**5. Further considerations**

#### **5.1 Animal control**

Dog "perpetrators" are not commonly reported unless a police or animal control report is filed. A dog with multiple offenses may go undetected to law enforcement unless victims report their injuries, provide the name or address of the dog owner, and breed of dog. At our institution, all dog bites are reported to the county animal control agency. Potentially, a dog owner with a record of multiple reports could be reprimanded with fees or have their dog removed from the house.

#### **5.2 Prevention and anticipatory guidance to dog owners**

As previously discussed, the majority of dog bites are caused by household pets or animals known to the victim [2, 26]. Many of the attacks occur in or around the family home [2, 26, 27]. By nature, dogs are social animals that navigate within a pack hierarchy [26]. Communication is relayed through both vocal means and body language, which can be missed or misinterpreted by their human counterparts [26]. The posture, tail movements, facial features, and noises made by the dog can often provide information on an imminent attack [26]. Of course, this is not to say that the victim is to blame for a dog attack. Rather, dog owners should be made aware of signs of aggression and how to properly respond to them. There are plenty of resources available through the internet or local canine training programs for owners to learn techniques of de-escalating signs of aggression. Additionally, children should never be left unsupervised with a dog. Some tips to help prevent dog bites include:


#### **5.3 Psychological Sequelae of dog bites**

Although poorly reported, the psychological impact of dog bites can range from avoidance behaviors to formally diagnosed post-traumatic stress disorder (PTSD) [27–29]. One study reports that nearly one-third of all children that suffered a dog bite injury developed a new fear or avoidance of dogs [29]. The same study found that 5% were diagnosed with PTSD at three months post-injury [29]. Symptoms of PTSD included numbness, apathy, avoidance behaviors, increased arousal, hypervigilance, and vivid recollections of the event [27–29]. These can present anywhere from immediately after the event to months later [27–29]. Additionally, an overwhelming 85% of parents whose children sustained a dog bite injury reported changes in their own emotional state [29]. Approximately two-thirds reported feelings of guilt and half reported fear and anger surrounding the event [29].

The first step toward recovery after a traumatic event is recognizing the effects it has had on the victim and those around them. Informing family members of the signs and symptoms of trauma is essential for identifying when professional help is needed [28–29]. As providers, referral to a psychiatrist or psychologist for therapeutic intervention is appropriate after any incidence of the dog attack, even if there are no apparent stress disorder symptoms [28, 29]. Particularly important for early

intervention are children who sustained multiple or severe dogs bite wounds, which has been shown to increase the risk of PTSD development [29].
