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Got a Pandemic Puppy? Learn How to Prevent Dog Bites

The Checkup

Got a Pandemic Puppy? Learn How to Prevent Dog Bites

With new puppies and kids at home, doctors are worried about treating more children for dog bites.

Credit…Manon Cezaro

  • Feb. 23, 2021, 2:33 p.m. ET

The surge in pet adoptions during the pandemic brought much-needed joy to many families, but doctors are worrying about a downside as well: more dog bites.

A commentary published in October in The Journal of Pediatrics noted an almost threefold increase in children with dog bites coming into the pediatric emergency room at Children’s Hospital Colorado after the stay-at-home order went into effect.

The lead author, Dr. Cinnamon Dixon, a medical officer in the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said: “If someone were to tell me they were going to get a new dog during Covid, I would first and foremost want to make sure that family is prepared to have a new entity in their household, a new family member.”

Dr. Dixon said that as a pediatric emergency room doctor, taking care of children who get bitten had been a priority for her. Still, she said, from the stories she heard, she often felt “that dogs are victims in this as well.”

Brooke Goff, a partner in the personal-injury law firm the Goff Law Group in Hartford, Conn., said, “We’re definitely seeing a huge uptick in dog bite cases.”

Ms. Goff said that dog bites harm children in ways that go well beyond the physical damage. “It creates major emotional issues and PTSD,” she said. “If you’ve ever spoken to a dog bite victim as an adult that was bitten as a child, they are deathly afraid of dogs.”

Dog bites are “an underrepresented public health problem” in the United States, said Dr. Dixon, the daughter of a veterinarian who grew up around animals. The Centers for Disease Control and Prevention’s best estimates from old research put the number of dog bites at 4.5 million a year. There are over 300,000 nonfatal emergency department visits a year related to dog bites, and among children, the greatest incidence is in school age children, aged 5 to 9, but the most severe injuries are among infants and young children, presumably because they are less mobile, and lower to the ground, with their heads and faces closer to the dogs.

Dr. Robert McLoughlin, a general surgery resident at the University of Massachusetts Medical School in Worcester, was the first author on a 2020 study of hospitalizations for pediatric dog bite injuries in the United States. He said that his research grew out of an interest in pediatric surgery and pediatric injury prevention. “I had seen a lot of cases of toddlers with head and neck injuries,” he said.

The study showed that younger children, ages 1 to 4 and 5 to 10, were much more likely to need hospitalization than those over 11. In the youngest children, most injuries are to the head and neck, and beyond the age of 6, extremity wounds (arms, legs, hands) become increasingly prevalent and predominate after the age of 11, Dr. McLoughlin said.

The bites that require hospitalization and surgical repair are the most serious injuries, such as toddlers bitten in the face and neck, where many critical structures can be damaged, including eyes and ears, and there can be devastating cosmetic damage done as well. But hand injuries can also have a very lasting impact and need expert repair.

For dog bite prevention, Dr. Dixon said, “the No. 1 strategy remains supervision.” Children should learn to leave dogs alone when they are eating, when they are sleeping with a favorite toy, when they are caring for their puppies. They should not reach out to unfamiliar dogs. And dog owners should keep their dogs healthy and should socialize and train them from an early age.

“It’s important we take responsibility for our animals,” said Ms. Goff, who has a dog named Daisy that she brings with her to the office. “Most dogs don’t bite to attack, they bite because they’re scared or provoked.”

Ms. Goff also emphasized that from the point of view of liability, anyone who owns a dog should have insurance coverage. In her state, Connecticut, a strict liability state, “I don’t have to prove anybody was at fault,” she said, and the dog owner is responsible for the damages. “If you can afford the dog, you can afford the insurance,” she said.

She said that it’s important as well that dog bites be reported because of the need to track dogs who bite multiple times, but reassured those who were worried that a dog might be destroyed that, at least in Connecticut, unless there is a catastrophic or fatal injury, “our forgiveness about animals extends quite heavily.”

