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Anticipatory guidance: Having a dog in the family
ORIGINAL ARTICLE
Anticipatory Guidance: Having a Dog in the Family ‘I1
Loretta
lazzetti,
MS,
RN,
CPNP
n
are a common occurrence among children. This article assists the nurse practitioner to learn about the unique characteristics of the canine, what to teach families and children about safety around dogs, responsible dog ownership, and dog training. ] Pediatr Health Care. (1998). 72, 73-79.
March/April
1998
1 e d’t’ la ric nurse practitioners use anticipatory guidance in several areas such as growth and development, nutrition, and safety. However, nurse practitioners may not know how to counsel parents about pet safety, particularly with dogs. When the health history is obtained, nurse practitioners should ask whether a dog is in the household or whether the family is considering getting a dog at any time in the future. Pets are important to American society. In fact, nearly 55 million households in the United States have a dog, cat, bird, or other companion animal as a member of their family (American Veterinary Medical Association, 1993). Pets are popular because they provide companionship, joy, rmconditional love, a sense of safety, and often service (American Veterinary Medical Association, 1993). Companion animals include dogs, cats, birds, horses, or any of several other pets such as hamsters, gerbils, fish, and rabbits (American Veterinary Medical Association, 1993). The overall number of dogs owned by Americans and the number of households owning dogs have not changed since 1987 (American Veterinary Medical Association, 1993). Approximately 34.6 million households own dogs. The American Veterinary Medical Association reported in 1993 that more dogs are owned by parents in all age groups. These households also include one or more children. Households with many members are most likely to have dogs. Dogs have interacted with humankind for thousands of years. A dog’s purpose was to hunt and retrieve game, herd livestock, guard the farmer’s wares, or rid the farm of vermin. Today most dogs being bred do not serve
Loretta lazzetti is a Certified Pediatric Nurse Practitioner Center in Bronx, New York. Reprint requests: Copyright
Loretta lazzetti, MS, RN, CPNP, 7 Durst PI., Yonkers,
0 1998 by the National Association
0891-5245/98/$5.00
in the Pediatric Intensive Care Unit at Jacobi Medical
+ 0
NY 10704-I
of Pediatric Nurse Associates
803.
& Practitioners.
25/l/80277
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lazzetti
humans in the same capacity. Families now select dogs as pets to provide companionship and to instill a sense of responsibility in their children. Some animals are obtained to be service dogs, for example, to aid a deaf child or to warn a child of an impending seizure. Some parents buy a dog to show. The sport of dogs can be enjoyed by adults and chiIdren in a variety of disciplines. These include the breed ring, obedience trials, agility, lure coursing, field trials, earth dog trials, and junior showmanship. SELECTION
OF A DOG
The American Kennel Club currently recognizes 140 breeds. A dog or puppy should be selected from a reputable breeder rather than from a pet shop or neighbor. Breeders are interested in the welfare of their dogs. Nevertheless, a newly purchased dog should be examined by a veterinarian to ensure that the animal is healthy. A dog should never be bought on impulse or because of its looks. Parents should be willing to commit themselves to 10 or more years of dog ownership. Unfortunately, within the first week or so after a puppy or dog is brought home, many children quickly lose their fascination with the animal, and the responsibility belongs to the adult. Before purchasing a particular breed of dog, families should try to attend a dog show, where they will see adult dogs who have reached their maximum size. Dogs within each group have a variety of sizes ranging from small to large. Smaller dogs such as toy breeds and some nonsporting breeds do well in an apartment setting. The medium to larger sized dogs thrive in a home with a yard enclosed by a chain link fence. Parents must also consider the age of their children. Larger breeds may accidently knock over a toddler or preschool-age child because of the dog’s size and weight. Dogs in the Sporting and Terrier group possess high levels of energy. School-age children and adolescents may be better suited to these breeds of dogs. An older child is less likely to be pushed down by a dog because of its inherent rambunctious nature and are better able to control the dog while the animal is on a leash.
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All dogs of any size and breed need exercise. Awalk several times a day can accomplish this. The length of the walk will vary depending on the size of the dog. In addition, dogs receive exercise during short lo-minute training periods three or four times a day Dogs afford children companionship and can be a gateway to helping children meet new friends during their walks. Families must understand that there will be additional expenses for a dog that do not end with the initial purchase. The cost of a dog can range from a minimal adoption fee, if one selects a dog from a shelter, to $950 or more for a show-quality puppy. Other initial expenses include a crate, leash, and collar. Older children who earn money by baby-sitting or delivering newspapers can share in the ongoing care of their pet by assisting with the payment of veterinary care, licensing fee, and dog food. Parents can than instruct their children about the importance of their dog’s health and the need for vaccinations to maintain the dog’s health. Younger children can share in the responsibility of dog ownership by helping to name the new dog, feeding it, providing it with fresh water, and assisting with grooming. Parents should also instruct their children that responsible dog ownership means spaying or neutering the dog if they do not plan to show it. Children should understand that there is a need to prevent unwanted puppies. The role of the nurse practitioner in assisting families with their decision to purchase a dog involves making an assessment of the family lifestyle. When both parents work, it is unlikely that there will be adequate time for house training or training a new dog. Furthermore, if parents work, they are not able to supervise their children’s interactions around the dog. The nurse practitioner must also consider allergies in family members. Many breeders will state that their particular breed of dog is “hypoallergenic” because it does not shed. Any breed can trigger allergic reactions. Finally, the nurse practitioner can direct the family to resources about different breeds such as The Complete Dog Book (American Kennel Club, 1992) and other breed-specific books, which are often located in the public library
TRAINING
NEEDS
Pet shops, book stores, veterinarian offices, and the public library offer an array of dog training books. To the novice dog owner and parent these training methods appear correct, quick, simple, and able to produce a gentle pet with whom their children will be safe in a short amount of time. However, most expert trainers who claim to advocate such “positive” training techniques actually are using violent methods. Some examples of these violent methods are encouraged by Handler (1987), who recommends the “scruff shake” for a disobedient dog. This is performed by picking the puppy or dog up behind the back of the neck and shaking the dog hard from side to side. If 10 seconds of this appears sufficient, the dog should be dropped to the floor. The dog owner is further advised to “set the dog up” to provoke it. If the dog has previously snapped at the owner, a coat and ski
‘18? ,,,,,..c /,,: if
r=
i *jn$ki@ $6 assessment of’ the family lifestyle.
