Musings: Blog of the JAAPA Editorial Board


Blog of the JAAPA editorial board.

Monday, March 20, 2017

An exceptional bite

Ellen D. Mandel, DMH, MPA, MS, PA-C
This Musings post has a personal flavor. You see, my daughter is a special education teacher who has been bitten several times, and fully expects to be bitten again and again in the course of teaching preschool children with autism spectrum disorder (ASD).

This JAAPA issue offers readers a review of evaluating and treating mammalian bites, noting that dog bites are most common, cat bites more often get infected, and human bites account for a meager 2% to 3% of bite-related ED visits. Despite the known infection rate of cat bites, the authors write that human bites contain more than 600 bacterial species, not to mention the risk of hepatitis B and the unlikely risk of tetanus and HIV transmission. We know that bites must be treated with care to prevent significant morbidity. Got it!

However, when it is your own daughter who is bitten while trying to shape behavior in a non-vocal, emotionally charged child on the spectrum, a bite makes a lasting impression. For unlike a bite from a moody cat, or a provoked dog, or a neurotypical child with bullying tendencies, the bite of a child with ASD is different. These bites not only break the skin, they can affect the heart.

These bites originate from a child who may not know a functional way to communicate, yet needs to learn how to adapt to society in some way, shape, or form. Teaching a child with ASD that biting is not a socially acceptable manner to gain attention, avoid an activity, access a tangible, resolve a sensory need, or reveal an emotion to a classroom teacher is more than difficult. For those of you with some experience with this population and the angels who teach them, you know that the biter can rarely be reasoned with, and the teacher continues to teach the child with empathy, compassion, and a goal of finding the method of communication that works best for the child.

When my daughter has been bitten, gone to the ED, received antibiotics and a tetanus booster, and been discharged, the experience does not end. She tells me that it touches her heart that her students bite instead of functionally communicating. That it truly upsets the child’s family. That biting may create a barrier of fear, lessening contact by classmates, teachers, and the community. It may hinder a child’s progress, as teachers fear bites as much as anyone else. As PAs, we need to acknowledge that not all bites are the same, and emotionally support teachers who were bitten, knowing that they will go back to the same classroom with a bandage and antibiotics on board, and continue to nurture children who may bite again and again.

Ellen D. Mandel is a clinical professor in the Department of PA Studies at Pace University-Lenox Hill Hospital in New York City. The views expressed in this blog post are those of the author and may not reflect AAPA policies.