Dog attacks: it's time for doctors to bite back

This year, like previous years, has seen a spate of coverage in the British media of maulings by dogs, such as the one that killed a girl in Merseyside on 1 January (www.guardian.co.uk, “Dog kills five-year-old girl in home”). The most recent available data from the Royal Society for the Prevention of Accidents (www.rospa.co.uk) show that 70 000 people attended UK emergency departments in 2002 for injuries caused by dog bites. Many of these are attacks on children by the family pet and take place in the home (European Journal of Pediatrics 2003;162:254-8). Dog bites have become a public health concern and a child protection issue. As with many public health issues, however, individuals are reluctant to take responsibility and modify their behaviour. The medical profession is left to mop up the mess. Children are particularly vulnerable; one American study found that children aged under 5 years were the age group most likely to have severe head and neck injuries (American Surgeon 1999;65:863-4).

Undoubtedly, few people bitten by dogs die or are left with a profound disability. However, the number of people admitted to UK hospitals after being bitten by a dog is rising, despite a fall in dog ownership. Data collected by the Information Centre for Health and Social Care (www.hesonline.nhs.uk) show that 4133 patients were admitted to hospital in England in 2006 as a result of injuries from dog bites, almost double the number in 1996, and that 22% of these people were children aged under 9. Apart from the psychological and physical consequences (including infections) of dog bites, they result in unnecessary expense.

Although early studies reported various benefits to health of owning a dog, such as a reduced risk of cardiovascular disease and less likelihood of needing to use GPs' services, more recent studies have not replicated such results. However, having a dog does seem to increase the chance of survival after myocardial infarction and reduce absenteeism from school through sickness (BMJ 2005;331:1252-4). So, rather than just banning the estimated 6.8 million dogs in the UK or, better still, dog owners, might it be wiser to consider other ways to prevent bites, so people can continue to enjoy the health benefits of dog ownership?

Regulation, though, has not so far succeeded. With 70 000 dog bites each year, it is clear that the 1991 Dangerous Dogs Act does not work. For a start, it does not cover the majority of bites that occur in the family home, and only 764 people were prosecuted under the act in 2005. Also, all dogs bite, not just the four breeds prohibited under the act (the pit bull terrier, Japanese tosa, Argentine dogo, and fila Brasileiro, including cross-breeds). Indeed, one study showed that the most common dog bites were from Staffordshire bull terriers, Jack Russell terriers, medium sized mongrels, and Alsatians (BMJ 1991;303:1512-3).

If proposals to license ownership of dogs had succeeded, we would at least have a national canine register to document which dogs show aggression and need closer supervision. But even if the current laws were tightened, dog attacks would continue, because legislation does not get to the root of the problem of why the attacks occur. Unless we introduce the equivalent of antisocial behaviour orders for dogs—which would probably increase the number of attacks occurring in the family home—there needs to be a change in the way as a society we manage dogs in the future.

We must stop placing blame on the dogs themselves and focus attention instead on who holds the other end of the lead—or who isn't holding the lead, as the case may be. Irresponsible dog owners are like parents who condone poor behaviour in their children. Is it fair that only the child—or the dog—is punished? Ultimately, if that behaviour becomes uncontrollable then drastic action may be taken, but too often the action comes too late to be able to change behaviour.

Most dog bites to children at home happen when the child interacts with the dog in the absence of adult supervision (European Journal of Pediatrics 2003;162:254-8). So, if dog owners do not want to get rid of their dog or fail to keep it away from the child to minimise risk, they need to change their behaviour. It is clear that not all dog owners appreciate that children should not be left unsupervised with a dog. Just as some parents are obliged to take parenting classes, I would like to see equivalent mandatory classes for expectant dog owners to teach them about the responsibilities of dog ownership.

Unfortunately, just attending a class does not necessarily ensure engagement with the subject matter, even when a social worker is in tow, and so measures targeted at children are also needed. Educational programmes for children, such as the “Prevent-a-bite” scheme in Australia (BMJ 2000;320:1512-3), have shown the potential to instil precautionary behaviour around dogs. Teachers and health visitors are in a position to introduce dog awareness programmes, such as the new Blue Dog project (www.thebluedog.org).

Some people have advocated muzzling all dogs in public places. Although this might prevent some attacks, it would not prevent the large numbers of bites that occur in the family home. Dog-free parks might reduce people's anxiety about dogs and ensure that children don't encounter dogs (or their excrement), but again this would not reduce the problem of dog bites on private property. Neutering all dogs would ultimately resolve the problem, but I doubt whether such a move would meet ethical approval.

It is therefore time for medical professionals to act on this issue. Where, for instance, is the medical representative on the Pet Health Council? Doctors, vets, and schools need to work together to research, educate, and advise legislators to prevent dog attacks in the future. I would like to see vets advising all dog owners about bite prevention, and doctors have a part to play in promoting bite prevention when treating patients who have been bitten by dogs.

Ultimately perhaps the only way to stop dog bites will be to ban dogs. In the meantime I suggest a Department of Health campaign for next Christmas: “Just ask for a goldfish.”

I suggest a Department of Health campaign for next Christmas: “Just ask for a goldfish.”