gloves should be worn when correcting the dog. Handler (1987) states these methods are not cruel to the dog. Others, such as The Monks of New Skete (1978), inform dog owners that physical discipline should be used when training the dog. Their general rule is that if one does not get a response (a yelp or other physical sign) after hitting the dog under the chin, the slap was not hard enough. Owners are further advised that they cannot hurt the dog with this method or cause irreparable damage. Jester (1986) states that to correct a
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dog he must be hit hard enough underneath his jaw with enough force to cause his head to snap back, noting the trainer must gear the swat to the dog’s size and the handler’s strength to avoid breaking the dog’s neck. Although Jester (1986) recommends being humane, this same trainer encourages the owner to hit the dog hard enough to show the dog that its behavior will not be tolerated and to get the message across to the dog. Unfortunately, messages such as these violent approaches abound in the dog training literature. Parents mistakenly may view these types of training methods as correct and nonviolent because they are written by “expert trainers” in the dog world, or because a particular trainer who was seen on television or a book advocating dominant training methods was recommended by a veterinarian. Dominant training means using a force such as hitting, squeezing a dog’s ear or lip, electrically shocking the dog, angrily shouting at the dog to promote a feeling of power within the handler, and subjecting the animal to obey through submission and fear. Unfortunately, violence permeates our society today. Children need not be shown methods of forceful dog training that have no place in the home. Parents should be advised to be wary of books that recommend methods such as use of a “shake can,” the “scruff shake,” the “alpha wolf rollover,” the “chin slap,” and hanging or stringing up the dog to promote obedience. If the new dog owners decide that they wish to take the dog to formal training classes, the school should be visited first. Any training class that promotes dominant training techniques should be avoided. Many dog obedience schools offer puppy socialization or puppy kindergarten training classes. These classes became popular in the 1980s. In these classes young dogs are encouraged to playfully bite one another and pin each other down. After 10 minutes of this behavior puppies are given obedience training. If the dog begins biting the owner or jumping up, the owner is told to correct the dog by hitting or shaking him. The puppy now becomes confused. He is being punished for behaviors that only moments
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ago were being praised (Meisterfeld, 1991). Such puppy training classes instill within a dog the need to use its teeth and promote the use of violent training methods. Ideally, training for the new puppy or dog needs to be given in the home on a one-on-one basis. If group training classes are used, families should seek small classes (no more than five dogs to a class) with short training periods. In this type of class the dogs are worked for lo- to 15minute periods with frequent breaks within the hour session. Meisterfeld (1991) believes training should start immediately, when the new puppy or dog is brought home. One adult family member should consistently tram the dog by establishing mutual respect and trust in the animal. This form of training helps children understand that force is not necessary to discipline anyone. Moreover, hitting the animal does not achieve results and in turn only causes aggression. The child also learns that hitting or striking anyone, be it a friend or animal, is a behavior that is not tolerated within the family. Parents should not expect an 8- or 9-year-old child to take on the task of dog training. A child may quickly become frustrated if the dog does not listen and may become angry with the dog. Dogs do not have a prolonged attention span. Puppies 8 to 12 weeks of age should have no more than 2 minutes of training three times a day. By age 13 weeks, training periods can be increased to 5 to 10 minutes. All dogs should be taught to heel, stand, sit, down, stay, and come when called. Training should be done in an area of the home that is free from the distractions of other family members. In this way the dog directs its attention to the person who is handling him or her. At the time of their first interaction with a family, pediatric nurse practitioners should establish what type of parental discipline is used within the home, and nonviolent methods of redirecting a child’s behavior should be suggested and encouraged. Similarly, when the child’s health history is first obtained, the nurse practitioner can assess whether a dog is in the home and what type of training, if any, the dog has been given. The nurse practi-
tioner should encourage the use of nondominant training methods.
TYPICAL DOG BEHAVIORS Meisterfeld (1991) states all puppies, if they were living in a wild dog pack as they were hundreds of years ago, would need to learn and practice with their teeth to establish their ranking position and help their survival. In that situation physical dominance was a crucial issue, because the social interactions of the pack members were based on it. Only the strongest animal can be the pack leader and control the pack. As such, the dog had to respond to environmental challenges and fought to maintain his position (Meisterfeld, 1991). Puppies today no longer live in the wild but within a civilized human family Furthermore, Meisterfeld (1991) emphasizes they do not need to be dominant over other animals or further their survival with physical force. Puppies and dogs display their natural play behaviors of facial biting towards one another. Dogs express this biting behavior not only when they feel threatened but also to express their dominance over other dogs and species and while playfully fighting. Meisterfeld (1991) stresses that dogs practice this behavior from early puppyhood and during their whole adult life. Families should not humanize their dogs by allowing them to sleep on the couch or beg at the table or by using the dog as a child or mate substitute. The dog was born to serve mankind, not to be catered to (Meisterfeld, 1991). Catering to the dog by cooking it special foods or petting the dog each time it sits in front of its owner puts the dog in charge, which is unnatural for the domesticated dog. Meisterfeld (1991) believes that catering, humanization, not training the dog, or using force and aggressive training methods allows the dog to develop its own typical and natural dog behaviors that include barking back at a person, lunging, and mouthing a person’s hands. These behaviors may appear at first to be cute to the family but later may become unpleasant and frightening and can escalate into excessive barking, digging, chewing, chasing whatever moves, soiling the house, destroying the furniture, threat-
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FIGURE FIGURE 1 TWO Meisterfeld, respect
and
dogs
C.W.
(1991).
trust.
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SAFETY Dog bites account for up to 90% of all animal bites in the United States, and most victims are children (Avner & Baker, 1991). The public fear of breeds such as the pit bull terrier has led to bans in some communities and some military housing and to problems with insurance companies excluding some breeds from coverage on homeowner policies (Wheeler, 1995). Such thinking will eventually lead to a ban on most breeds, because all dogs will bite if they feel sufficiently threatened (Meisterfeld Seminar, 1995). Certain breeds of dogs such as pit bulls, rottweilers, doberman pinschers, boxers, great danes, chows, Siberian huskies, and german shepherds have been implicated as “dangerous dogs” because statistically they have been shown to have the highest at-
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tack rates (Wheeler, 1995). Contrary to the public’s misconception, dogs are not “trained” to bite. Meisterfeld (1989) states that breeds such as the pit bull have the genetic makeup to fight and attack prey but not humankind. German shepherds, dobermans, and rottweilers are used to guard but are not genetically bred to attack. Because every breed of dog, not only those named, has the propensity to bite, banning of breeds is not the answer to ensure safety; otherwise, it will not be long before beagles, poodles, golden and labrador retrievers, and other so-called friendly breeds will be banished (Staff, 1995). The answer lies in educating people about training dogs by mutual respect and trust. Parents must establish certain ground rules for their children when activities involve dogs, whether it is their own dog or another. These rules include how to approach a dog and how the child should behave around a dog. Dogs may show very aggressive behavior toward one another (Figure 1). This behavior is shown by curled lips, stiff and tense posture, and focusing on the other dog’s head and neck, an area a dog will attack when fighting another dog. The other dog will also display a similar posture. If the cl&d in Figure 1 were to break away from his mother’s arms, he could be seriously
and
of a child
kiss.
