What is the line of treatment for a 5-year-old boy with a small dog bite?

Management of Small Dog Bite in a 5-Year-Old Boy

For a 5-year-old child with a small dog bite, immediately wash the wound thoroughly with soap and water for 15 minutes, assess the dog's availability and health status, initiate rabies post-exposure prophylaxis if the dog cannot be observed, consider antibiotic prophylaxis (amoxicillin-clavulanate), ensure tetanus immunization is current, and suture the wound if cosmetically indicated (especially facial wounds). 1, 2, 3

Immediate Wound Management

Wound cleaning is the single most critical initial step:

• Thoroughly wash and flush the bite wound immediately with soap and copious amounts of water for approximately 15 minutes 2, 3
• Apply a virucidal agent such as povidone-iodine solution to the wound after washing 1, 2
• Copious irrigation with normal saline using a 20-mL or larger syringe (or 20-gauge catheter attached to syringe) should follow 3
• Explore the wound for tendon or bone involvement and possible foreign bodies 3

Dog Assessment and Rabies Risk

The management pathway depends critically on whether the dog is available for observation:

If Dog is Healthy and Available:

• Confine the dog and observe it daily for 10 days 4, 1
• Do NOT administer rabies vaccine to the dog during the observation period 4, 1
• Do NOT begin rabies prophylaxis in the child unless the dog develops clinical signs of rabies during observation 2
• Report any illness in the dog immediately to local health department 4

If Dog is Stray, Unwanted, or Unavailable:

• The dog should be euthanized immediately and head submitted for rabies examination 4, 1
• Begin rabies post-exposure prophylaxis immediately while awaiting test results 2
• Discontinue vaccine only if laboratory testing (direct fluorescent antibody test) is negative 2

Rabies Post-Exposure Prophylaxis (if indicated)

For previously unvaccinated children, administer BOTH:

• Human rabies immune globulin (RIG) - given at presentation 2, 3
• Rabies vaccine - administered on days 0,3,7, and 14 2, 3
• RIG and vaccine must be administered at different sites 2

Antibiotic Prophylaxis

Strongly consider prophylactic antibiotics given the high-risk features in children:

• Amoxicillin-clavulanate is the first-line prophylactic antibiotic 3
• Antibiotic prophylaxis is especially indicated for: 3, 5
  • Puncture wounds
  • Wounds to the hand or face
  • Deep wounds with evidence of edema or crushing
  • Wounds over tendons or bones
  • Immunocompromised patients

Important caveat: Even small bites in children warrant antibiotic consideration because children are at higher risk for infection complications 5, 6

Wound Closure

Wound closure decisions depend on location and contamination:

• Facial wounds should be sutured after careful debridement and irrigation for optimal cosmetic outcome 3, 6
• Gaping wounds may be closed if cosmetically favorable 3
• Avoid primary closure of heavily contaminated wounds or hand wounds 6
• Children commonly sustain facial injuries due to their low stature, making cosmetic closure particularly important 7, 6

Tetanus Prophylaxis

• Administer tetanus prophylaxis as indicated based on the child's immunization history 2, 3, 5
• This is a standard component of bite wound management 2, 8

Critical Pitfalls to Avoid

• Never delay wound washing - this is the most effective infection prevention measure 2, 3
• Do not vaccinate the dog during the 10-day observation period - this can confuse rabies signs with vaccine side effects 4, 1
• Do not assume domestic dogs are low-risk - rabies risk varies regionally and even domestic animals are often unvaccinated 2, 3
• Do not underestimate infection risk in children - they have higher complication rates and frequently sustain facial injuries requiring aggressive management 7, 5, 6