Human Bites in Pediatric Patients

Human Bites in Pediatric Patients

Key Points

High infection risk (10-50% of cases)
Require thorough evaluation and early intervention
Common in daycare and school settings
Risk of blood-borne pathogen transmission
Significant psychological implications

Epidemiology

Peak age: 3-6 years for occlusal bites
Adolescents: More common in fight bites
Gender distribution: Equal in children
Location frequency:
- Upper extremities (36%)
- Face and neck (31%)
- Lower extremities (16%)
- Trunk (17%)

Classification

Occlusal Bites:
- True bites with dental arch impression
- Common in young children
- Usually during play or conflicts
Clenched Fist Injuries (Fight Bites):
- More common in adolescents
- High risk for joint space involvement
- Often underreported or minimized

Clinical Features and Assessment

Initial Presentation

Wound Characteristics:
- Crescentic or oval-shaped marks
- Central contusion
- Possible tissue avulsion
- Puncture wounds
- Crush injury component
Early Signs:
- Local pain and tenderness
- Immediate bleeding
- Erythema
- Edema
- Ecchymosis

Physical Examination

Essential Components:
- Wound size and depth measurement
- Joint range of motion
- Neurovascular status
- Tendon function assessment
- Regional lymph node examination
- Documentation of tooth marks/impressions
Special Testing:
- Flexor tendon testing
- Joint stability assessment
- Sensation testing
- Capillary refill time

Microbiology and Infection Risk

Common Pathogens

Aerobic Organisms:
- Streptococcus species (70-80%)
- Staphylococcus aureus (60-70%)
- Eikenella corrodens (25%)
- Haemophilus species
- Corynebacterium species
Anaerobic Organisms:
- Fusobacterium species
- Peptostreptococcus species
- Prevotella species
- Bacteroides species

Risk Assessment

High-Risk Factors:
- Delay in treatment >12 hours
- Deep puncture wounds
- Joint space involvement
- Crush component
- Hand injuries
- Immunocompromised state
Blood-Borne Pathogens:
- Hepatitis B virus
- Hepatitis C virus
- HIV
- Risk assessment protocol needed

Management Protocol

Initial Management

Wound Care:
- Copious irrigation with sterile saline
- Wound culture if infection suspected
- Debridement of devitalized tissue
- Assessment for foreign bodies
- Photography for documentation
Laboratory Studies:
- Complete blood count
- C-reactive protein
- Erythrocyte sedimentation rate
- Blood cultures if systemic symptoms

Antibiotic Therapy

Empiric Treatment:
- First-line: Amoxicillin-clavulanate
  - Dosing: 45mg/kg/day divided q12h
  - Duration: 3-5 days for prophylaxis
  - 7-14 days for established infection
- Penicillin-allergic patients:
  - Clindamycin + Fluoroquinolone
  - Doxycycline (if >8 years old)

Wound Closure

Primary closure considerations:
- Clean, non-infected wounds <6 hours old
- Facial wounds (cosmetic importance)
- No underlying structure involvement
Delayed primary closure:
- 48-72 hours observation
- High-risk wounds
- Signs of early infection

Complications and Monitoring

Early Complications

Local Infection:
- Cellulitis
- Abscess formation
- Lymphangitis
- Tenosynovitis
Joint Complications:
- Septic arthritis
- Osteomyelitis
- Joint stiffness

Late Complications

Structural:
- Scarring
- Contractures
- Joint dysfunction
- Growth plate damage in children
Infectious:
- Chronic osteomyelitis
- Chronic joint dysfunction
- Systemic infection sequelae

Special Considerations

Child Protection Concerns

Assessment for:
- Non-accidental injury
- Pattern of repeated injuries
- Inconsistent history
- Delayed presentation
Documentation Requirements:
- Detailed injury description
- Photographic evidence
- Witness statements if available
- Social history documentation

Psychological Aspects

Immediate Impact:
- Acute stress reaction
- Fear of social interaction
- School avoidance
Long-term Support:
- Behavioral assessment
- School reintegration plan
- Family support services

Prevention and Documentation

Prevention Strategies

Educational Interventions:
- Age-appropriate behavior management
- Conflict resolution skills
- Recognition of trigger situations
- Staff training in childcare settings
Environmental Modifications:
- Adequate supervision
- Structured activities
- Safe space design
- Clear behavioral guidelines

Documentation Requirements

Clinical Records:
- Detailed wound description
- Timeline of events
- Treatment provided
- Follow-up plan
Legal Considerations:
- Incident reports
- Witness statements
- Photographic documentation
- Communication with authorities if required

Further Reading