C.W.
Dr. Jekyll
for the safety
ening the family, and even biting and attacking a child (Meisterfeld, 1991). The nurse practitioner can suggest to the family that the dog must be treated as a dog. Special privileges such as sleeping on the sofa, walking through an open door first, or jumping up on visitors should not be given to the dog. The family can be made aware that through nondominant training a dog’s natural behaviors such as biting and barking will disappear.
Result
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(1989). & Mr.
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children Petaluma,
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bitten. Children and parents alike should be warned against walking between two dogs, even if one of the dogs is their own. The two dogs may attempt to challenge one another, resulting in a dog fight. Parents should not encourage their children to kiss the dog or allow the dog to lick their face. Dogs do not express their affection by hugging and kissing. When dogs “kiss” another dog, it is their way of showing submissiveness to another dog. Therefore when a child or adult bends down to kiss or hug a dog, the dog becomes confused by this body language, which tells the dog he is in charge (Staff, 1995). Small children who are at the dog’s eye level risk being bitten if they attempt to hug or kiss the dog. A dog who is trained by force or untrained may view the child’s hard squeezing as an attack and try to protect itself (Staff, 1995). Parents therefore should not encourage their children to kiss the dog or allow the dog to lick their face. There is also the risk of infection from a dog bite, because the dog’s oral flora frequently includes pasteurella multocida, Streptococcus spp., S. aureus, Staphylococcus epidermidis, Staphylococcus sapuophyticus, neisseria spp., unclassified gram-nega-
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tive rods (DF-2, EF-4, others), and anaerobes (Feder, Shanley, & Barbera, 1987). Figure 2 depicts what happened to a child when he gave his dog a hug and kiss. Children can be taught how to gently pat the dog on the chest or shoulder to show affection. Children should not engage in rough play around a dog. Meisterfeld (1989) believes that often a dog may interpret the child’s arm waving and jumping as part of aggressive play and may inadvertently bite. Dogs should never be approached and disturbed while sleeping or eating. A dog may perceive this surprise approach as a threat to his survival (Meisterfeld, 1989). Children should be taught how to safely approach a dog. One should never greet a dog with an outstretched hand (Figure 3). Rather, the dog should be approached with a closed fist (Meisterfeld, 1989). The dog discovers its surroundings through its nose. Meisterfeld (1989) acknowledges that dogs are able to detect a myriad of scents and distinguish among these. During the discrimination process when a dog meets a stranger, especially within the first 15 seconds, the dog is in a state of alert. The body becomes tense, and the tail stiffens to alert the dog to the signals of danger. If the dog receives pleasant impressions, the adrenals quiet down in the time frame of 15 to 30 seconds, and the dog starts to relax. Between 30 to 45 seconds the adrenal reaction has nearly or
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completely ceased. However, it is safer to wait another 15 seconds, that is, up to 1 minute, before establishing the first contact with a strange dog, provided he exhibits friendliness (Figure 4) (Meisterfeld, 1989). Friendliness is exhibited by a wagging tail and no harshness in the eyes. The rationale behind these ground rules is clear when one understands how the senses within the dog function. A dog’s hearing is far superior to that of humans. A dog can distinguish different tones of voice (Meisterfeld, 1989). Because of this ability, no family member needs to shout at the dog, because this evokes fear within the dog. Fear does not establish trust between the dog and family members. Furthermore, Meisterfeld (1989) states that a dog’s vision excels that of humans. Dogs see greater distances. Any gestures or facial expressions that are hostile, according to the dog’s code, such as making sudden jerky movements, can excite an alarm reaction in the dog. Staring at a dog can trigger an adverse response, because that is how dogs challenge one another. The sodium content within the dog is higher than that in humans (Meisterfeld, 1989). Therefore, dogs are more sensitive to electric shocks. Family members should never use electric collars to train the dog or use electric fences to contain the dog within the property. This type of force can only evoke a re-
sponse of aggression or fear within the dog. Meisterfeld (1989) warns that any type of physical threat strengthens the dog’s survival instinct, and he will show it by use of his teeth. By comparing an animal’s reaction to danger with the human reaction of anger to violence syndrome (Figures 5 and 6), one is able to see the end point when an animal or human is confronted-violence (Meisterfeld & Pecci, 1993). Pediatric nurse practitioners should discuss with parents during their visits the need for adult supervision when children and dogs interact. Children need to be reminded to play quietly when around the dog. If quiet play is not likely, the dog should be put in a separate room. Parents must also be reminded that children should not touch anyone’s dog without first asking the owner’s permission. Children can also be taught that if they are approached by a stray dog, they should not attempt to reach out to the dog and pet it. Rather, they should stand still and slowly turn away from the dog. Direct eye contact should not be made with the dog. Finally, parents can understand that a dog can and does provide companionship to children when the dog is trained with respect and the dog is not abused by the child.
DOG BITES Dog bites are an underrecognized public health problem. Every year in the
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FIGURE 4 Discrimination safety period. (From Meisterfeld, C.W. (I 989). Jelly bean versus Dr. Jekyll & Mr. Hyde: Written for the safety of our children and the welfare of our dogs. Petaluma, CA: M.R.K. Publishing.)
United States dog bites cause approximately 20 deaths and an estimated 585,000 injuries resulting in the need for medical attention or restricted activity (Gershman, Sacks,&Wright, 1994).The dog bite rate (higher than that for most accidents and infectious diseases)is not truly appreciated as a medical problem, probably because the age of the victim, the severity, and cost factors are not usually put into context (Beck, Loring, & Lockwood, 1975). An analysis of the epidemiology of dog bite injuries in St. Louis, Missouri, provided the following information. The attack rate for children 5 to 9 years old was 1231.4 per 100,000,and for those 10 to 14 years old, it was 1171.5 per 100,000. Approximately 3.4% of all bites were classified as serious, and generally the victims were young. For example, the age group of 5 to 9 years (8% of the popdation) received 27.4% of all bites and 32.5% of the serious ones (Beck,Loring, & Lockwood, 1975). Another aspect of severity is the location of the bite. Beck, Loring, and Lockwood (1975) found that the pattern for the victims younger than 9 years was 37.1% on the legs, 19.7% on the torso, 26.9% on the arms and hands, and 18.5% on the neck and face. In 1973 more than 35% of the 245 bites in children younger than 4 years were on the face. A face bite is traumatic and is a source of concern regardless of the
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FIGURE 5 Stress-rest pattern in the animal & Pecci, E. (1993). Crazy dogs & crazy people: Petaluma, CA: M.R.K. Publishing.)
