Bites (Human and Animal)—Child Care and Schools
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Human Bites

Biting is very common among young children but usually does not lead to serious infectious disease issues. If the skin is broken, bacteria introduced into the wound can cause a tissue infection that needs to be treated by a health professional. Blood-borne diseases 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, which transfers germs to the bitten person. Hepatitis B virus, HIV, and hepatitis C virus are examples of blood-borne disease- causing germs. However, the risk of transmission of these viruses is very low in child care and school settings. For HIV, there have not been any episodes of transmission in a child care setting or school. 

What are the roles of the teacher/caregiver and the family?

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    Provide first aid to the child who was bitten by washing any broken skin and applying a cold compress to any bruise.
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    Notify the parent/guardian of the biter and of the bitten child, if possible without identifying the biter to the family of the child who was bitten or the child who was bitten to the family of the biter.
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    Recommend a pediatric health professional visit if the skin is broken because, in some cases, preventive antibiotics may be indicated.
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    Initially focus on the injured child, rather than on the child who did the biting. Later, try to determine why the biting happened. Biting may occur when a child is excited, frustrated, or angry. See if future biting situations can be prevented by identifying what may cause these behaviors and avoiding them, distracting the child before biting occurs, or offering alternative activities. Suggest the child use words to express frustration or anger. Offer a harmless, vigorous physical activity the child can do when frustrated or angry. If the biting behavior of a child is repetitive despite 3 or 4 weeks of using these suggested measures, consider seeking additional professional help to develop an effective management plan. Consult the program’s mental health consultant and your health consultant (if your program has one) or the child’s health professional. Use the following resources:
     
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      Play Nicely, a free video for parents and early childhood educators about how to handle aggressive behavior in young children (http://playnicely.vueinnovations.com).
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      Early Childhood Education Linkage System (ECELS)- Healthy Child Care Pennsylvania of the Pennsylvania Chapter of the American Academy of Pediatrics (www.ecels-healthychildcarepa.org). Search for “biting” and “challenging behavior” to locate resources. The ECELS materials may be used at no cost. Pennsylvania early educators may pay a fee to have ECELS staff review their responses to the self-learning module assessment questions and obtain state-authorized training credits for using the self-learning module.

Exclude from group setting?

No, unless the bite caused broken skin or prolonged bleeding, which may require treatment by a health professional, or the child who was bitten or the child who bit the other 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. 

Readmit to group 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 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%. After cat bites, the rate of infection is as high as 80%. (See Infections Caused by Interactions of Humans With Pets and Wild Animals in Chapter 8 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: 
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    First, there is a chance of developing a bacterial infection. The longer the animal’s mouth germs stay in the wound, the greater the potential of infection that will need antibiotics. Some wounds require preventive antibiotics. The health professional needs to decide whether the wound should be left open or closed with materials such as special tape or stitches. All animal bites need to be watched closely for signs of infection until they are fully healed.
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    Second, the situation in which the animal bite occurred should be evaluated for the possibility of transmission of rabies. 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 child care facilities or schools. Children should not have direct contact with wild animals in any setting. Rodents (mice, squirrels, and gerbils), bats, 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 that infects the nervous system. The virus spreads from a rabies-infected animal’s saliva into the bite site. Rabies is usually transmitted by the bite of wild animals. However, the virus can be spread by unimmunized pets and, in rare cases, immunized pets that have been infected with the rabies virus. 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?

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    By immunizing dogs and cats with rabies vaccination
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    By avoiding contact with wild or stray animals, particularly those acting peculiarly or aggressively
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    By not allowing children to touch dead animals

What are the roles of the teacher/caregiver and the family?

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    Provide first aid by washing any broken skin and applying a cold compress to any bruise.
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    Teach children to avoid contact with stray, wild, or dead animals.
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    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 child care facility, a time- specified certificate from a veterinarian indicating the pet meets this list of conditions should be on file.
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    All contact between animals and children should be supervised by a teacher/caregiver.
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    Contact a health professional if
     
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      A child or an adult is bitten by a pet or an unknown or wild animal.
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      There is redness, swelling, drainage, or pain at the site of the bite.
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      The skin is broken.
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      A bat is found in a room with sleeping children or if children have touched a bat. Bat bites are not easily detected.
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    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).
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    If there is a chance a person has been exposed to rabies, arrange for urgent medical attention.

Exclude from group 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. 

Readmit to group 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. 

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.

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