Dog bites can leave kids with emotional scars too

NEW YORK (Reuters Health) - When animals attack, some kids might develop post-traumatic stress disorder, or PTSD.

That’s the message of a new study that followed kids in China after they came to the emergency room (ER) for animal bites - the cause of millions of injuries every year.

Some people suffer from PTSD after experiencing an event that puts them or another person in danger, such as a car accident or assault. People with PTSD often have disturbing memories and dreams of that event that may interfere with their everyday lives.

PTSD may be especially worrisome in kids, said Dr. Nancy Kassam-Adams, co-director of The Center for Pediatric Traumatic Stress at The Children’s Hospital of Philadelphia, because it can interfere with their normal development. For example, if a child suffers from a traumatic event at the age when most kids learn to read, it’s a “bigger deal” for that child to need time to recover than it would be for an adult, she said.

In the study, Dr. Li Ji, a pediatrician at Peking Union Medical College Hospital in Beijing and his colleagues studied 358 kids age 5-17 that came into the ER at Peking University People’s Hospital, also in Beijing, after being attacked by an animal. Most kids had dog bites, but some had been bitten by cats, rabbits, rats, or guinea pigs.

The kids got normal treatment for their bites, depending on how severe they were, including rabies vaccines, cleaning and closing the wounds, and antibiotics. The kids were also checked for symptoms of PTSD and similar conditions when they came to the ER, as well as one week later and three months later.

At their three-month check-up, 19 of the 358 kids were diagnosed with PTSD. Kids who had been hospitalized for severe bites were most at risk for the disorder - 10 out of 38 of them had developed PTSD. There was no significant difference in how often younger or older kids got PTSD, and boys and girls were diagnosed at similar rates.

The results are published today in the journal Pediatrics.

The authors didn’t compare the group of bite victims to a wider population of kids, but the finding that about 5 percent of kids who were bitten got PTSD is similar to what other studies that have found for injured kids, Kassam-Adams said.

But that number might not really reflect what all kids are going through, she said. Lots of kids will have trouble going back to normal after a traumatic event but won’t be disturbed enough to get diagnosed with PTSD.

The authors say that doctors should be aware that kids are at risk for PTSD after animal attacks, especially after severe bites.

Kassam-Adams, who was not involved with the study, said that the injury itself might not be the only thing that influences whether a kid gets PTSD - the care the kid gets afterward can play a role too.

“It’s every important what happens in that ER, and how doctors and nurses respond,” she told Reuters Health. This study, she said, “certainly speaks to the need to attend to the psychological impact of these kids of injuries.”

Ji said that the study’s findings got that message across to doctors in his hospital. “At the very beginning, some of the doctors did not understand and did not realize the importance of these (psychological) check-ups,” he told Reuters Health.

But after his team shared their results, “nearly all of the pediatric patients coming into the ER in the hospital received this check-up,” he said.

SOURCE: Pediatrics, online July 12, 2010.