When dogs do show aggressive behavior, Dr. Dixon said, owners should seek expert help from a veterinarian or “a behavioral expert in canine aggression — ideally before something bad happens.”

Dr. Judy Schaechter, a professor of pediatrics and public health at the University of Miami, said that given the increase in puppy buying during the Covid epidemic, “We’re now a year into this; puppies may be big, strong dogs at this point.” And with many parents juggling work from home with their children’s school issues, it can be difficult for them to supervise all the children (and pets) all the time.

Bites often occur, Dr. Schaechter said, “around playing and feeding behaviors.” Small children are particularly at risk, in part because they may be close to the dog’s food dish, or on the ground when food falls, and the dog may see the child as competition. “Any dog can bite, any breed can bite, and that can be horrific,” she said, but a medium or large dog, or a dog with a very strong jaw, “can quickly do a lot more damage.”

When Dr. Dixon saw children who had been bitten in the emergency room, “the most common story I would hear over and over,” she said, involved “resource guarding,” in which the child seemed to be encroaching on something that belonged to the dog. “The child was next to the dog’s food or had gone next to a dog’s toy or was playing with the dog and the dog jumped up and grabbed the arm instead of the bone,” she said.

Dr. McLoughlin sees opportunities for programs to address dog bite prevention, perhaps drawing lessons from programs that discuss “stranger danger.” It’s important to teach children not to approach strange dogs, he said, but also to help them interpret dogs’ behavior, “to identify when a dog is saying leave me alone, give me some space.” He is interested in the possibility of taking dogs into schools in order to educate children about dogs they may encounter outside their homes, but emphasized that parents should be teaching even very young children about how to approach a dog — including that they should always ask the owner first.

Dr. Schaechter pointed to research on the benefits of having a dog in the family, from the joys of companionship and the lessons children learn from caring for a pet to the medical evidence that children may be at lower risk of allergy and asthma if they are exposed early to animals. The bond between children and their pets is the substance of so many books and movies, Dr. Schaechter said. “It’s real — but don’t let that be so romantic that a child ends up being hurt or scarred.”

[Get the C.D.C.’s advice on dogs, the A.A.P.’s advice on dog bite prevention, and more tips from the American Veterinary Medical Association]

To Keep Obesity at Bay, Exercise May Trump Diet

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Credit Getty Images

Young rats prone to obesity are much less likely to fulfill that unhappy destiny if they run during adolescence than if they do not, according to a provocative new animal study of exercise and weight. They also were metabolically healthier, and had different gut microbes, than rats that keep the weight off by cutting back on food, the study found. The experiment was done in rodents, not people, but it does raise interesting questions about just what role exercise may play in keeping obesity at bay.

For some time, many scientists, dieting gurus and I have been pointing out that exercise by itself tends to be ineffective for weight loss. Study after study has found that if overweight people start working out but do not also reduce their caloric intake, they shed little if any poundage and may gain weight.

The problem, most scientists agree, is that exercise increases appetite, especially in people who are overweight, and also can cause compensatory inactivity, meaning that people move less over all on days when they exercise. Consequently, they wind up burning fewer daily calories, while also eating more. You do the math.

But those discouraging studies involved weight loss. There has been much less examination of whether exercise might help to prevent weight gain in the first place and, if it does, how it compares to calorie restriction for that purpose.

So for the new study, which was published last week in Medicine & Science in Sports & Exercise, researchers at the University of Missouri in Columbia and other schools first gathered rats from a strain that has an inborn tendency to become obese, starting in adolescence. (Adolescence is also when many young people begin to add weight.)

These rats were young enough, though, that they were not yet overweight.

After weighing them, the researchers divided the animals into three groups.

One group was allowed to eat as much kibble as they wished and to remain sedentary in their cages. These were the controls.

Another group, the exercise group, also was able to eat at will, but these animals were provided with running wheels in their cages. Rats like to run, and the animals willingly hopped on the wheels, exercising every day.

The final group, the dieting group, was put on a calorie-restricted meal plan. Their daily kibble helpings were about 20 percent smaller than the amount that the runners ate, a portion size designed to keep them at about the same weight as the runners, so that extreme differences in body size would not affect the final results.

