JOMS study: Children at risk for dog bites in eye area

ROSEMONT, Ill. – Children are twice as likely as adults to experience a dog bite in the eye area, and public health measures should warn against children being at eye level with dogs, even those that are familiar and under adult supervision, according to a new study.

The most frequently injured area in adults and children was the area of the nose, lips and cheeks known as the central target area (CTA), states the study in the January issue of the Journal of Oral and Maxillofacial Surgery, the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS). Yet, children were at less risk for dog bites in this area, possibly because of their body structures or because attacking dogs aim at their eyes, researchers wrote.

The study involved 313 patients – including 183 children – who experienced at least one dog bite in the head, neck or face and went to the emergency department. Injury to the eye area – called the periorbital region – was defined as injury to an eyebrow, eyelid, inner or outer corner of the eye, the tear duct system or the eye socket and its contents. Injuries to the CTA included the lip, nose, area above the cheekbone and inner lining of the cheeks.

Researchers found children were more likely to be bitten on the head, neck or face by a familiar dog at home. Injured children also were more likely to go to the hospital and undergo treatment in the operating room. The greatest incidence of injury to the eye area was between ages 0 and 4.

Factors related to children’s body structure as well as behavior of children and dogs could factor in the increased risk of injury to the eye area, according to the study. Other studies have stated dogs have an instinct to attack the face, and further research has indicated dogs regard children at eye level as a playmate or threat, resulting in biting the face or mouth as if the child is another dog.

The JOMS study also notes that children could be unaware they are interacting with a dog inappropriately, or a dog could feel threatened when a child moves his or her face near it. Children’s head, neck and face could be more accessible to an attack due to their shorter height and larger head-to-body ratio, and they could appear more threatening because their eyes are proportionally larger than those of adults, the study adds.

The most commonly identified breed of dog in cases involving adults (26 percent) and children (18 percent) was the pit bull. However, in most cases, the breed was listed as unknown among adults and children.

According to the study, knowing children are at higher risk for an eye injury from dog bites could be important for treating and preventing these injuries. Examination of a head and neck injury should include a comprehensive evaluation of signs of an eye injury, researchers wrote.

“Public health and preventive measures should stress that young children not be left at eye level on the floor with a dog, with or without immediate adult supervision and regardless of the familiarity with the dog,” researchers wrote. “In addition, potentially risky behavior such as interfering with food, hugging, kissing, staring or playing roughly should be discouraged.”

The authors of “Children Have an Increased Risk of Periorbital Dog Bite Injuries” are from the University of Washington, Department of Oral and Maxillofacial Surgery, Seattle, Wash.: Philip J. Hurst, DDS, MD; Thomas B. Dodson, DMD, MPH; and Jasjit K. Dillon, DDS, MBBS, FDSRCS; and from the university’s School of Dentistry: Marcus Ji Hoon Hwang, BS.

The full article can be accessed at


The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.