extent of its severity (Beck, Loring, & Lockwood, 1975). If a dog bite should occur, parents should not delay in seeking emergency medical management. This manage ment includes thoroughly irrigating, cleansing, and debriding the wound with saline solution (Caserta, 1992).The wound is then sutured to preserve function and for cosmetic masons. Exceptions to this include injuries to the hand, soft tissues, punctures, and deep tissue injuries more than 8 hours old. Bite wounds that have the potential for becoming infected include those to the hand, foot, scalp, or face. Other injuries with a high risk for infection are crush injuries and wounds that have been sutured. Children who are immunocompromised are also considered to be at high risk for infection. Antibiotics are not indicated in those bite wounds in which the risk of infection is low, such as the common superficial and open dog bite wounds (Caserta, 1992). Antibiotic therapy is administered in those high-risk categories as previously stated.
kingdom. (From Meisterfeld, C.W., Looking at behavior in our society
The duration of treatment is related is used for the purpose of prophylaxis or treatment of an already infected wound. Prophylaxis begun shortly after the bite occurs should be discontinued after 5 days if infection does not develop. However, Caserta (1992) reports treatment of an established uncomplicated wound infection usually requires 7 to 14 days of antibiotics; duration is dependent on the severity of the infection and patient response. Penicillin G (or V) and broad-spectrum penicillins (such as ampicillin or ticarcillin) are the antibiotics of choice for many pathogens, including Pasteurella multocida, Eikenella corrodens, and the CDC ol-numeric organisms DF-2, M-5, EF-4, and II-j (Caserta, 1992). Because of the presence of Staphylococcusaweus- and B-lactamaseproducing anaerobes in a high percentage of wounds, the combination drug of a B-lactamaseinhibitor, clavulinic acid, and amoxicillin is a very useful prophylaxis and initial therapy of established infection. Erythromycin and clinto whether the treatment
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basic principles of safety around dogs by treating them with respect, never harshness. Parents need to understand they must take charge and be responsible for the dog’s welfare and training and not depend on their children to take full responsibility. Training of the pet must be done with respect and trust, not force; this in turn sets an example for children to follow. Pediatric nurse practitioners can achieve the goal of preventing dog bites rather than treating the physical and emotional injuries that are their consequences.
REFERENCES
FIGURE 6
Anger
to violence
syndrome.
(1993). Crazy dogs & crazy people: CA:
M.R.K.
Looking
Meisterfeld,
at behavior
C.W.,
& Pecci,
E.
in our society. Petaluma,
Publishing.)
damycin are inadequate for treating bite wound infections because of the drug resistance of major pathogens, especially Pasteurella multocida (Caserta, 1992). Alternatives for the patient allergic to penicillin include cefuroxime axetil or tetracycline, depending on the age of the patient (Caserta, 1992). Caserta (1992) states that a parenteral third-generation cephalosporin such as ceftriaxone or cefotaxime can also be used for therapy of severe bites in hospitalized patients. Tetanus toxoid should be administered as necessary. Other care includes rabies prophylaxis in those areas known to be endemic (Brook, 1989). Prophylaxis is recommended to those persons bitten by dogs unavailable for observation or testing. If the dog is available, the Health Department’s Veterinary Public Health Service should be called. This service is responsible for observing the dog for a
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period of 10 days or arranging for a laboratory test of the animal’s brain tissue. If the dog does not exhibit any signs of rabies during the observation period or if the laboratory test is negative for rabies, postexposure vaccination is not necessary (Staff, 1992). Parents require education regarding monitoring for signs of infection, which include fever, erythema, edema, tenderness, or discharge from the wound. The pediatric nurse practitioner should reexamine the wound after 24 hours of initial treatment. Any wound that becomes infected requires hospitalization for parenteral therapy,
SUMMARY Pediatric nurse practitioners can give anticipatory guidance to families about how they and their children can have a healthy relationship with any breed of dog and any age of child by following simple guidelines. Children can learn
American Kennel Club. (1992). The complete dog book. (18th ed.). New York: Howell Book House. American Veterinary Medical Association. (1993). U.S. pet ozonewhip & demographics sourcebook. Schaumburg, IL: Center for Information Management. Avner, J.R., & Baker, M.D. (1991). Dog bites in urban children. Pediatrics, a&55-57. Beck, A.M., Loring. H., & Lockwood, R. (1975). The ecology of dog bite injury in St. Louis, Missouri. Public Health Reports, 90,262-267. Brook, I. (1989). Human and animal bite infections. T!e Journal ofFamify Pmctice, 28,713-718. Caserta, M.T. (1992). Infections from animal and human bites. The Report on Pediatric Infectious Diseases, 2,9-u. Feder, H.M., Shanley, J.D., & Barbera, J.A. (1987). Review of 59 patients hospitalized with animal bites. Pediatric Infectious Disease Journal, 6, 24 28. Gershman, K.A., Sacks, J.J., &Wright, J.C. (1994). Which dogs bite? A case-control study of risk factors. Pediatrics, 93,913-917. Handler, B.S. (1987). Positively obedient: Good mdnnners for the fumi2y dog. Loveland, CO: Alpine Publications. Jester, T. (1986). Common behavior problems in dogs and how to solve them. Novato, CA: Marin Humane Society. Meisterfeld, C.W. (1991). Psychological dog training: Behavior conditioning with respect and trust. Petaluma, CA: M.R.K. Publishing. Meisterfeld, C.W. (1989). Jelly bean versus Dr. Jekyll b Mr. Hyde: Written fouthe safety of our children and the we&e of our dogs. Pet&ma, CA: M.R.K. Publishing. Meisterfeld, C.W., & l’ecci, E. (1993). Crazy dogs & crazy people: Look@ at behavior in our society. Pet&ma, CA: M.R.K. Publishing. Meisterfeld, C.W. (1995, April). Seminar. Reston, VA. Monks of New Skete. (1978). How to be your dog’s best friend: A training manual for dog owners. Boston, MA: Little, Brown & Company. Staff. (1992, March). Rabies alert. City health information. The New York City Department ofHealth, ll, l-4. Staff. (1995, May). Applying the philosophy of Meisterfeld’s psychological dog training. Newsfetkr, 1,2. Wheeler, L. (1995). He rarely meets a dog he doesn’t like. The W&zington Post, May 1, p. 50.