After 11 weeks, all of the animals were moved to specialized cages that could measure their metabolisms and how much they moved around. They then returned to their assigned cages for several more weeks, by which time they were effectively middle-aged.

At that point, the control animals were obese, their physiques larded with fat.

The runners and the lower-calorie groups, however, although they also had gained ounces, had put on far less weight than the controls. None were obese.

Both exercise and portion control, in other words, had effectively protected the animals against their fated fatness.

But beneath the skin, the runners and the dieters looked very unalike. By almost all measures, the runners were metabolically healthier, with better insulin sensitivity and lower levels of bad cholesterol than the dieters. They also burned more fat each day for fuel, according to their metabolic readings, and had more cellular markers related to metabolic activity within their brown fat than the dieting group. Brown fat, unlike the white variety, can be quite metabolically active, helping the body to burn additional calories.

Interestingly, the runners also had developed different gut microbes than the dieters, even though they ate the same food. The runners had greater percentages of some bacteria and smaller populations of others than the dieters or the control group; these particular proportions of gut bugs have been associated in a few previous studies with long-term leanness in both animals and people.

Perhaps most striking, “the runners showed no signs of compensatory eating or compensatory inactivity,” said Victoria Vieira-Potter, an assistant professor of nutrition and exercise physiology at the University of Missouri who oversaw the study. They didn’t scarf down more food than the control group, despite running several miles every day and, according to the specialized cages, actually moved around more when not exercising than either of the other groups of rats.

In essence, the runners, while weighing the same as the dieters at the end of the study, seemed better set up to avoid weight gain in the future.

Of course, these were rats, which do not share our human biology or our tangled psychological relationships with food and body fat.

This study also involved young, normal-weight rodents and cannot tell us whether exercise or dieting alone or in combination would aid or hinder weight loss in people (or animals) who already are overweight, Dr. Vieira-Potter said. Metabolisms change once a body contains large amounts of fat, and it becomes increasingly difficult to permanently drop those extra pounds.

So better to avoid weight gain in the first place, if possible. And in that context, she said, “restricting calories can be effective,” but exercise is likely to be more potent in the long term and, of course, as common sense would tell us, doing both—watching what you eat and exercising—is best of all.

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Turning Your Pet Into a Therapy Dog

Photo

Credit Paul Rogers

It did not take long for me to recognize the therapeutic potential of Max, the hypoallergenic 5-month-old Havanese puppy I adopted in March 2014. He neither barked nor growled and seemed to like everyone, especially the many children that come up and down our block.

When I asked if a crying child passing by would like to pet a puppy, the tears nearly always stopped as fluffy little Max approached, ready to be caressed.

So I signed us up for therapy dog training with the Good Dog Foundation, which met conveniently in my neighborhood. If we passed the six-week course, we would be certified to visit patients in hospitals and nursing homes, children in schools, and people in other venues that recognize the therapeutic potential of well-behaved animals.

Training involves a joint effort of dog and owner, usually in groups of four to eight pairs. The dog can be any size, any breed, but must be housebroken; nonaggressive; not fearful of strangers, loud or strange noises, wheelchairs or elevators, and able to learn basic commands like sit, lie down and leave it. Good temperament is critical; a dog that barks incessantly, nips or jumps on people uninvited would hardly be therapeutic.

During our first visit to patients at my local hospital, a woman who said she’d had a “terrible morning” invited Max onto her bed, showered him with affection and, crying with pleasure, thanked me profusely for bringing him around to cheer her up.

Moments later, on the pediatrics ward, a preverbal toddler hospitalized with croup spotted Max and came charging down the hall squealing with delight. The two met eye-to-eye; Max even appeared to smile, and she giggled as she patted his head.

I don’t know about Max, but I was hooked. I agreed to bring him for monthly patient visits, with a promise to do more if my schedule permitted, and I was able to do the required pre-visit bath.

