Is child biting a dangerous behavior?

Child Biting: Dangers and Management

Human bites from children can be dangerous and require prompt medical attention due to the risk of infection and disease transmission. 1

Health Risks of Human Bites

• Human bites can be more virulent than animal bites and can cause severe trauma, with the oral flora containing numerous potentially pathogenic bacteria 1, 2
• The bacteriologic characteristics of human bite wounds reflect the normal oral flora, including streptococci (in 80% of wounds), staphylococci, Haemophilus species, and Eikenella corrodens as prominent aerobic pathogens 1
• Anaerobic bacteria are present in 60% of human bite cases, including Fusobacterium species, peptostreptococci, Prevotella species, and Porphyromonas species, usually in mixed culture 1
• Many anaerobes in human bites produce β-lactamases, making them resistant to penicillin and first-generation cephalosporins 1
• Human bites have potential to transmit viral diseases such as herpes, hepatitis B and C, and HIV infection 1

Management of Human Bite Wounds

• All human bite wounds should receive prophylactic antimicrobials as early as possible regardless of the wound's appearance 1
• Wounds should be irrigated thoroughly (with antibiotic-containing solutions) and superficial debris removed 1
• Infected wounds should not be closed 1
• Tetanus prophylaxis status should be confirmed and updated if outdated or unknown 1
• Deeper wounds, especially on hands (clenched-fist injuries), should be evaluated by a specialist for potential penetration into synovium, joint capsule, or bone 1

Child Biting in Different Contexts

Developmental Context

• Biting is considered a common developmental stage in infant growth but becomes inappropriate once children enter daycare and school settings 3
• Biting is especially common among toddlers 13 to 30 months of age who often lack appropriate verbal skills and resort to aggressive means 2
• Children with developmental and neurologic impairment may be at higher risk for biting behaviors 1, 4

Abuse Context

• Child biting can be a form of child abuse, as documented in cases where parents have bitten children, causing injuries such as tongue lacerations 5
• Multiple bite marks on a child should raise suspicion of potential abuse 5

School and Daycare Setting

• Having a protocol in place for human bite incidents in school settings helps ensure appropriate and timely care 3
• Bite injuries in daycare are usually minor but should still be treated by washing, applying cold compresses, and comforting the child 2
• Schools should document bite incidents to identify triggers and knowledge deficits for planning educational interventions 3

Prevention Strategies

• For habitual self-biting behaviors, management approaches include counseling, sedatives, or prosthetic shields like soft mouth guards 4
• In daycare settings, prevention methods include physical changes within the room, behavior modification, and classroom management techniques 2
• Punishment is not effective for managing biting behaviors 6
• Education for children, parents, siblings, and teachers about appropriate responses to biting is essential 6, 3

When to Seek Medical Care

• All human bite wounds that break the skin should receive medical attention due to high infection risk 1
• Immediate medical attention is required if the bite:
  • Penetrates deeply into tissue 1
  • Occurs on the hand, face, or near joints 1
  • Shows signs of infection (redness, swelling, warmth, pus) 1
  • Occurs in someone with compromised immunity 1

Human bites from children represent a significant health concern that requires proper assessment, treatment, and prevention strategies. While developmental biting is common in young children, appropriate intervention is necessary to prevent complications and transmission of infectious diseases.