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Anticipatory Guidance: Having a Dog in the Family ‘I1
Loretta
lazzetti,
MS,
RN,
CPNP
n
are a common occurrence among children. This article assists the nurse practitioner to learn about the unique characteristics of the canine, what to teach families and children about safety around dogs, responsible dog ownership, and dog training. ] Pediatr Health Care. (1998). 72, 73-79.
March/April
1998
1 e d’t’ la ric nurse practitioners use anticipatory guidance in several areas such as growth and development, nutrition, and safety. However, nurse practitioners may not know how to counsel parents about pet safety, particularly with dogs. When the health history is obtained, nurse practitioners should ask whether a dog is in the household or whether the family is considering getting a dog at any time in the future. Pets are important to American society. In fact, nearly 55 million households in the United States have a dog, cat, bird, or other companion animal as a member of their family (American Veterinary Medical Association, 1993). Pets are popular because they provide companionship, joy, rmconditional love, a sense of safety, and often service (American Veterinary Medical Association, 1993). Companion animals include dogs, cats, birds, horses, or any of several other pets such as hamsters, gerbils, fish, and rabbits (American Veterinary Medical Association, 1993). The overall number of dogs owned by Americans and the number of households owning dogs have not changed since 1987 (American Veterinary Medical Association, 1993). Approximately 34.6 million households own dogs. The American Veterinary Medical Association reported in 1993 that more dogs are owned by parents in all age groups. These households also include one or more children. Households with many members are most likely to have dogs. Dogs have interacted with humankind for thousands of years. A dog’s purpose was to hunt and retrieve game, herd livestock, guard the farmer’s wares, or rid the farm of vermin. Today most dogs being bred do not serve
Loretta lazzetti is a Certified Pediatric Nurse Practitioner Center in Bronx, New York. Reprint requests: Copyright
Loretta lazzetti, MS, RN, CPNP, 7 Durst PI., Yonkers,
0 1998 by the National Association
0891-5245/98/$5.00
in the Pediatric Intensive Care Unit at Jacobi Medical
+ 0
NY 10704-I
of Pediatric Nurse Associates
803.
& Practitioners.
25/l/80277
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humans in the same capacity. Families now select dogs as pets to provide companionship and to instill a sense of responsibility in their children. Some animals are obtained to be service dogs, for example, to aid a deaf child or to warn a child of an impending seizure. Some parents buy a dog to show. The sport of dogs can be enjoyed by adults and chiIdren in a variety of disciplines. These include the breed ring, obedience trials, agility, lure coursing, field trials, earth dog trials, and junior showmanship. SELECTION
OF A DOG
The American Kennel Club currently recognizes 140 breeds. A dog or puppy should be selected from a reputable breeder rather than from a pet shop or neighbor. Breeders are interested in the welfare of their dogs. Nevertheless, a newly purchased dog should be examined by a veterinarian to ensure that the animal is healthy. A dog should never be bought on impulse or because of its looks. Parents should be willing to commit themselves to 10 or more years of dog ownership. Unfortunately, within the first week or so after a puppy or dog is brought home, many children quickly lose their fascination with the animal, and the responsibility belongs to the adult. Before purchasing a particular breed of dog, families should try to attend a dog show, where they will see adult dogs who have reached their maximum size. Dogs within each group have a variety of sizes ranging from small to large. Smaller dogs such as toy breeds and some nonsporting breeds do well in an apartment setting. The medium to larger sized dogs thrive in a home with a yard enclosed by a chain link fence. Parents must also consider the age of their children. Larger breeds may accidently knock over a toddler or preschool-age child because of the dog’s size and weight. Dogs in the Sporting and Terrier group possess high levels of energy. School-age children and adolescents may be better suited to these breeds of dogs. An older child is less likely to be pushed down by a dog because of its inherent rambunctious nature and are better able to control the dog while the animal is on a leash.
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All dogs of any size and breed need exercise. Awalk several times a day can accomplish this. The length of the walk will vary depending on the size of the dog. In addition, dogs receive exercise during short lo-minute training periods three or four times a day Dogs afford children companionship and can be a gateway to helping children meet new friends during their walks. Families must understand that there will be additional expenses for a dog that do not end with the initial purchase. The cost of a dog can range from a minimal adoption fee, if one selects a dog from a shelter, to $950 or more for a show-quality puppy. Other initial expenses include a crate, leash, and collar. Older children who earn money by baby-sitting or delivering newspapers can share in the ongoing care of their pet by assisting with the payment of veterinary care, licensing fee, and dog food. Parents can than instruct their children about the importance of their dog’s health and the need for vaccinations to maintain the dog’s health. Younger children can share in the responsibility of dog ownership by helping to name the new dog, feeding it, providing it with fresh water, and assisting with grooming. Parents should also instruct their children that responsible dog ownership means spaying or neutering the dog if they do not plan to show it. Children should understand that there is a need to prevent unwanted puppies. The role of the nurse practitioner in assisting families with their decision to purchase a dog involves making an assessment of the family lifestyle. When both parents work, it is unlikely that there will be adequate time for house training or training a new dog. Furthermore, if parents work, they are not able to supervise their children’s interactions around the dog. The nurse practitioner must also consider allergies in family members. Many breeders will state that their particular breed of dog is “hypoallergenic” because it does not shed. Any breed can trigger allergic reactions. Finally, the nurse practitioner can direct the family to resources about different breeds such as The Complete Dog Book (American Kennel Club, 1992) and other breed-specific books, which are often located in the public library
TRAINING
NEEDS
Pet shops, book stores, veterinarian offices, and the public library offer an array of dog training books. To the novice dog owner and parent these training methods appear correct, quick, simple, and able to produce a gentle pet with whom their children will be safe in a short amount of time. However, most expert trainers who claim to advocate such “positive” training techniques actually are using violent methods. Some examples of these violent methods are encouraged by Handler (1987), who recommends the “scruff shake” for a disobedient dog. This is performed by picking the puppy or dog up behind the back of the neck and shaking the dog hard from side to side. If 10 seconds of this appears sufficient, the dog should be dropped to the floor. The dog owner is further advised to “set the dog up” to provoke it. If the dog has previously snapped at the owner, a coat and ski
‘18? ,,,,,..c /,,: if
r=
i *jn$ki@ $6 assessment of’ the family lifestyle.
