Children bite each other all the time, especially in daycare, and most of these bites never break the skin.1PubMed Central. A bite in the playroom: Managing human bites in child care settings. A bite that leaves only a bruise or tooth marks is almost never dangerous. Once teeth pierce the skin, though, mouth germs are pushed inside the wound, and where on the body that happens matters as much as how big the bite looks. The disease parents fear most, HIV, is the one a bite is least likely to pass on.2PubMed. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm
Bruise, Scrape or Broken Skin, Sorting the Bite
Start by checking whether the skin is broken. A child’s bite usually leaves an arc of marks, or two curved bruises facing each other.3RCPCH Child Protection Portal. Bites: systematic review Redness, bruising, or tooth dents with no opening in the skin can be cared for at home. A puncture or tear, even a tiny one, lets mouth bacteria under the skin, and most bite infections start in puncture wounds.4MDedge. Bite Type, Infection Risk Should Dictate Treatment A small, deep hole can be riskier than a wide scrape.
Right after the bite, rinse off any blood and look closely in good light for an actual break. Press gently on the area: blood or clear fluid coming out is a sign the skin may be open. Note where the bite is and how deep it seems before swelling makes it harder to judge, and take a photo so you can compare it over the next day or two.
Location raises or lowers the risk. Bites on the hands, upper limbs and feet get infected more often.5PubMed Central. Managing human bites6MDedge. Bite Type, Infection Risk Should Dictate Treatment In the hand, even small wounds can lead to aggressive infections.7PubMed. Human and other mammalian bite injuries of the hand: evaluation and management Ear cartilage has a poor blood supply, so bites there are more likely to get infected too.8PubMed Central. Managing human bites A skin-breaking bite on a finger, a knuckle, or an ear should be seen promptly.
Some bites need care right away. Go urgently if the bite bleeds heavily or keeps bleeding after 10 minutes of pressure, if it is on the face and might scar or need stitches, or if it is so deep you can see the tissue underneath. The same goes for a hand bite after which a finger hurts to move or won’t bend.
How to Clean a Bite at Home
Wash the wound with soap and water under a running faucet for at least 5 minutes.9Nationwide Children’s Hospital. Treatment for Human Bites Don’t scrub, because scrubbing can bruise the tissue.10Nationwide Children’s Hospital. Treatment for Human Bites Then press with a clean cloth until the bleeding stops and cover the wound with a clean bandage.
Pat the wound dry with a clean towel rather than rubbing it. A thin layer of antibiotic ointment is fine on a minor scrape. Don’t close a puncture tightly with tape or glue, because a sealed hole holds germs in. Write down the time of the bite, since getting seen late raises the chance of infection.
If your child was the biter, rinse their mouth, especially if there was blood in it. Gently check their mouth and gums for cuts, and note any bleeding to mention to the doctor.
Why Human Bites Get Infected
Infected human bites carried about 6 or 7 different kinds of bacteria per wound.11Elsevier / Anaerobe (PubMed Central). Bacteriology of human bite wound infections These include bacteria that need oxygen and bacteria that grow without it.12PubMed. Human and Animal Bites Many of these germs thrive deep inside a closed puncture, where there is little air.
About 1 in 10 human bites in children become infected.13PubMed. Human and Animal Bites Untreated human bites to the hand, however, became infected about half the time.14PubMed Central. Mammalian Bite Injuries to the Hand and Their Management
Other animals’ bites are worse. About 1 in 5 dog bites in children become infected, and up to half of cat bites do.15PubMed. Human and Animal Bites Cat teeth make deep punctures, while dog jaws tend to crush.16MDedge. Bite Type, Infection Risk Should Dictate Treatment
Signs a Bite Is Getting Infected
Most infections show up within about one to three days after the bite. Some redness and soreness on the first day is normal, and swelling should shrink by day two or three. If redness keeps growing, draw around its edge with a pen to track it. Watch for:
- Redness or swelling that spreads, rather than fading over a day or two
- Warmth in the area, or pain that gets worse instead of better
- Pus or cloudy fluid draining from the wound
- Red streaks running from the wound toward the body, which mean the infection is spreading
- Fever, or swollen tender lumps in the armpit or groin
Any of these means the child should see a doctor that day.
