Children are the victims of about 60% of all dog bites in the United States. Fortunately, a relatively small number of these bites spread the very serious rabies infection. Rabies has become a very rare disease, averaging no more than 5 cases a year in the United States and 1 to 2 deaths annually.
Rabies is caused by a virus that is present in an infected animal and spread to humans via bites or scratches. The greatest risk comes from wild animals, especially bats, but also raccoons, skunks, foxes, and coyotes. Domestic pets such as dogs and cats are usually immunized against rabies. The incubation period averages 4 to 6 weeks, although it can be shorter with bites on the face or much longer in some cases of bites on the feet or legs (extending more than a year on occasion).
Signs and Symptoms
When the rabies virus enters the body, it can move along the nerve pathways to the brain. It causes serious symptoms beginning with pain, tingling, and numbness at the site of the bite or scratch and progresses rapidly to:
Anxiety, restlessness, and aggressiveness
Swallowing difficulties, particularly water (hydrophobia)
Coma and death
What You Can Do
If your child has been bitten by an animal, thoroughly flush the wound with water and wash it with soap and water.
If possible, it is important that the animal be captured so it can be evaluated by a veterinarian for the presence of a rabies infection. Unless proper equipment is available, however, capturing a possibly rabid animal should not be attempted. Captured animals are killed and their brains are examined for rabies immediately. Pets who appear well and have been immunized can be watched for symptoms of the disease. This observation period should extend for 10 days. If the animal develops symptoms, it must be killed and the brain examined.
When to Call Your Pediatrician
Any time that your child is bitten by an animal, contact your pediatrician. All animal bites should be reported to health officials who will be able to tell you whether the bite presents a risk of rabies. Any bite by a wild animal should be considered a risk for rabies until proven otherwise. Exceptions to this include rabbits, hares, squirrels, rats, mice, and other small rodents. If a bat is found in a room where your child has been sleeping or playing, you should report it immediately to your pediatrician, even if you don’t find a bite mark.
How Is the Diagnosis Made?
Your pediatrician will examine your child. If rabies is suspected, a skin biopsy may be done to look for evidence of the virus. If your child develops encephalitis and lapses into a coma, a brain biopsy may be needed to confirm the diagnosis.
There is no specific treatment for rabies once the infection develops in a child. There have been very few survivors of the infection. Therefore, prevention is extremely important.
What Is the Prognosis?
Rabies is almost always a fatal infection. Death is usually caused by respiratory or heart failure within days after the appearance of symptoms. However, prompt and proper treatment of bites can prevent or control the infection before it involves the brain and produces the serious symptoms.
Following a bite, if your pediatrician determines that the animal has a high risk of having rabies, the doctor will immediately immunize your child with rabies immune globulin, a type of passive immunization. The globulin, disease-battling antibodies, is injected into the skin around the bite. At the same time, your pediatrician will give your child injections of the rabies vaccine, which stimulates the body to make its own antibodies against the infection. Your child will be given a series of 5 inoculations over a period of 4 weeks.
If the animal is a domestic and healthy pet, your pediatrician will ask you to observe your child. The pediatrician will start the shots only if the animal shows signs of rabies.
Teach your child to avoid contact with any stray or wild animals. Your child should not tease or bother an animal and shouldn’t examine or play with a dead animal that she may find.
You can reduce the presence of wild animals in the area of your home by tightly closing garbage can lids. Chimney covers can prevent bats from getting into the home.
Make sure your own family pet receives animal rabies shots according to your veterinarian’s recommendations.