A physician acquaintance of mine is on a mission to promote awareness, especially amongst emergency physicians, of the potential for post-traumatic stress disorder in children who have been attacked and/or bitten by dogs. Thus this blog post. As a practicing psychiatrist, he has treated a number of such children, and he believes that it is very important for physicians who are treating these children for their bite wounds to inform parents to actively watch for signs of PTSD and to obtain evaluation and treatment if indicated. Dr. Schmitt has lectured and published on this topic (Larry Schmitt, MD, Dog bites in children: Focus on posttraumatic stress disorder, Contemporary Pediatrics, Jul 1, 2011). He makes a good case for the need for parents and pediatricians to monitor these children closely after their injury, and for incorporating information about PTSD into post-treatment ED and inpatient discharge instructions.
One may not readily consider the diagnosis of PTSD in children, but after dog bites it appears that children pick up on the guilt and sadness in their parents’ faces, and tend to bury their feelings and avoid discussion of the attack. This of course may precipitate PTSD, and make it more difficult to identify this pathology unless one recognizes the symptoms (excessive anxiety, irritability, decreased school performance, sleep disturbance, reduced creativity, withdrawal, altered appetite, depression, physical complaints, pronounced startle responses, and behavior problems), and relates them back to the attack. Parents need to know not only how to recognize PTSD, but also what to do to mitigate the potential for their child to develop PTSD. Preemptive psychological management is likely to be helpful, and parents need to participate in helping their children cope with this trauma and its psychological impact.
Dr. Stanley Goodman published a pdf on the web which provides an extensive outline of this issue; and he suggests that ‘children need to be helped to understand the following, in order to lessen their feelings of vulnerability and helplessness:
1. that many children become fearful whenever they have reminders of the incident, such as seeing other dogs or even watching movies/TV shows with dogs.
2. that they may feel more nervous when they leave their house, fearing they may be attacked and bitten again by a dog.
3. that they may experience depressive symptoms, such as feelings of helplessness, frustration, and diminished social and/or educational functioning; but these feelings are not a sign of weakness. Rather, they are a foreseeable reaction to having been bitten.’
Emergency physicians treat a lot of children with dog bites, and they have an important role to play beyond caring for the injuries themselves. Making parents aware of the potential for PTSD, providing information about the signs and symptoms of PTSD in written dog-bite discharge instructions, and suggesting referrals for preemptive psychological counseling can all make a significant contribution to the child’s successful recovery from this kind of trauma.
This post also appears in The Fickle Finger