gloves should be worn when correcting the dog. Handler (1987) states these methods are not cruel to the dog. Others, such as The Monks of New Skete (1978), inform dog owners that physical discipline should be used when training the dog. Their general rule is that if one does not get a response (a yelp or other physical sign) after hitting the dog under the chin, the slap was not hard enough. Owners are further advised that they cannot hurt the dog with this method or cause irreparable damage. Jester (1986) states that to correct a
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dog he must be hit hard enough underneath his jaw with enough force to cause his head to snap back, noting the trainer must gear the swat to the dog’s size and the handler’s strength to avoid breaking the dog’s neck. Although Jester (1986) recommends being humane, this same trainer encourages the owner to hit the dog hard enough to show the dog that its behavior will not be tolerated and to get the message across to the dog. Unfortunately, messages such as these violent approaches abound in the dog training literature. Parents mistakenly may view these types of training methods as correct and nonviolent because they are written by “expert trainers” in the dog world, or because a particular trainer who was seen on television or a book advocating dominant training methods was recommended by a veterinarian. Dominant training means using a force such as hitting, squeezing a dog’s ear or lip, electrically shocking the dog, angrily shouting at the dog to promote a feeling of power within the handler, and subjecting the animal to obey through submission and fear. Unfortunately, violence permeates our society today. Children need not be shown methods of forceful dog training that have no place in the home. Parents should be advised to be wary of books that recommend methods such as use of a “shake can,” the “scruff shake,” the “alpha wolf rollover,” the “chin slap,” and hanging or stringing up the dog to promote obedience. If the new dog owners decide that they wish to take the dog to formal training classes, the school should be visited first. Any training class that promotes dominant training techniques should be avoided. Many dog obedience schools offer puppy socialization or puppy kindergarten training classes. These classes became popular in the 1980s. In these classes young dogs are encouraged to playfully bite one another and pin each other down. After 10 minutes of this behavior puppies are given obedience training. If the dog begins biting the owner or jumping up, the owner is told to correct the dog by hitting or shaking him. The puppy now becomes confused. He is being punished for behaviors that only moments
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ago were being praised (Meisterfeld, 1991). Such puppy training classes instill within a dog the need to use its teeth and promote the use of violent training methods. Ideally, training for the new puppy or dog needs to be given in the home on a one-on-one basis. If group training classes are used, families should seek small classes (no more than five dogs to a class) with short training periods. In this type of class the dogs are worked for lo- to 15minute periods with frequent breaks within the hour session. Meisterfeld (1991) believes training should start immediately, when the new puppy or dog is brought home. One adult family member should consistently tram the dog by establishing mutual respect and trust in the animal. This form of training helps children understand that force is not necessary to discipline anyone. Moreover, hitting the animal does not achieve results and in turn only causes aggression. The child also learns that hitting or striking anyone, be it a friend or animal, is a behavior that is not tolerated within the family. Parents should not expect an 8- or 9-year-old child to take on the task of dog training. A child may quickly become frustrated if the dog does not listen and may become angry with the dog. Dogs do not have a prolonged attention span. Puppies 8 to 12 weeks of age should have no more than 2 minutes of training three times a day. By age 13 weeks, training periods can be increased to 5 to 10 minutes. All dogs should be taught to heel, stand, sit, down, stay, and come when called. Training should be done in an area of the home that is free from the distractions of other family members. In this way the dog directs its attention to the person who is handling him or her. At the time of their first interaction with a family, pediatric nurse practitioners should establish what type of parental discipline is used within the home, and nonviolent methods of redirecting a child’s behavior should be suggested and encouraged. Similarly, when the child’s health history is first obtained, the nurse practitioner can assess whether a dog is in the home and what type of training, if any, the dog has been given. The nurse practi-
tioner should encourage the use of nondominant training methods.
TYPICAL DOG BEHAVIORS Meisterfeld (1991) states all puppies, if they were living in a wild dog pack as they were hundreds of years ago, would need to learn and practice with their teeth to establish their ranking position and help their survival. In that situation physical dominance was a crucial issue, because the social interactions of the pack members were based on it. Only the strongest animal can be the pack leader and control the pack. As such, the dog had to respond to environmental challenges and fought to maintain his position (Meisterfeld, 1991). Puppies today no longer live in the wild but within a civilized human family Furthermore, Meisterfeld (1991) emphasizes they do not need to be dominant over other animals or further their survival with physical force. Puppies and dogs display their natural play behaviors of facial biting towards one another. Dogs express this biting behavior not only when they feel threatened but also to express their dominance over other dogs and species and while playfully fighting. Meisterfeld (1991) stresses that dogs practice this behavior from early puppyhood and during their whole adult life. Families should not humanize their dogs by allowing them to sleep on the couch or beg at the table or by using the dog as a child or mate substitute. The dog was born to serve mankind, not to be catered to (Meisterfeld, 1991). Catering to the dog by cooking it special foods or petting the dog each time it sits in front of its owner puts the dog in charge, which is unnatural for the domesticated dog. Meisterfeld (1991) believes that catering, humanization, not training the dog, or using force and aggressive training methods allows the dog to develop its own typical and natural dog behaviors that include barking back at a person, lunging, and mouthing a person’s hands. These behaviors may appear at first to be cute to the family but later may become unpleasant and frightening and can escalate into excessive barking, digging, chewing, chasing whatever moves, soiling the house, destroying the furniture, threat-
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FIGURE FIGURE 1 TWO Meisterfeld, respect
and
dogs
C.W.
(1991).
trust.
Petaluma,
displaying
aggression
Psycbo/ogical CA:
M.R.K.
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one
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2
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SAFETY Dog bites account for up to 90% of all animal bites in the United States, and most victims are children (Avner & Baker, 1991). The public fear of breeds such as the pit bull terrier has led to bans in some communities and some military housing and to problems with insurance companies excluding some breeds from coverage on homeowner policies (Wheeler, 1995). Such thinking will eventually lead to a ban on most breeds, because all dogs will bite if they feel sufficiently threatened (Meisterfeld Seminar, 1995). Certain breeds of dogs such as pit bulls, rottweilers, doberman pinschers, boxers, great danes, chows, Siberian huskies, and german shepherds have been implicated as “dangerous dogs” because statistically they have been shown to have the highest at-
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tack rates (Wheeler, 1995). Contrary to the public’s misconception, dogs are not “trained” to bite. Meisterfeld (1989) states that breeds such as the pit bull have the genetic makeup to fight and attack prey but not humankind. German shepherds, dobermans, and rottweilers are used to guard but are not genetically bred to attack. Because every breed of dog, not only those named, has the propensity to bite, banning of breeds is not the answer to ensure safety; otherwise, it will not be long before beagles, poodles, golden and labrador retrievers, and other so-called friendly breeds will be banished (Staff, 1995). The answer lies in educating people about training dogs by mutual respect and trust. Parents must establish certain ground rules for their children when activities involve dogs, whether it is their own dog or another. These rules include how to approach a dog and how the child should behave around a dog. Dogs may show very aggressive behavior toward one another (Figure 1). This behavior is shown by curled lips, stiff and tense posture, and focusing on the other dog’s head and neck, an area a dog will attack when fighting another dog. The other dog will also display a similar posture. If the cl&d in Figure 1 were to break away from his mother’s arms, he could be seriously
and
of a child
kiss.