A therapy dog need not be small and fluffy. A neighbor with a “mush” of a 90-pound American pit bull named Pootie has had similar experiences at the Veterans Affairs New York Harbor Healthcare System’s Brooklyn campus. During the first visit, one patient told him repeatedly, “You made my day.”

But while a hospital’s voluntary pet therapy program is designed to aid patients, in my experience the chronically-stressed hospital staff benefits as much if not more from pet visits. “Can I pick him up?” is the typical request from hospital personnel I encounter, and some don’t even wait for me to say yes.

Therapy pets differ from service animals like those that guide the blind, detect impending health crises for people with epilepsy or diabetes, or stimulate learning for children with autism or cerebral palsy.

Pet therapy most often involves privately owned animals – usually dogs, but also cats, rabbits, even kangaroos, birds, fish and reptiles – that their owners take to facilities to enhance the well-being of temporary or permanent residents. Thus, in addition to relieving the monotony of a hospital stay or entertaining residents in a nursing home, Max might visit a school where young children wary of reading aloud will happily read to a dog that does not care about mistakes.

At my local hospital, therapy dogs often attend group sessions for psychiatry patients. Cynthia Chandler, a counseling professor at the University of North Texas and author of “Animal Assisted Therapy in Counseling,” reports that visits by her dog Bailey increased patient participation in group therapy and improved hygiene and self-care among those with severe mental illness.

At Veterans Affairs hospitals, not only therapy dogs but also parrots have reduced anxiety and other symptoms among patients being treated for post-traumatic stress disorder.

Valerie Abel, a psychologist who coordinates the pet therapy program at the Brooklyn Veterans Affairs hospital, said, “The presence of therapy dogs makes such a difference. Many ask when they’ll next be back. A big dog can put its head on patients’ beds and you can actually see them relax.”

Studies have shown that after just 20 minutes with a therapy dog, patients’ levels of stress hormones drop and levels of pain-reducing endorphins rise. Endorphins are the brain’s natural narcotic, the substance responsible for the runner’s high that helps injured athletes ignore pain.

In elderly patients with dementia, depression declines after they interact with a therapy animal. And researchers at the University of Southern Maine showed that therapy dog visits can calm agitation in patients with severe dementia.

In a controlled study of therapy dog visits among patients with heart disease, researchers at the University of California, Los Angeles, found a significant reduction in anxiety levels and blood pressure in the heart and lungs in those who spent 12 minutes with a visiting animal, but no such effect occurred among comparable patients not visited by a dog.

Therapy dogs are often described as better than any medicine. They know instinctively when someone needs loving attention. Last winter, when I was felled by the flu (despite my annual shot), 1-year-old Max lay at the foot of my bed for hours on end, making none of his usual demands for attention and play.

In an intriguing pet therapy program, sometimes called pets behind bars, benefits accrue to both the animals and the humans with whom they interact. Shelter dogs considered unadoptable and living on “death row” are assigned to be cared for and trained by selected prison inmates, including convicted killers and rapists, many of whom have serious anger issues.

The inmates work to socialize the dogs, teaching them to trust people, behave appropriately and obey simple commands. In turn, violence and depression among the inmates is lessened; they learn compassionate behavior, gain a sense of purpose, and experience unconditional love from the dogs in their care.

At the completion of training, rehabilitated dogs are offered to people who want to give a shelter animal a permanent home. Through the Safe Harbor Prison Dog Program at Lansing Correctional Facility in Lansing, Kansas, for example, some 1,200 dogs have been adopted as pets.

In a related program, veterans back from service in Iraq and Afghanistan are giving basic obedience training to shelter dogs, a project that helps the vets readjust to being home and offers the dogs a chance to gain a home of their own.

Before signing up for therapy dog training, you’d be wise to find out first what the program involves and its cost and what will be required of you by the facilities you hope to visit. I’ve had to provide annual documentation of Max’s vaccinations and freedom from intestinal parasites, which typically requires a visit to the vet. I too had to show I was immune to multiple infectious diseases and free of H.I.V., and the hospital had to test me for drug abuse.

Still, the rewards Max and I have accrued as hospital volunteers more than compensate for these requirements.

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