ST. LOUIS — Most dogs don't bite, and most dog bites aren't serious.
But hospitalizations for dog bites have nearly doubled in the past 15 years, according to recent federal government data.
About 4.5 million dog bite incidents occur in the United States each year. Dog bites caused 316,200 trips to the emergency room and 9,500 hospitalizations in 2008, the latest figures from the Agency for Healthcare Research and Quality.
The cost of treating the injuries is $54 million a year, or $18,200 per hospital stay.
Although dog bites are most common in the Midwest, local hospital officials say they have not seen an upward trend of emergency room visits or hospitalizations.
More than 30 children are admitted to local hospitals each year for dog bite treatment, which usually involves surgery.
Avery Imhof has had four reconstructive surgeries for a dog bite to her cheek when she was 19 months old.
The toddler leaned down to kiss Tank, her grandparents' American Staffordshire terrier, who was sleeping on the floor. The dog got spooked and snapped at Avery, now 5.
Part of Avery's cheek was gone, and she was airlifted to St. Louis Children's Hospital. Plastic surgeons grafted skin from Avery's abdomen onto her cheek.
The dog, who had not been aggressive before, was euthanized after the attack.
"We all took turns blaming ourselves," said Trista Imhof, Avery's mother. "It was nobody's fault. It was just a freak kind of thing. We don't harbor any ill feelings toward dogs or breeds."
The preschooler is sometimes sensitive to people's questions and comments about her injury, but the experience hasn't left Avery scared of dogs, Imhof said.
"Avery asks for a dog all the time," Imhof said. "She loves animals."
Serious dog bites are most common in children and older adults. With teenagers and adults, the legs and arms are usually targeted. Children are bitten more often in the head and neck.
"Little kids tend to be down in the face of the dog," said John Peter, emergency department director at Cardinal Glennon Children's Medical Center.
The dog is usually "not some stray dog that's just attacking people," Peter said. More commonly, children are bitten by dogs belonging to family members, friends or neighbors.
"Children need to be told not to fear the dog but to respect the dog," Peter said. "Children aren't born with the knowledge of how to behave around dogs and traffic and guns."
Rabies has been virtually eliminated in domestic animals, so the chance of a child contracting the disease from a dog bite is "vanishingly small," Peter said.
The death of a Texas County man in 2008 after a bat bite was the first in Missouri in 50 years. Dog bites must be reported to the city or county health department for investigation. The St. Louis County Department of Health received 1,480 such reports in 2009.
Animal control officers will visit the animal and inspect its vaccination records. If the dog is up to date on vaccines, officers recommend a home quarantine to make sure the animal is healthy. If the dog was running loose when it bit someone, officers will quarantine the dog for 10 days at a county shelter.
At that point, some dog owners choose to euthanize a dog that is getting old or has turned aggressive. After a second bite offense, authorities will usually seize a dog.
"The owners typically comply and sign the dog over, understanding it's a safety issue," said Rebecca Smail, program director for the county's animal control division.
When a child is bitten by a stray dog, and investigators can't locate the animal, the child may be started on a series of anti-rabies shots as a precaution.
"It's certainly not uncommon for the dogs not to be able to be checked out by animal control," said Robert Kennedy, emergency physician at St. Louis Children's. "If you know the owner, that simplifies things a whole lot."
Dog bites aren't simple lacerations, Kennedy said. "These dogs have tremendous power in their jaws to crush bones."
There is a high risk for bacterial infection after a dog bite, especially if the wound is sewn shut. If the bite is not on the face, doctors usually leave it open to let it drain and scar over, Kennedy said.
Between 5 percent and 25 percent of children who experience dog bites will develop post-traumatic stress disorder, said Sarah Hanly, a psychologist at Cardinal Glennon.
"It's really important for parents to monitor their child's reaction to that kind of an injury," Hanly said.
After a bite, a child's fear can extend from dogs to general feelings of not being safe.
Parents should acknowledge the child's fears and let them talk openly. Gradually, the child can be exposed to whatever is scaring them. By starting with books or movies about dogs and working up to visiting a pet store or shelter, the child can be reprogrammed to conquer the fear, Hanly said.
"It's really common for us to have these strong reactions, ... but we can work through it so we can be more realistic about the risks we're facing."