California, Texas and Illinois had the largest number of fatal attacks, while six states reported no dog bite deaths. There were more fatalities in the South than in any other region and fewest in the Northeast. The majority of attacks involved one dog, while 6 percent involved three to seven. In attacks on children between the ages of 1 and 9, 45 percent involved an unrestrained dog on the owner's property; 29 percent occurred when a child wandered too close to a chained dog.

Of the 41 fatal attacks in which there was detailed information about the animal, 25 involved a male dog, of which 20 were unneutered. Many dogs involved in fatal attacks had a history of previous aggression. Reducing the number of dog bites, the authors note, may require guidance from pediatricians as well as more stringent animal control laws that target "chronically irresponsible dog owners." Dog bites, they write, are a major,  largely overlooked public health problem that has received far less attention than playground injuries.

Parents should be instructed by pediatricians to choose a dog carefully and to have it neutered to reduce aggressive tendencies. Infants and young children should never be left alone with an animal, regardless of the breed. In addition, parents should be told that aggressive games such as wrestling or getting an animal to "sic" are potentially dangerous.

Children should be taught never to approach a strange dog, never to play with a dog unless supervised by an adult and to avoid direct eye contact with a dog, which an animal can interpret as provocation.

 -- Sandra G. Boodman