What is the management for a 3-year-old (three-year-old) with a dog bite?

Management of Dog Bite in a 3-Year-Old Child

A 3-year-old child with a dog bite requires immediate wound cleaning, assessment for infection risk, prophylactic antibiotics with amoxicillin-clavulanate, and observation of the biting dog for 10 days to rule out rabies. 1

Initial Wound Management

• Immediate and thorough wound cleaning is essential:
  • Clean with sterile normal saline (no need for iodine or antibiotic solutions)
  • Remove superficial debris
  • Deep debridement is usually unnecessary unless there is significant tissue damage
  • Elevate the injured body part, especially if swollen, to accelerate healing 1

Antibiotic Prophylaxis

• Prophylactic antibiotics are indicated for:

  • Moderate or severe bite wounds
  • Puncture wounds (especially if penetration of bone, tendon, or joint)
  • Facial bites
  • Bites to hands or feet
  • Wounds in immunocompromised children 2

• First-line antibiotic choice:

  • Amoxicillin-clavulanate (oral) 1, 2
  • Duration: typically 3-5 days for prophylaxis, 7-14 days for established infection

• Alternative oral options if allergic to penicillin:

  • Doxycycline (for children >8 years old)
  • Trimethoprim-sulfamethoxazole plus metronidazole or clindamycin 1

Rabies Prevention

• The biting dog should be confined and observed daily for 10 days 1
• Administration of rabies vaccine to the dog is not recommended during this observation period
• If the dog shows signs of illness during confinement:
  • Report immediately to local health department
  • If signs suggestive of rabies develop, the dog should be euthanized and tested 1
• If the dog is stray or unwanted, it may be euthanized immediately and tested for rabies 1

Special Considerations for Children

• Children, especially those under 5 years old, are at higher risk for severe dog bites 3
• Facial bites are most common in children (58.5%), followed by extremity bites (35.5%) 3
• Younger children (mean age 6.3 years) tend to have more severe bites than older children 3

Wound Closure

• Primary closure of dog bite wounds is acceptable unless infection is present 4
• Consider delayed closure for:
  • Heavily contaminated wounds
  • Wounds >12 hours old with signs of infection
  • Puncture wounds that cannot be adequately cleaned 1

Tetanus Prophylaxis

• Ensure tetanus vaccination is up to date
• If vaccination status is unknown or inadequate:
  • Administer tetanus toxoid (DTaP for children <7 years)
  • Consider tetanus immune globulin for heavily contaminated wounds 2

Follow-up and Complications

• Schedule follow-up within 24-48 hours to assess for signs of infection
• Monitor for complications such as:
  • Infection (redness, swelling, increased pain, purulent discharge)
  • Septic arthritis or osteomyelitis (especially with bites near joints or bones)
  • Tendonitis
  • Nerve or tendon injury 1

Public Health Reporting

• Document and report the bite to local public health authorities 3
• This reporting is often inadequately performed but is essential for public health monitoring 3

Dog bites in children can be serious and even lethal if not managed properly. The comprehensive approach outlined above addresses both immediate wound care and prevention of infectious complications while ensuring appropriate rabies surveillance.