Definition

• Bite from a human child or teen

Health Information

Types of Wounds from Bites

• Bruising. There is no break in the skin. No risk of infection.
• Scrape (Abrasion) or Scratch. A wound that doesn’t go all the way through the skin. Low chance of infection. Antibiotic drugs are not needed.
• Laceration (cut). A wound that goes through the skin to the fat or muscle tissue. Some chance of infection. Most need to be seen. Cleaning the wound can help prevent this. Antibiotic drugs may be needed.
• Wound Infection. Any redness (regardless of size) that starts 24-96 hours later suggests an infection. Human bites are more likely to become infected than animal bites.

Symptoms

• The main symptom is pain.

Causes

• Clenched Fist Injury. “Fight bites” occur during fist fights, usually in teen boys. The knuckle becomes cut when it strikes a tooth. The wound happens from punching someone in the mouth with a clenched fist. There is little skin protection over the knuckle joint. Mouth bacteria can be pushed into the joint and/or tendon sheath. Severe joint and tendon infections can result.
• Occlusive Fight Bites. Deliberate bites of a finger, arm, ear, etc. during a fight. High risk of infection, especially bites of the hand.
• Love Bites. Teens can leave bite marks on the neck or other sites. These “love bites” are a show of affection. Appear as a circle of tooth marks, usually with a clear center. These wounds are usually mild. They don’t go through the top layer of the skin. Low risk of infection.
• Toddler Bites. Most toddler bites are safe because they don’t break the skin. They usually leave red marks or sometimes bruise marks of individual teeth. Some cause a small scrape.

Care Advice

1. Overview:
   • Most open bites need to be seen. Reason: they need to be cleaned with saline to prevent infection.
   • Minor scratches are safe to treat at home. If washed well, they rarely become infected.
   • Many toddler bites don’t break the skin and just cause a bruise. If it didn’t break the skin, it can’t become infected.
   • Here is some care advice that should help.
2. Clean the Wound:
   • Wash all wounds right away with soap and water for 5 minutes.
   • Then, flush well under running water for a few minutes. Reason: Can prevent many wound infections.
3. Antibiotic Ointment:
   • For any open cuts, buy an antibiotic ointment (no prescription needed).
   • Put it on the cut 3 times per day for 3 days.
4. Treating Bruises:
   • Cold Pack: For bruising, use a cold pack. You can also use ice wrapped in a wet cloth. Apply it to the bruise for 20 minutes. Repeat in 1 hour, then as needed for the first 48 hours. Reason: Helps with bleeding, pain and swelling.
   • Heat Pack: After 48 hours, put heat on the bruise. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, 3 times per day. Reason: This helps to remove the blood. Caution: Avoid burns.
5. Pain:
   • For pain relief, give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed.
6. What to Expect:
   • Most scratches, scrapes and other minor bites heal up fine in 5 to 7 days.
   • Bruises should fade away in 7-14 days.
7. Biting at Home - How to Stop:
   • Biting behaviors are a normal part of toddlerhood. But, biting can quickly become a bad habit and make your child very unpopular. So quickly get rid of it by using the tips below:
   • Establish a rule. “‘We never bite people because biting hurts.” Tell your child that if he wants something he should come to you. He needs to ask for help or point to it.
   • Stop biting with a sharp ‘No.’ Be sure to use an unfriendly voice. Look your child straight in the eye. Try to stop them when they look as if they might bite someone. Do this before they actually do it.
   • Give your child a time-out. Send them to a boring place for about one minute per year of age. If time-out does not work, take away a favorite toy. Do this for the rest of the day.
   • Never bite your child back. Reason: You will only teach your child that it’s okay to bite if you’re bigger. If your child is aggressive, be sure to avoid any physical punishment like spanking.
8. Biting at Child Care - How to Stop:
   • Biting behavior among a group of toddlers is common in child care settings. Up to 50% of children are bitten there at some point.
   • In general, biting is physically harmless since most bites by younger children don’t puncture the skin. Infections are rare. Biting must be stopped, however, because it causes fear among the other children.
   • Many toddlers need help learning to control their aggressive behaviors. The biter should not be expelled from child care, because he can be helped.
   • The child care staff should provide careful supervision of the biter. They should quickly place the biting child in time-out. Do this even when he acts like he might bite someone. The problem should be dealt with right away by the person who sees it.

Call Your Doctor If

• Fever occurs
• Wound begins to look infected (pus, redness, red streaks)
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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