Dog bites can have very serious repercussions in a child’s life and can change their behavior, functioning, personality, self-esteem, impact a child’s educational progress as well as anxiety and years of counseling. For example, this patient is a seven-year-old white female, experienced a severe dog bite on her face. This was the result of a neighbor not keeping his Pit Bull on a leash. The neighbor was subsequently arrested and charged with Child Endangerment. The patient is now left with some significant scarring on her face. She is teased about this at school and her self-esteem has become quite low. Prior to the dog bite, she was a normal little girl and did well in all aspects of her life. Since the dog bite, she has had a deterioration in functioning.
The patient has had some counseling, with little improvement. She has never seen a Child Psychiatrist, nor has she ever taken any Psychotropic Medication. Her diagnosis is consistent, according to the DSM IV with Post-Traumatic Stress Disorder-Chronic. Here is an excellent reference from The American Academy of Child and Adolescent Psychiatry, which reviews the criteria for PTSD in children: *
As per the above reference, the symptoms of PTSD may last from several months to many years. In my experience, (I have seen over 18,000 children and their families over the past 25 years), in severe cases such as this, children may have symptoms of anxiety which can become pervasive and can negatively impact their lives in tremendous ways and for years and years to follow.
For example, I have seen children with PTSD who really never seem to completely recover from their condition and in fact, seem to become worse over time with very debilitating anxiety affecting all major life areas. Such children may develop more pervasive phobic avoidance and antipitory anxiety, and for example, refuse to leave their homes or attend school. Such a situation of avoiding all meaningful activities can impact a child’s educational progress and they can become behind in their academics.
Furthermore, avoidant behaviors can negatively influence how well a child can make and keep friends. Both the educational problems with a child potentially falling behind, even having to repeat grade levels, as well as a child with few if any friends, can create a child with a very low self-esteem. *
Such a child may then further regress and develop behavioral disturbances and conduct problems. One can easily see how then, a child may continue to worsen and even develop Depressive Disorders such as Major Depression and/or Dysthymia (a chronic form of Depression). Children and Adolescents with Anxiety and/or Mood Disorders are more prone to have Substance Abuse Disorders and Dependencies. Substance Use Disorders are associated with other Antisocial Behaviors such as Truancy, Delinquencies and problems with the law.
It is really not possible to accurately predict which child will progress to the much more severe and persistent conditions as above; and which child will completely recover. In my opinion, this patient is at risk for her condition not improving and worsening, stemming from the initial trauma of the horrific dog bite incident.
I strongly recommend this patient have a Comprehensive Psychiatric Evaluation by a Board Certified Child Psychiatrist. The most effective type of Psychotherapy for a case like this, consists of attempts toward desensitization, as part of what is known as Exposure Therapy. In addition, Psychotropic Medication Management may indeed be indicated, ideally coordinated and prescribed by a Board Certified Child Psychiatrist.