OBJECTIVES. This study focuses on the pattern of incidence, mechanisms, and circumstances of accident and injury in a series of pediatric patients who sustained dog bites.METHODS. In our retrospective survey, the medical charts of all children who were younger than 17 years and sought medical attention after a dog bite between 1994 and 2003 were reviewed. To obtain the total number of each dog breed in the administrative district, we analyzed 5873 files from the community dog registers. For establishment of a risk index, the representation of a dog breed among the total canine population was divided by the frequency of dog bites from this breed.RESULTS. A total of 341 children (mean age: 5.9 years) were identified. The annual incidence of dog bites was 0.5 per 1000 children between 0 and 16 years of age. Incidence was highest in 1-year-old patients and decreased with increasing age. The relative risk for a dog attack by a German shepherd or a Doberman was ϳ5 times higher than that of a Labrador/retriever or cross-breed. The vast majority (82%) of the dogs were familiar to the children. Most (322; 94%) of the children had injuries to 1 body region; in the remaining 19 (6%) children, up to 3 body regions were injured. Of 357 injuries, the face, head, and neck region was the leading site affected (50%). Inpatient treatment was required in 93 (27%) patients.CONCLUSIONS. Dog bites in children are frequent and influenced by the breed-related behavior of dogs, dog owners, children, and parents. Therefore, prevention strategies should focus on public education and training of dogs and their owners. Children who are younger than 10 years represent the high-risk group for dog attacks.www.pediatrics.org/cgi

As the Department of Pediatric Surgery in Graz serves as the referral center at least for nearly all major pediatric fractures in the Austrian state of Styria, mechanisms and patterns of major fractures in this study can serve as the basis for state-wide pediatric injury prevention efforts. These prevention strategies should not aim to reduce the level of exposure but should increase the risk awareness and encourage children and their parents to use necessary precautions.

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While it has been shown that non-parental child care is associated with a reduced risk for unintentional injuries, a considerable number of accidents in kindergartens do result in severe injuries. We have collected data on the behavioral and environmental aspects of accidents that occurred in kindergartens in Austria with the aim of determining possible prevention measures. Included in the study were all kindergarten-related injuries (347) from among 21,582 pediatric trauma cases treated in a 22-month period in Graz, Austria. Kindergarten-related injuries that were treated during the same period at six participating hospitals located throughout Austria were used for comparison. A questionnaire was completed at first attendance, and additional information was achieved by interviews with the parents and kindergarten teachers. Only the 347 kindergarten accidents that occurred in Graz were analyzed in detail. Half of the injuries occurred in an outdoor environment (outside), even though most of the time was spent indoors. Boys were more frequently involved in accidents than girls (male:female=3:2). We identified seasonal and circadian differences, with most children being injured during the first 2 months of attendance (September and October), during the first 3 days of the week (Monday to Wednesday) and in the hour before and after lunch, respectively. Of the 347 accidents analyzed, 24% resulted in serious injury, and injuries occurring outdoors were more severe than those occurring indoors. Most parents felt that the accidents were unpreventable (47%), while 18% stated that improved supervision may have prevented the accident. Kindergarten accidents in Austria still result in a significant number of severe injuries. Kindergarten injuries were related to gender, season, time of day and location. Our results indicate the necessity of a continuous child safety training program that involves the participation of all teachers in day-care functions.