Biting in day care centers: Incidence, prevention, and intervention

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      Analysis of accident logs in child day care centers indicates that biting is common, especially among toddlers 13 to 30 months of age. Children of this age often lack appropriate verbal skills and resort to aggressive means to achieve their goals. Still awkward in gross-motor skills, toddlers can also suffer self-bites following accidental falls. According to medical reports, human bites sometimes are more virulent than animal bites and can cause severe trauma. Although the AIDS virus has been cultured from saliva, transmission from saliva alone has not been documented. Bite injuries in day care, however, usually are minor and can be treated by washing, applying cold compresses, and comforting the child. Suggested methods to diminish the frequency of biting in day care include physical changes within the room, behavior modification, and other classroom management techniques.
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        • Adelson L.
        The battering child.
        Journal of the American Medical Association. 1972; 222: 159-161
      1. AIDS inmate convicted. Iowa City Press Citizen, April 12, 1990
      2. Quad-Cite Times. March 26, 1990;
      3. AIDS Weekly Surveillance Report. Centers for Disease Control, AtlantaFebruary 6, 1989
        • American Academy of Pediatrics
        • Committee on School Health
        • Committee on Infectious Diseases
        School attendance of children and adolescents with Human T Lyphotropic Virus III/ Lymphadenopathy-Associated Virus infection.
        Pediatrics. 1986; 77: 430-432
        • American Academy of Pediatrics
        • Task Force on Pediatric AIDS
        Pediatric guidelines for infection control of Human Immunodeficiency Virus (Acquired Immunodeficiency Virus) in hospitals, medical offices, schools, and other settings.
        Pediatrics. 1988; 84: 801-807
        • American Academy of Pediatrics
        • Task Force on Pediatric AIDS
        Infants and children with acquired immunodeficiency syndrome: Placement in adoption and foster care.
        Pediatrics. 1989; 83: 609-612
        • Baker M.D.
        • Moore S.E.
        Human bites in children.
        American Journal of Diseases of Children. 1987; 141: 1285-1290
        • Bitner S.O.
        • De Lissovoy V.
        Accident patterns in a nursery school sample of children.
        Journal of Nursery Education. 1964; 19: 194-197
        • Blackman J.A.
        • Appel B.R.
        Epidemiologic and legal considerations in the exclusion of children with acquired immunodeficiency syndrome, cytomegalovirus or herpes simplex virus infection from group care.
        Pediatric Infectious Disease Journal. 1987; 6: 1011-1015
      4. Bredekamp S. Developmentally appropriate practice in early childhood programs serving chidren from birth through age 8. National Association for the Education of Young Children, Washington, D.C1987 (expanded edition)
        • Centers for Disease Control
        Education and foster care of children infected with Human T-Lyphotropic Virus Type III Lymphadenopathy-Associated Virus.
        Morbidity and Mortality Weekly Report. 1985; 34: 517-521
        • Chang A.
        • Lugg M.M.
        • Nebedum A.
        Injuries among preschool children enrolled in day-care centers.
        Pediatrics. 1989; 83: 272-277
        • Church J.A.
        • Allen J.R.
        • Stiehn E.R.
        New scarlet letter(s). Pediatric AIDS.
        Pediatrics. 1986; 77: 423-426
        • Elardo R.
        • Solomons H.C.
        • Snider B.C.
        An analysis of accidents at a day care center.
        American Journal of Orthopsychiatry. 1987; 57: 60-65
        • Elkind D.
        Children who bite.
        Young Children. 1987; 42: 2
        • Fuller E.M.
        Injury-prone children.
        American Journal of Orthopsychiatry. 1948; 18: 708-723
        • Garrard J.
        • Leland N.
        • Smith D.K.
        Epidemiology of human bites to children in a day-care center.
        American Journal of Diseases of Children. 1988; 142: 643-650
        • Gold M.H.
        • Roenigk Jr, H.H.
        • Smith E.S.
        • Pierce L.J.
        Evaluation and treatment of patients with human bite marks.
        American Journal of Forensic Medicine and Pathology. 1989; 10: 140-143
      5. Young Children. 1987; 142: 49-50
        • Groopman J.E.
        • Salahuddin S.Z.
        • Sarngadharan M.D.
        • Markham P.D.
        • Gonda M.
        • Sliski A.
        • Gallo R.C.
        HTLV-III in saliva of people with AIDS related complex and healthy homosexual men at risk for AIDS.
