events. A child, especially a very young one, attempts to read the environment in order to enhance his comfort and further survival. A traumatic event like a dog bite is often misunderstood as a statement about life in general, that it is uncertain, painful and precarious. Furthermore, such an event might be internalized as a statement about the child himself, that he is somehow "bad" and even responsible for not only his physical pain but even the emotional pain suffered by his parents as a result of the dog attack. These psychic wounds may become significant determinants of the adult personality, so that the dog attack truly affects the child victim for life.

Either being exposed to violence within the home for an extended period of time or exposure to a one-time event like an attack by a dog can cause PTSD in a child. Some scientists believe that younger children are more likely to develop the disorder than older ones. PTSD can develop at any age, including in childhood. Symptoms typically begin within 3 months of a traumatic event, although occasionally they do not begin until years later. Once PTSD occurs, the severity and duration of the illness varies. Some people recover within 6 months, while others suffer much longer. 

Emotional reactions to trauma may appear immediately after the dramatic event or days and even weeks later.  Rates of PTSD identified in child and adult survivors of violence and disasters vary widely. For example, estimates range from 2% after a natural disaster (tornado), 28% after an episode of terrorism (mass shooting), and 29% after a plane crash. The disorder may arise weeks or months after the traumatic event. 

Children and adolescents exposed to a dramatic events frequently lose trust in adults and have fear that the event may occur again.  Other reactions vary according to age:

• For children five years of age and younger, typical reactions may include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging.  Parents may also noticed children returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.

• Children six to eleven years old may show extreme withdrawal, disruptive behavior, and/or inability to pay attention.  Regressive behaviors, nightmares, sleep problems, irrational fears, inability or refusal to attend school, outbursts of anger and fighting are also common in traumatized children of this age.  Also, the child may complain of stomach aches or other bodily symptoms that have no medical basis. School work often suffers. Depression, anxiety, feelings of guilt and emotional numbing or "flatness" are often present as well.

• Adolescents 12 to 17 years old may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers, and anti-social behavior. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances, and confusion. The adolescent may feel extreme guilt over his or her failure to prevent injury or loss of life, and may harbor revenge fantasies that interfere with recovery from the trauma. 

• Re-experiencing the event through play or in trauma-specific nightmares or flashbacks, or distress over events that resemble or symbolize the trauma. 

• Routine avoidance of reminders of the event or a general lack of responsiveness (e.g., diminished interests or a sense of having a foreshortened future).

• Increased sleep disturbances, irritability, poor concentration, startle reaction and regressive behavior.

People with PTSD are treated with specialized forms of psychotherapy and sometimes with medications or a combination of the two. One of the forms of psychotherapy shown to be effective is cognitive/behavioral therapy, or CBT. In CBT, the patient is taught methods of overcoming anxiety or depression and modifying undesirable behaviors such as avoidance. The therapist helps the patient examine and re-evaluate beliefs that are interfering with healing, such as the belief that the traumatic event will happen again. Children who undergo CBT are taught to avoid "catastrophizing." For example, they are reassured that dark clouds do not necessarily mean another hurricane, that the fact that someone is angry doesn't necessarily mean that another shooting is imminent, etc. 

Play therapy and art therapy also can help younger children to remember the traumatic event safely and express their feelings about it. Other forms of psychotherapy that have been found to help persons with PTSD include group and exposure therapy. 

A reasonable period of time for treatment of PTSD is 6 to 12 weeks with occasional follow-up sessions, but treatment may be longer depending on a patient's particular circumstances. 

Research has shown that support from family and friends can be an important part of recovery and that involving people in group discussion very soon after a catastrophic event may reduce some of the symptoms of PTSD. 

There has been a good deal of research on the use of medications for adults with PTSD, including research on the formation of emotionally charged memories and medications that may help to block the development of symptoms. Medications appear to be useful in reducing overwhelming symptoms of arousal (such as sleep disturbances and an exaggerated startle reflex), intrusive thoughts, and avoidance; reducing accompanying conditions such as depression and panic; and improving impulse control and related behavioral problems. Research is just beginning on the use of medications to treat PTSD in children and adolescents. 

There is preliminary evidence that psychotherapy focused on trauma and grief, in combination with selected medications, can be effective in alleviating PTSD symptoms and accompanying depression. More medication treatment research is needed to increase our knowledge of how best to treat children who have PTSD.

Parents' responses to a violent event or disaster strongly influence their children's ability to recover. This is particularly true for mothers of  young children. If the mother is depressed or highly anxious, she may need to get emotional support or counseling in order to be able to help her child.

PTSD is often accompanied by depression. In a group of teenage. Depression must be treated along with PTSD in these instances, and early treatment is best.

Social effects of a disfiguring injury 

• A prominent scientist had an ugly scar on her wrist from a dog's teeth; she repeatedly was asked whether she had tried to slit her wrists. 

• An attractive lady was bit in the face and the end of her nose was ripped away; she reported that men were less attracted to her, even after reconstructive surgeries.

Treatment for emotional and social injuries 

• A psychologist is trained to provide therapy and usually is the best choice for a dog bite victim. 

• A psychiatrist is a medical doctor who may provide therapy or medical solutions for a psychological problem. Medical solutions can include prescription drugs and surgery, for which reason they usually are not appropriate in a dog bite case.

The cost of such services is usually covered by insurance. Be sure to get your insurance agent's advice about whom to see and how much treatment is covered. In the section entitled Legal Rights, you will see that the owner of the dog frequently has to pay for all necessary expenses including mental health treatment (among other things).

More information for parents of injured kids 

www.dogbitelaw.com and each of its sections and products, including Dog Bite Law, The Dog Bite Law Adviser, Dog Bite Litigation Forms, What To Do If Your Dog Is Injured Or Killed, Avoiding Liability When You Train, Shelter or Adopt-Out, Anatomy of a Dog Bite Case, and the foregoing text, are (c) 1999-2009 Kenneth M. Phillips. All rights reserved. Reproduction in whole or part prohibited except where advance permission is granted in writing. Please read the disclaimer and our rules for linking and quoting. Reporters seeking interviews are welcome to contact us by clicking here.