C.W.
Dr. Jekyll
for the safety
ening the family, and even biting and attacking a child (Meisterfeld, 1991). The nurse practitioner can suggest to the family that the dog must be treated as a dog. Special privileges such as sleeping on the sofa, walking through an open door first, or jumping up on visitors should not be given to the dog. The family can be made aware that through nondominant training a dog’s natural behaviors such as biting and barking will disappear.
Result
a hug
(1989). & Mr.
of our
welfare
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M.R.K.
Publishing.)
giving
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children Petaluma,
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bitten. Children and parents alike should be warned against walking between two dogs, even if one of the dogs is their own. The two dogs may attempt to challenge one another, resulting in a dog fight. Parents should not encourage their children to kiss the dog or allow the dog to lick their face. Dogs do not express their affection by hugging and kissing. When dogs “kiss” another dog, it is their way of showing submissiveness to another dog. Therefore when a child or adult bends down to kiss or hug a dog, the dog becomes confused by this body language, which tells the dog he is in charge (Staff, 1995). Small children who are at the dog’s eye level risk being bitten if they attempt to hug or kiss the dog. A dog who is trained by force or untrained may view the child’s hard squeezing as an attack and try to protect itself (Staff, 1995). Parents therefore should not encourage their children to kiss the dog or allow the dog to lick their face. There is also the risk of infection from a dog bite, because the dog’s oral flora frequently includes pasteurella multocida, Streptococcus spp., S. aureus, Staphylococcus epidermidis, Staphylococcus sapuophyticus, neisseria spp., unclassified gram-nega-
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Right Approacl1
FGkzardoa~5Xmproper Approacfr
FIGURE versus
3 Improper
Dr. Jekyll
& Mr.
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tive rods (DF-2, EF-4, others), and anaerobes (Feder, Shanley, & Barbera, 1987). Figure 2 depicts what happened to a child when he gave his dog a hug and kiss. Children can be taught how to gently pat the dog on the chest or shoulder to show affection. Children should not engage in rough play around a dog. Meisterfeld (1989) believes that often a dog may interpret the child’s arm waving and jumping as part of aggressive play and may inadvertently bite. Dogs should never be approached and disturbed while sleeping or eating. A dog may perceive this surprise approach as a threat to his survival (Meisterfeld, 1989). Children should be taught how to safely approach a dog. One should never greet a dog with an outstretched hand (Figure 3). Rather, the dog should be approached with a closed fist (Meisterfeld, 1989). The dog discovers its surroundings through its nose. Meisterfeld (1989) acknowledges that dogs are able to detect a myriad of scents and distinguish among these. During the discrimination process when a dog meets a stranger, especially within the first 15 seconds, the dog is in a state of alert. The body becomes tense, and the tail stiffens to alert the dog to the signals of danger. If the dog receives pleasant impressions, the adrenals quiet down in the time frame of 15 to 30 seconds, and the dog starts to relax. Between 30 to 45 seconds the adrenal reaction has nearly or
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completely ceased. However, it is safer to wait another 15 seconds, that is, up to 1 minute, before establishing the first contact with a strange dog, provided he exhibits friendliness (Figure 4) (Meisterfeld, 1989). Friendliness is exhibited by a wagging tail and no harshness in the eyes. The rationale behind these ground rules is clear when one understands how the senses within the dog function. A dog’s hearing is far superior to that of humans. A dog can distinguish different tones of voice (Meisterfeld, 1989). Because of this ability, no family member needs to shout at the dog, because this evokes fear within the dog. Fear does not establish trust between the dog and family members. Furthermore, Meisterfeld (1989) states that a dog’s vision excels that of humans. Dogs see greater distances. Any gestures or facial expressions that are hostile, according to the dog’s code, such as making sudden jerky movements, can excite an alarm reaction in the dog. Staring at a dog can trigger an adverse response, because that is how dogs challenge one another. The sodium content within the dog is higher than that in humans (Meisterfeld, 1989). Therefore, dogs are more sensitive to electric shocks. Family members should never use electric collars to train the dog or use electric fences to contain the dog within the property. This type of force can only evoke a re-
sponse of aggression or fear within the dog. Meisterfeld (1989) warns that any type of physical threat strengthens the dog’s survival instinct, and he will show it by use of his teeth. By comparing an animal’s reaction to danger with the human reaction of anger to violence syndrome (Figures 5 and 6), one is able to see the end point when an animal or human is confronted-violence (Meisterfeld & Pecci, 1993). Pediatric nurse practitioners should discuss with parents during their visits the need for adult supervision when children and dogs interact. Children need to be reminded to play quietly when around the dog. If quiet play is not likely, the dog should be put in a separate room. Parents must also be reminded that children should not touch anyone’s dog without first asking the owner’s permission. Children can also be taught that if they are approached by a stray dog, they should not attempt to reach out to the dog and pet it. Rather, they should stand still and slowly turn away from the dog. Direct eye contact should not be made with the dog. Finally, parents can understand that a dog can and does provide companionship to children when the dog is trained with respect and the dog is not abused by the child.
DOG BITES Dog bites are an underrecognized public health problem. Every year in the
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FIGURE 4 Discrimination safety period. (From Meisterfeld, C.W. (I 989). Jelly bean versus Dr. Jekyll & Mr. Hyde: Written for the safety of our children and the welfare of our dogs. Petaluma, CA: M.R.K. Publishing.)
United States dog bites cause approximately 20 deaths and an estimated 585,000 injuries resulting in the need for medical attention or restricted activity (Gershman, Sacks,&Wright, 1994).The dog bite rate (higher than that for most accidents and infectious diseases)is not truly appreciated as a medical problem, probably because the age of the victim, the severity, and cost factors are not usually put into context (Beck, Loring, & Lockwood, 1975). An analysis of the epidemiology of dog bite injuries in St. Louis, Missouri, provided the following information. The attack rate for children 5 to 9 years old was 1231.4 per 100,000,and for those 10 to 14 years old, it was 1171.5 per 100,000. Approximately 3.4% of all bites were classified as serious, and generally the victims were young. For example, the age group of 5 to 9 years (8% of the popdation) received 27.4% of all bites and 32.5% of the serious ones (Beck,Loring, & Lockwood, 1975). Another aspect of severity is the location of the bite. Beck, Loring, and Lockwood (1975) found that the pattern for the victims younger than 9 years was 37.1% on the legs, 19.7% on the torso, 26.9% on the arms and hands, and 18.5% on the neck and face. In 1973 more than 35% of the 245 bites in children younger than 4 years were on the face. A face bite is traumatic and is a source of concern regardless of the
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FIGURE 5 Stress-rest pattern in the animal & Pecci, E. (1993). Crazy dogs & crazy people: Petaluma, CA: M.R.K. Publishing.)
