"Dog bites are the second most costly public health problem in the United States with half of all Americans being bitten in their lifetime". - Hoff GL, Cai J, Kendrick R, Archer R. 2005. Emergency department visits and hospitalizations resulting from dog bites, Kansas City, MO, 1998-2002. Mo Med 102(6):565-8
You Are Not Alone!
According to the Centers of Disease Control roughly 889,000 children require medical attention for dog bites per year. Of those, 31,000 require reconstructive surgery. A dog attack is a form of violence and is traumatic for a child, as is any type of violence. Such violence to a child can and does result in Post Traumatic Stress Disorder or other anxiety or mood disorders. If you are a parent of a child with lingering emotional effects as a result of a dog bite you are not alone, although you may feel isolated. One source of support you may wish to explore is the Dog Bite Victim Support Group, hosted by Doggone Safe. http://groups.yahoo.com/group/doggonesafe/
Dog bite Laws and support are in their infancy with the children survivors being, as in the sexual abuse survivors of more than a decade ago, those who are now isolated despite the prevalence.
Mental Health Care for Your Child
A child attacked by a dog has experienced a traumatic loss of control of their body and may require mental health assistance in order to recover emotionally. Keeping in mind the age and maturity of the child, a parent should discuss the available options for help and allow the child to have a say or even make the decision about accessing mental health care. It is important for the child to be made aware that help is available, even at a later time down the road.
Ideally mental health care would begin as soon as possible after the traumatic experience. In many cases, law suits, insurance claim settlements or other factors prevent therapy from starting when it is most required.
Treatment options should include both psychiatric, meaning an M.D., who is a physician, Board Certified in Psychiatric Medicine as well as a therapist. A therapist includes a psychologist which is a PhD in psychology, or a social worker which is usually an MSW or LCSW, among others. The treating provider, if possible, should not only be specialized in the care of children, yet also have experience with treating traumatized individuals.
How to Determine if Your Child Needs Help
Children, particularly over the age of 9, are usually resilient and while they don’t forget the incident they will recover emotionally within weeks to a few months. It is beneficial to keep in mind that the child has suffered not only a tremendous personal event, yet also a loss of control at a young age when coping with such adult issues is simply not in their emotional repertoire.
Signs that indicate the child is not coping:
· Intense fear of dogs (or other fears not present before the attack)
· Loss of interest in previously enjoyed activities
· Failing to attend to personal hygiene
· Change in interactions with peers (isolation from or aggression towards)
· Decline in school work
· Obstinate conduct toward caregiver, teacher or peers
· Aggression, anger or irritability
· Social withdrawal
· Child is emotionally distant (appears not to feel joy or sadness)
· Child seems cold, detached, robotic in their interactions
The latter three are associated with Post Traumatic Stress Disorder and professional help is required immediately.
Keep Parental Stress Private from the Child
A parent may have very real and significant feelings about the trauma, which may involve guilt, anger, frustration, fear, worry, and can include PTSD as well as other mental health issues as a result of their own trauma. These need to be dealt with privately with the parent’s own mental health provider and not be an additional burden to the child.
Talk to the Child
Parents can support the child in the immediate aftermath by talking and listening to their child without judgment or opinion and without being overly concerned about the future or complicating the child’s concerns with the parents’ own feelings. Discussing initially with the child, in a compassionate yet problem solving manner their current issues such as social problems, where their scars are concerned, without deliberating the future of surgeries or wearing makeup if it is a younger child, can be a way to remain problem-focused. Should the child survivor have difficulties with problem-solving during this acute or immediate phase after the trauma, despite the caregiver’s efforts, it may be important to revisit the option to seek mental health guidance, so that the child may still be able to maintain their own independence in control-related matters.
Give Child Control in Decisions Affecting their Body
When possible and when the decision does not interfere with the child's physical wellbeing, giving them back some of that control can be quite valuable. For example, if at some point scar revision as a result of the attack becomes an issue, the child should have a voice in the matter. Oftentimes children receive reconstructive operations, without their voices being heard, due to the physician’s discretion primarily. Another influence in the decision to undergo scar revision arises from parental distress about their child's scars or deformity, a reminder to the caretaker yet not necessarily to the child, of the traumatic experience. A reasonable manner to approach the topic, depending upon the age and the individual child, would be to simply in an age-appropriate manner, ask if the revisions are within their wishes at the present time and how they feel about their scars. It is a very personal issue and providing them with some control again can be for many children, of vital importance regardless of their age.
Reestablish Normal Routines
Once it is medically reasonable, reestablishing usual household routines can be of benefit for the survivor and also the caretaker. Disruption of school, playtime and vacations may exacerbate and even draw further pathologic attention to disturbing issues that are of concern to the child and family as well.
Talk About the Fate of the Family Dog
In some cases (in fact most dog bites are by the family dog or a dog known to the child), the family will have to decide the fate of the dog that bit. The decision should be made with the child's opinion taken into consideration. The strength of their ballot so to speak, as with any loss, being more so depending upon their age and maturity level, rather than their physical injury level or immediate, emotional components. A reasonable rule of thumb is to seek professional guidance on this issue, if it arises, as such a decision warrants perhaps, outside objective thoughts beyond that of the authority figures who may be acting to some degree, out of, understandably their own anxiety. In addition, seeking some professional mediation may dampen any potential ill feelings within the family dynamics during a time when cohesion is of far more import.
Parents are affected by their children's exposure to traumatic events and their own responses and behaviors may often adversely affect the child. If a parent begins to feel sad, anxious, or begins to experience any behavioral changes themselves, these changes, would quite likely affect the child as well. Taking care of oneself is essential to taking care of one's child during such a difficult time.
If the parent suffers from a pre-existing condition, depression or anxiety disorder, in particular PTSD, then seeking a mental health care provider is essential for the caregiver immediately after the attack. Generally it is the caregiver more so than the child survivor at some point who understandably, requires psychiatric and oftentimes psychological assistance, given the burdens and suffering of the uniqueness of the parental trauma after their child has been bitten.
About Dr. King
Michelle R. King, M.D. is a recently, retired physician, who was nearly mauled to death as an eleven-year old child, with subsequent, multiple reconstructive operations. She went on to undergraduate, graduate and medical schools, then residencies in Family Medicine, Neurology and Psychiatry. More recently, over the last two decades, she worked primarily with PTSD patients, predominantly with combat veterans from the Vietnam and Korean Wars. In her private office Dr. King has worked with both traumatized Veterans as well as distressed civilians as a result of dog bites and attacks, as well as those who are survivors of the violent, modern world. Dr. King continues to this day rescuing homeless and abused dogs.