        Science,. 1984; 226: 447-449
      6. Inmate indicted for biting officers to pass AIDS virus. Iowa City Press-Citizen, August 17, 1989
        • Kaplan J.E.
        • Oleske J.M.
        • Getchell J.P.
        • Kalyanaraman V.S.
        • Minnefor A.B.
        • Zabala-Ablan M.
        • et al.
        Evidence against transmission of human T-lymphotropic virus/lympadenopathy-associated virus (HTLV-III/LAV) in families of children with the acquired immmunodeficiency syndrome.
        Pediatric Infectious Disease Journal. 1985; 4: 468-471
        • Kounin J.
        Discipline and group management in classrooms.
        Holt, Rinehart & Winston, New York1970
        • Landman P.F.
        • Landman G.B.
        Accidental injuries in children in day-care centers.
        American Journal of Diseases of Children. 1987; 141: 292-293
        • Leland N.
        • Garrard J.
        • Smith D.K.
        • Johnson E.
        Injuries to preschool age children in four day care centers: A retrospective record review.
        1987 (Unpublished manuscript)
        • Lifson A.R.
        Do alternate modes for transmission of human immunodeficiency virus exist?.
        Journal of the American Medical Association. 1988; 259: 1353-1356
        • Loughlin C.E.
        • Suina J.H.
        The learning environment.
        Teachers College Press, New York1982
        • Marr J.S.
        • Beck A.M.
        • Lugo Jr, J.A.
        An epidemiologic study of the human bite.
        Public Health Reports. 1979; 94: 514-521
        • McGuire P.F.
        Debbie won't stop biting her playmates: Behavior modification in family medicine.
        Journal of the Maine Medical Association. 1977; 68: 267-268
        • Peeples E.
        • Boswick Jr, J.A.
        • Scott F.A.
        Wounds of the hand contaminated by human or animal saliva.
        Journal of Trauma. 1980; 20: 383-389
        • Peter G.
        • Hall C.B.
        • Lepow M.L.
        • Phillips C.F.
        Report of the Committee on Infectious Diseases. 21st ed. American Academy of Pediatrics, Wlk Grove Village, IL1988
        • Rawson R.D.
        • Koot A.
        • Martin C.
        • Jackson J.
        • Novosel S.
        • Richardson A.
        • Bender T.
        Incidence of bite marks in a selected juvenile population: A preliminary report.
        Journal of Forensic Science. 1984; 29: 254-259
        • Rest J.G.
        • Goldstein E.J.C.
        Management of human and animal bite wounds.
        Emergency Medicine Clinics of North America. 1985; 3: 117-126
        • Rivara F.P.
        • DiGuiseppi C.
        • Thompson R.S.
        • Calonge N.
        Risk of injury to children less than 5 years of age in day care versus home care settings.
        Pediatrics. 1989; 84: 1011-1016
        • Sacks J.J.
        • Smith J.D.
        • Kaplan K.M.
        • Lambert D.A.
        • Sattin R.W.
        • Sikes R.K.
        The epidemiology of injuries in Atlanta day-care centers.
        Journal of the American Medical Association. 1989; 262: 1641-1645
        • Scheerer K.
        Developing a toddler room: My experiences at ECEC during 1979–1980.
        1979 (Unpublished manuscript)
        • Schmitz K.
        • ten Bensel R.W.
        The biting child syndrome.
        Child Abuse and Neglect. 1980; 4: 285-288
        • Schweich P.
        • Fleisher G.
        Human bites in children.
        Pediatric Emergency Care. 1985; 1: 51-53
        • Shirley L.R.
        • Ross S.A.
        Risk of transmission of human immunodeficiency virus by bite of an infected toddler.
        Journal of Pediatrics. 1989; 114: 425-427
        • Solomons H.C.
        • Elardo R.
        Bite injuries at a day care center.
        Early Childhood Research Quarterly. 1989; 4: 89-96
        • Solomons H.C.
        • Lakin J.A.
        • Snider B.C.
        • Paredes-Rojas R.R.
        Is day care safe for children? Accident records reviewed.
        Children's Health Care. 1982; 10: 90-93
      7. Lancet. 1987; 2: 522
        • Vale G.L.
        • Noguchi T.T.
        Anatomical distribution of human bite marks in a series of 67 cases.
        Journal of Forensic Science. 1983; 28: 61-69
        • Wahn V.
        • Kramer H.H.
        • Voit T.
        • Bruster H.T.
        • Scrampical B.
        • Scheid A.
        Horizontal transmission of HIV infection between two siblings.
        Lancet. 1986; 2: 694