The most common problem after a hand bite is infection.17PubMed Central. Mammalian Bite Injuries to the Hand and Their Management It can spread through the skin or reach deeper, into the sheaths around tendons, a joint, or the bone.18PubMed Central. Mammalian Bite Injuries to the Hand and Their Management
Red streaks after an insect bite are different. They tend to itch, are not painful, come without fever, and clear up on their own.19PubMed Central. Delineating the Boundaries of Superficial Lymphangitis: A Retrospective Study of 11 Cases with a Review of Literature Streaks from a bacterial infection come with pain, tenderness, fever, or swollen lumps.20PubMed Central. Delineating the Boundaries of Superficial Lymphangitis: A Retrospective Study of 11 Cases with a Review of Literature
Can a Bite Spread HIV or Hepatitis
Viruses that travel in blood rarely spread through bites.21PubMed. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm HIV and hepatitis C need contact with visible blood, and saliva usually contains none.22PubMed. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm The risk of getting either from a bite is close to zero.23PubMed. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm
Hepatitis B is the one to check. It can rarely pass through broken skin even from saliva without blood.24PubMed. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm Both the child who bit and the child who was bitten need their hepatitis B protection checked.25PubMed. Human bites: bloodborne pathogen risk and postexposure follow-up algorithm Most children who have had their routine shots are already protected. If the bite broke the skin, bring your child’s vaccine record to the doctor.
A skin-breaking bite is also a good moment to confirm tetanus shots are up to date. Most children are covered by routine childhood vaccines, and a booster may be offered if a dose is overdue.
Antibiotics and Stitches for Bites
Preventive antibiotics lowered the rate of infection after human bites,26PubMed Central. Antibiotic prophylaxis for mammalian bites though they did not lower infection rates after cat or dog bites.27PubMed Central. Antibiotic prophylaxis for mammalian bites They are advised for human bites, bites seen late, deep punctures, and people with weak immune systems.28MDedge. Bite Type, Infection Risk Should Dictate Treatment If your child gets a course, finish all of it even after the wound looks better.
Every bite wound needs thorough early cleaning and removal of damaged tissue, whatever its size.29PubMed Central. Choice of Primary Repair in Animal Bite Wound: A Novel Management Strategy Face bites are often closed with stitches to limit scarring,30PubMed Central. Choice of Primary Repair in Animal Bite Wound: A Novel Management Strategy and carefully chosen bites that were stitched became infected about 6% of the time.31PubMed. Primary closure of mammalian bites Hand bites and punctures are often left open, because closing them can trap germs inside.32PubMed Central. Choice of Primary Repair in Animal Bite Wound: A Novel Management Strategy
At the visit, the doctor may numb the area and rinse it with a large amount of water. An x-ray may be ordered if a tooth may have hit bone. You may be asked to come back in one or two days for a wound check.
Keep an open wound covered and change the dressing as you were told. It may heal with a slightly wider scar.
Children Who Face Higher Risk
A weakened immune system and existing muscle disease raise the risk of infection after a bite.33MDedge. Bite Type, Infection Risk Should Dictate Treatment Children with weakened immunity also have more serious problems when an infection does take hold,34PubMed. Important emerging bacterial zoonotic infections affecting the immunocompromised and diabetes is treated as a high-risk factor when doctors decide how to care for a bite wound.35PubMed Central. Choice of Primary Repair in Animal Bite Wound: A Novel Management Strategy For these children, even a small puncture needs a doctor promptly. Children who count as immunocompromised include those going through chemotherapy, those taking steroids or other medicines that lower immunity, those without a working spleen, and those with an organ transplant.
Helping a Child Afterward
After dog bites, more than 7 in 10 children showed at least one new worrying behavior.36PubMed Central. Pediatric dog bite injuries in the USA: a systematic review These included nightmares, fear, avoiding dogs, and worry about doctors.37PubMed Central. Pediatric dog bite injuries in the USA: a systematic review Some children went on to develop post-traumatic stress or a phobia,38PubMed Central. Review of psychological effects of dog bites in children and without support, some withdraw socially over time.39PubMed Central. Psychological Sequelae of Dog Bites in Children: A Review
Most children get over a playmate’s bite quickly. Let your child talk about what happened and reassure them that they are safe at daycare. Tell the teacher so they can keep a closer eye on things. If the child is still afraid after a few weeks, get help.
How to Stop a Toddler From Biting
Toddlers bite because of teething, to explore, or to see what reaction they get.40kidshealth.org. Biting They also bite to express frustration, anger, or fear before they have the words for it,41kidshealth.org. Biting and to claim space or to get a toy.42NAEYC. Understanding and Responding to Children Who Bite43ZERO TO THREE. Toddler Biting: Finding the Right Response
In the moment:
- Stay calm and firm.44kidshealth.org. Biting
- Comfort the child who was bitten first.45kidshealth.org. Biting
- Comfort the child who bit, if they need it.46kidshealth.org. Biting
- Offer another way to handle the feeling and redirect them.47kidshealth.org. Biting
To head off the next bite, distract a child who seems about to bite.48ZERO TO THREE. Toddler Biting: Finding the Right Response Give them words to use, like “You’re too close.”49ZERO TO THREE. Toddler Biting: Finding the Right Response Use a timer so children can take turns with a toy.50ZERO TO THREE. Toddler Biting: Finding the Right Response Keep routines predictable and offer teething rings or cold, wet washcloths to chew.51NAEYC. Understanding and Responding to Children Who Bite
Don’t bite the child back, and don’t give a big, dramatic reaction. Keep expectations realistic for the child’s age.