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Pediatrics - Bite Injuries, Human Bites

Introduction

Human bite injuries result from fist fighting or the intentional act of biting to inflict harm.  Bite injuries occur during fist fighting if the fist of one person strikes the teeth of another person.  Sometimes toddlers bite other people when they are frustrated or angry.

Hand injuries from human bites can result in lacerations and injuries to the bones, joints, ligaments, tendons, nerves, blood vessels, and muscles.  Human bites are more dangerous than animal bites because they transmit higher concentrations of infectious bacteria.  Human bites require prompt medical attention.  Hand surgery may be necessary to properly clean wounds, and or to repair structural injuries.

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Anatomy
The hand is composed of many bones that provide structure for the wrist and fingers.  The bones are connected with strong ligament tissues.  Tendons are strong fibers that attach muscles to bones and allow movement.  The hand also contains nerves, blood vessels, and fat.  The skin that covers the hand protects it from the environment.
 
The "knuckles" as they are commonly known, are the metacarpal phalangeal joints of the hand.  Simply put, these are the joints where the hand attaches to the fingers.  These joints are the ones most commonly affected when a tooth causes an injury after a punch in the mouth.

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Causes
Human bite injuries can result from fist fighting or one person biting another.  A penetrating injury can occur if one person’s fist hits another person in the teeth.  If the impact breaks the skin, it is considered a bite injury.
 
Human bite injuries can occur from one person biting the other.  Toddlers may bite each other, but they generally do not cause significant injury.  Bite injuries most frequently occur as intentional acts of violence during child abuse or domestic abuse. 
 
Hand injuries from human bites can result in cuts and injuries to the hand bones, joints, ligaments, tendons, nerves, blood vessels, and muscles.  Human bites are more dangerous than animal bites because they transmit higher concentrations of infectious bacteria.  Additionally, HIV, the virus that causes AIDS, and hepatitis can be transmitted from one person to another by blood and saliva contact. 
 
Human bite bacterial infections are usually caused by a staphylococcus or streptococcus species.  However, Eikenella species are common organisms causing human bite infections.

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Symptoms
A human bite can cause pain and swelling.  It may be difficult for your child to move his o her fingers following such an injury.  You should inspect your child’s hand for puncture wounds and bleeding.  Signs of infection include warmth, redness, pain, tenderness, and a pus discharge.  Infections can also cause a fever, chills, or sweats.  Infection can occur rapidly following a human bite.
 
You should contact your doctor if your child receives a human bite.  You should carefully wash the wound with soap and water, unless the area is actively bleeding.  If your child experiences bleeding apply direct pressure and elevate his or her hand above the level of your child’s heart.  You should take your child to your doctor or an emergency department for immediate treatment in such instances.

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Diagnosis
You should tell your doctor that your child received a human bite.  Your doctor will examine your child’s hand and arm for signs of injury and infection.  An X-ray can help rule out fractures or indentations of the bone caused by teeth.

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Surgery
The type of surgery that your child receives depends on the type and extent of your child’s injury.  Your child will most likely participate in therapy following surgery.  The goal of surgery is to return your child’s hand structure and function to its pre-injured condition.  Unfortunately, if joint infection from a human bite is not treated promptly, significant functional problems can occur.

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Treatment
Your doctor will carefully wash and remove any foreign substances from your child’s wound.  Your child may need to get a tetanus shot and prescription antibiotics to fight infection.  Your doctor will instruct you on home care for your child’s wound.  You should make and attend all of your child’s follow up appointments.
 
If there is risk of the bite entering a joint, your child will require surgery to completely wash out the joint.  If infection has already set in, surgical drainage is mandatory, with the wound left open to drain.  Intravenous antibiotics will be necessary.
 
Your child will most likely participate in rehabilitation following non-surgical or surgical treatment of his or her injury.  A therapist will teach your child exercises to help gain range of motion, flexibility, coordination, and strength.  Therapy may help to reduce swelling, pain, and stiffness.  The extent of therapy that your child receives depends on the type of injury and treatment that your child had.  The goal of therapy is to maximize the restoration of hand function.

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Recovery
Recovery from human bites is an individualized process.  Your child’s recovery will depend on the extent of his or her injury or infection and the type of treatment your child receives.  Your doctor will let you know what to expect.  Attend all of your child’s doctor and hand therapy appointments to ensure the best recovery possible. 

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Prevention
Your child can prevent human bite injuries by not hitting or biting other people.  You should talk to your doctor about resources that can help your child learn more appropriate coping techniques. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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