Thursday, July 28, 2011

How to Help Your Child Emotionally After a Dog Bite

Child psychiatrist Dr. R. Larry Schmitt has been very concerned about the welfare of dog bitten children. Dr. Schmitt has been very helpful to Doggone Safe and to dog bite victims by providing us with information for parents and for spreading the word in the medical community about the importance of emotional support and counseling for dog bite victims.
The typical dog bite on a child hits them at or above their shoulders. Such attacks equate to that of a bear attack on an adult, in terms of the shock, overwhelming fear and residual stress. The emotional impact on the child and the adult is huge. The difference is the adult will talk about their experience until the day they can no longer speak. The child will not talk about it and greatly needs to. This is because the child sees the sad faces of his parents anytime the topic comes up. They remain silent to save their parents from additional grief. So the child keeps this emotion load locked up in his mind. Parents must repeatedly encourage and allow their child to talk about the accident and their feelings.
R. Larry Schmitt, M.D. Child Psychiatrist
Read more in a article by Dr. Schmitt published in the journal Contemporary Pediatrics.

Here are the answers to some frequently asked questions from parents supplied by Dr Schmitt and published at the Doggone Safe website:

How soon after the incident should I start talking to my child about it? 

Immediately! It is important to completely avoid making any comments about your own feelings other than to express your regret that it happened.
How many times per day should we talk about it? 
For the first few days at least twice a day followed by once a day for the following three weeks.
For how long after the incident should we keep talking about it?
Depending on the degree of fright and injury, until the parental waves of guilt are close to flat and/or the child shows easy emotion, not suppressed or keyed up emotion when it is discussed.
What if my child starts to cry? 
Try saying something like, “Wow, I see it really hurts/frightens/upsets you. It is so good for you to let me see how you feel about the dog biting you.”
What if my child withdraws or becomes irritated and refuses to talk? 
This is very likely a sign that it may be time for trauma counseling with a mental health expert.  Say to the child, "Are you worried about how talking about it makes me feel?  If you are, please understand that I am a grown-up and can handle such feelings of being sad because you were injured. This will help you to look at all the feelings that came from that dog attack.”
What if my child insists that he is fine and doesn't want to talk about it anymore?
Reply to the child, “That may be right". (This is true if the parent notes that it has been discussed a great deal with a noticeable decrease in affect/emotion). Then say  “I want to think about it some more.”  Later, if the child still seems reluctant to talk and bothered by the topic,” I notice that any mention of it finds your face changing as if it still hurts.”  “How about drawing a picture of the dog attack scene, before, during and after?”
What kinds of questions or statements can I use to engage my child in a conversation?
In an intact family, observing  parents conversing with each other about the accident and making gentle guesses about how the child thinks and feels about the attack. “I still think about the day when the dog hurt and scared you, do you?”  “Sometimes I feel really mad about that dog biting you.”  “I saw a dog barking at me when I was jogging today. I remembered what happened to you and was scared when the dog barked!”

With teenagers, whose skills in talking about a dog attack are probably closer to that of an adult you might say something like:  “What do your friends say about the dog attack?”;  “How many others at your school have been bitten by dogs?”; “ If you find you are dreaming about the attack or thinking about it a lot and you do not want to, consider this paradox, that talking about it with anyone will reduce such dreams and thoughts.”
What are the signs that my child needs professional help? 
The big ones are decreased success at school, (both socially and academically), lack of pleasure from past enjoyments, and early resistance to speak about the attack. Watch for dog phobia, avoidance of other animals, or the appearance of other new fears and anxieties.

When in doubt seek a mental health consultation and if the parents have doubts about the recommendations/conclusions of that first consultant, seek a second opinion.  Consider an analogous  situation with a post-surgical issue.  The surgeon says they think an abscess developed out of sight with minimal symptoms that if ignored will cause problems later.  Of course, with an x-ray or digital exam it may be evident.   A competent child mental health expert can be expected to probe in an interview and demonstrate an emotional abscess.
What should I look for in a mental health professional?
First, one who works with children; second, one with at least a five-year record in the field; third, a referral from a trusted mental health professional, and most of all, one with whom the parent feels comfortable. I prefer one who works with the child and parents together and spends less time with the child individually. In other words, family oriented therapy.
How do we know when to stop the therapy? 
This obviously varies with the severity, both physical and emotional, of the injury. Assuming the child and family have a positive relationship with a competent therapist, the therapist should suggest when to stop. If the parents are concerned that it is going on too long they should suggest a hiatus of four to eight weeks, observe the child during that time and return for termination in the absence of symptoms. In the typical situation, success comes early, with promoting the child and family to discuss all aspects of the attack and its potential residuals. (2-6 sessions).

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