extent of its severity (Beck, Loring, & Lockwood, 1975). If a dog bite should occur, parents should not delay in seeking emergency medical management. This manage ment includes thoroughly irrigating, cleansing, and debriding the wound with saline solution (Caserta, 1992).The wound is then sutured to preserve function and for cosmetic masons. Exceptions to this include injuries to the hand, soft tissues, punctures, and deep tissue injuries more than 8 hours old. Bite wounds that have the potential for becoming infected include those to the hand, foot, scalp, or face. Other injuries with a high risk for infection are crush injuries and wounds that have been sutured. Children who are immunocompromised are also considered to be at high risk for infection. Antibiotics are not indicated in those bite wounds in which the risk of infection is low, such as the common superficial and open dog bite wounds (Caserta, 1992). Antibiotic therapy is administered in those high-risk categories as previously stated.
kingdom. (From Meisterfeld, C.W., Looking at behavior in our society
The duration of treatment is related is used for the purpose of prophylaxis or treatment of an already infected wound. Prophylaxis begun shortly after the bite occurs should be discontinued after 5 days if infection does not develop. However, Caserta (1992) reports treatment of an established uncomplicated wound infection usually requires 7 to 14 days of antibiotics; duration is dependent on the severity of the infection and patient response. Penicillin G (or V) and broad-spectrum penicillins (such as ampicillin or ticarcillin) are the antibiotics of choice for many pathogens, including Pasteurella multocida, Eikenella corrodens, and the CDC ol-numeric organisms DF-2, M-5, EF-4, and II-j (Caserta, 1992). Because of the presence of Staphylococcusaweus- and B-lactamaseproducing anaerobes in a high percentage of wounds, the combination drug of a B-lactamaseinhibitor, clavulinic acid, and amoxicillin is a very useful prophylaxis and initial therapy of established infection. Erythromycin and clinto whether the treatment
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basic principles of safety around dogs by treating them with respect, never harshness. Parents need to understand they must take charge and be responsible for the dog’s welfare and training and not depend on their children to take full responsibility. Training of the pet must be done with respect and trust, not force; this in turn sets an example for children to follow. Pediatric nurse practitioners can achieve the goal of preventing dog bites rather than treating the physical and emotional injuries that are their consequences.
REFERENCES
FIGURE 6
Anger
to violence
syndrome.
(1993). Crazy dogs & crazy people: CA:
M.R.K.
Looking
Meisterfeld,
at behavior
C.W.,
& Pecci,
E.
in our society. Petaluma,
Publishing.)
damycin are inadequate for treating bite wound infections because of the drug resistance of major pathogens, especially Pasteurella multocida (Caserta, 1992). Alternatives for the patient allergic to penicillin include cefuroxime axetil or tetracycline, depending on the age of the patient (Caserta, 1992). Caserta (1992) states that a parenteral third-generation cephalosporin such as ceftriaxone or cefotaxime can also be used for therapy of severe bites in hospitalized patients. Tetanus toxoid should be administered as necessary. Other care includes rabies prophylaxis in those areas known to be endemic (Brook, 1989). Prophylaxis is recommended to those persons bitten by dogs unavailable for observation or testing. If the dog is available, the Health Department’s Veterinary Public Health Service should be called. This service is responsible for observing the dog for a
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period of 10 days or arranging for a laboratory test of the animal’s brain tissue. If the dog does not exhibit any signs of rabies during the observation period or if the laboratory test is negative for rabies, postexposure vaccination is not necessary (Staff, 1992). Parents require education regarding monitoring for signs of infection, which include fever, erythema, edema, tenderness, or discharge from the wound. The pediatric nurse practitioner should reexamine the wound after 24 hours of initial treatment. Any wound that becomes infected requires hospitalization for parenteral therapy,
SUMMARY Pediatric nurse practitioners can give anticipatory guidance to families about how they and their children can have a healthy relationship with any breed of dog and any age of child by following simple guidelines. Children can learn
American Kennel Club. (1992). The complete dog book. (18th ed.). New York: Howell Book House. American Veterinary Medical Association. (1993). U.S. pet ozonewhip & demographics sourcebook. Schaumburg, IL: Center for Information Management. Avner, J.R., & Baker, M.D. (1991). Dog bites in urban children. Pediatrics, a&55-57. Beck, A.M., Loring. H., & Lockwood, R. (1975). The ecology of dog bite injury in St. Louis, Missouri. Public Health Reports, 90,262-267. Brook, I. (1989). Human and animal bite infections. T!e Journal ofFamify Pmctice, 28,713-718. Caserta, M.T. (1992). Infections from animal and human bites. The Report on Pediatric Infectious Diseases, 2,9-u. Feder, H.M., Shanley, J.D., & Barbera, J.A. (1987). Review of 59 patients hospitalized with animal bites. Pediatric Infectious Disease Journal, 6, 24 28. Gershman, K.A., Sacks, J.J., &Wright, J.C. (1994). Which dogs bite? A case-control study of risk factors. Pediatrics, 93,913-917. Handler, B.S. (1987). Positively obedient: Good mdnnners for the fumi2y dog. Loveland, CO: Alpine Publications. Jester, T. (1986). Common behavior problems in dogs and how to solve them. Novato, CA: Marin Humane Society. Meisterfeld, C.W. (1991). Psychological dog training: Behavior conditioning with respect and trust. Petaluma, CA: M.R.K. Publishing. Meisterfeld, C.W. (1989). Jelly bean versus Dr. Jekyll b Mr. Hyde: Written fouthe safety of our children and the we&e of our dogs. Pet&ma, CA: M.R.K. Publishing. Meisterfeld, C.W., & l’ecci, E. (1993). Crazy dogs & crazy people: Look@ at behavior in our society. Pet&ma, CA: M.R.K. Publishing. Meisterfeld, C.W. (1995, April). Seminar. Reston, VA. Monks of New Skete. (1978). How to be your dog’s best friend: A training manual for dog owners. Boston, MA: Little, Brown & Company. Staff. (1992, March). Rabies alert. City health information. The New York City Department ofHealth, ll, l-4. Staff. (1995, May). Applying the philosophy of Meisterfeld’s psychological dog training. Newsfetkr, 1,2. Wheeler, L. (1995). He rarely meets a dog he doesn’t like. The W&zington Post, May 1, p. 50.
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