Bites (Human and Animal)—Child Care and Schools

Human Bites

Biting is common among young children but usually does not cause serious infectious disease issues. If the skin is broken, bacteria can enter the wound and cause an infection requiring medical treatment. Blood-borne diseases, such as hepatitis B and C virus and HIV, could be a concern if the biter breaks the skin and blood is drawn into the biter's mouth or if the biter has bleeding gums or mouth sores. However, the risk of transmission of these viruses is very low in early childhood education (ECE) or school settings. No cases of HIV transmission have been reported in ECE or school settings.

What are the roles of the educator and the family?

• Provide first aid to the child who was bitten by washing any broken skin and applying a cold compress to any bruise.

• Notify the parent/guardian of both the child who bit and the bitten child, without disclosing, if possible, the identity of each child to the other family.

• Recommend consulting a pediatric health professional if the skin is broken, as preventive antibiotics may be indicated in some cases.

• Focus first on caring for the injured child before addressing the child who did the biting. Later, try to determine why the biting happened. Biting may occur as sensory exploration or when a child is excited, frustrated, or angry. Identify potential triggers that may cause these behaviors and avoid them, redirecting the child's attention before biting occurs, or offering alternative activities or other appropriate items to bite or chew. Encourage the child to use words to express frustration or anger (eg, "no," "stop," or "I don't like that"). Offer a harmless, vigorous physical activity the child can do when frustrated or angry. Do not use punishment as this can reinforce the behavior. If biting behavior continues despite consistent use of these strategies for 3 or 4 weeks, seek professional help to create an effective management plan. Consult the program's mental health consultant and your Child Care Health Consultant (if your program has one) or the child's health professional. Use the following resources:

  • ? Play Nicely, a free video for parents and EC educators about how to handle aggressive behavior in young children (https://pediatrics.vumc.org/play-nicely).

  • ? Head Start National Center on Health, Behavioral Health, and Safety fact sheet about addressing biting (https://headstart.gov/mental-health/article/biting-fact-sheet-families).

Exclude from educational setting?

No, unless the bite caused broken skin or prolonged bleeding, which may require treatment by a pediatric health professional, or if the child (either the one who was bitten or the one who bit) cannot participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

Readmit to educational setting?

Yes, when all the following criteria are met:

When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group

Animal Bites/Rabies

Animal bites are common. Dog bites account for approximately 90% of bite wounds, perhaps because dogs are very common pets and have a great deal of contact with humans. Many adults allow interactions between children and dogs. Children can behave unpredictably, and dogs have normal protective instincts. The combination can result in injuries for children. The rate of infection after dog bites is 5% to 20%. After cat bites, the rate of infection is as high as 50%. (See Infections Caused by Interactions of Humans With Pets and Wild Animals in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition for a discussion of diseases spread by cats, including "cute" kittens.)

An animal bite that breaks or punctures the skin needs immediate wound care to reduce the risk of infection. The wound should be washed out with water and then promptly evaluated by a health professional for the following reasons:

• First, animal bites can cause bacterial infections. The longer germs from the animal's mouth stay in the wound, the greater the risk of infection. A health professional will determine whether the wound should be left open or closed with materials such as special tape or stitches and whether antibiotics are needed. All bites should be monitored closely for signs of infection until healed.

• Second, the situation in which the animal bite occurred should be evaluated for the possibility of transmission of rabies. The virus spreads from a rabies-infected animal's saliva into the bite site. Although any mammal bite can transmit rabies, bites of some wild animals (eg, bats, raccoons, skunks, foxes, coyotes, bobcats) and some stray and unvaccinated pet dogs and cats are of greatest concern for transmitting the rabies virus. Wild animals should not be kept or allowed to visit ECE or school facilities. Children should not have direct contact with wild animals in any setting. Rodents (mice, squirrels, and gerbils) and rabbits can, but rarely do, carry rabies (woodchucks are an exception). Rabies has occurred in animals in petting zoos, pet stores, animal shelters, and county fairs.

Rabies is a very serious viral infection of the nervous system. The possibility that an animal is infected with rabies is greatest when the animal is unimmunized and the bite was unprovoked. If a pet or wild animal bites and breaks the skin, the situation requires urgent medical attention. Because the rabies virus spreads from the animal's saliva and enters the bite site, the bite wound should be immediately and thoroughly cleaned as soon as possible. The bitten person should be referred for immediate evaluation by a health professional. If possible, the animal should be observed by a veterinarian for signs of rabies.

Report all suspected exposure to rabies promptly to public health authorities, and be sure health professionals are involved in deciding about appropriate treatment right away. Signs or symptoms of rabies in humans include anxiety, difficulty swallowing, seizures, and paralysis. Once signs or symptoms develop, rabies is nearly always a fatal disease.

How do you control rabies?

• By immunizing dogs and cats with rabies vaccination

• By avoiding contact with wild or stray animals

• By not allowing children to touch dead animals

What are the roles of the educator and the family?

• Provide first aid by washing any broken skin for at least 15 minutes with soap and water and applying a cold compress to any bruise.

• Teach children to avoid contact with stray, wild, or dead animals.

• Make sure any animal in a child's environment is healthy and a suitable pet for children; fully immunized; and on a flea-, tick-, and worm-control program (when appropriate). If a pet is on-site at the ECE facility, a certificate from a veterinarian indicating the pet meets this list of conditions and how long the certificate is valid should be on file.

• All contact between animals and children should be supervised by an educator.

• Contact a health professional if

  • ? A child or an adult is bitten by a pet or an unknown or wild animal.

  • ? Redness, swelling, drainage, or pain surrounds the site of the bite.

  • ? The skin is broken.

  • ? A bat is found in a room with sleeping children or if children have touched a bat. Bat bites are not easily detected.

• If you can do so safely, capture or confine the animal for an evaluation. If you cannot make the animal available for evaluation, note the size, appearance, and any distinguishing characteristics of the animal (eg, if it was wearing a collar; if so, if it had tags).

• If there is a chance a person has been exposed to rabies, arrange for urgent medical attention.

Exclude from educational setting?

No, unless

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).

Readmit to educational setting?

Yes, when all the following criteria are met:

When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group