Rabies in Children

What is rabies?

Rabies is a viral infection of certain warm-blooded animals and is caused by a virus in the Rhabdoviridae family. It attacks the nervous system. Once symptoms develop, it is 100 percent fatal in animals if left untreated.

In North America, rabies occurs mainly in skunks, raccoons, foxes, coyotes, and bats. In some areas, these wild animals infect domestic cats, dogs, and livestock. In the United States, cats are more likely than dogs to be rabid.

Individual states maintain information about animals that may carry rabies. It is best to check for region-specific information if you are unsure about a specific animal, and a child has been bitten.

How does rabies occur?

The rabies virus enters the body through a cut or scratch, or through mucous membranes (such as the lining of the mouth and eyes), and travels to the central nervous system. Once the infection reaches the brain, the virus travels into the nerves and multiplies in different organs.

The salivary glands are most important in the spread of rabies from one animal to another. When an infected animal bites another animal, the rabies virus is transmitted through the infected animal's saliva. Scratches by claws of rabid animals are also dangerous because these animals lick their claws.

Humans with open scratches or sores may be exposed to rabies when these areas are licked by an animal infected by rabies.

What are the symptoms of rabies?

The incubation in humans from the time of exposure to the onset of illness can range anywhere from five days to more than a year, although the average incubation period is about two months. The following are the most common symptoms of rabies. However, each child may experience symptoms differently. Symptoms may include:

Rabies: Stage 1

Rabies: Stage 2

  • Initial period of vague symptoms, lasting two to 10 days

  • Vague symptoms may include:

    • Fever

    • Headache

    • Malaise

    • Decreased appetite

    • Vomiting

  • Pain, itching, or numbness and tingling at the site of the wound may occur

  • Children often develop difficulty in swallowing (sometimes referred to as "foaming at the mouth") due to the inability to swallow saliva--even the sight of a glass of water may terrify the child.

  • Some children become agitated and disoriented, while others become paralyzed.

  • Immediate death, or coma resulting in death from other complications, may result.

The symptoms of rabies may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How is rabies diagnosed?

In animals, a test called direct fluorescent antibody test (dFA) is often used to detect rabies. Test results are usually known within a few hours. Knowing these results may save a child from undergoing treatment if the animal is not rabid.

In humans, a number of tests are needed to confirm or rule out rabies, as no single test can be used to rule out the disease with certainty. Tests are performed on samples of serum, saliva, spinal fluid, and skin biopsies taken from the nape of the neck.

What is the treatment for rabies?

Your child's doctor will determine specific treatment for rabies. Unfortunately, there is no known, effective treatment for rabies once symptoms of the disease occur. However, there are effective vaccines (HDCV, PCEC) that provide immunity to rabies when given soon after an exposure. Treatment for suspected exposure to rabies includes one dose of immune globulin and a series of shots of rabies vaccine over a two-week period. It may also be used for protection before an exposure occurs, for persons such as veterinarians and animal handlers.

Learn more about rabies and the rabies vaccine at CHOP's Vaccine Education Center.

How can animal bites and rabies be prevented?

Being safe around animals, even your own pets, can help reduce the risk of animal bites. Some general guidelines for avoiding animal bites and rabies include the following:

  • Keep pets in a fenced yard or on a leash when out in public.

  • Select family pets carefully.

  • Never leave a young child alone with a pet.

  • Have your pets immunized against rabies and all shots kept current.

  • Supervise pets so they do not come into contact with wild animals. Call your local animal control agency to remove any stray animals.

Teaching your child about animal safety may also help to prevent animal bites. Some things to remember include the following:

  • Do not try to separate fighting animals.

  • Avoid any strange or sick animals.

  • Leave animals alone when they are eating.

  • Do not approach or play with wild animals of any kind.

What facts need to be reported to your healthcare provider?

If you or someone you know has been bitten or scratched by an animal, remember to report the following facts to your healthcare provider:

  • Location of the incident (backyard, forest, etc.) 

  • Type of animal involved (domestic pet or wild animal)

  • Type of exposure (cut, scratch, licking of open wound)

  • Part of the body involved (hand, leg, face, etc.) 

  • Number of exposures

  • Whether or not the animal has been immunized against rabies (if known) 

  • Whether or not the animal is sick or well?if "sick," what symptoms were present in the animal

  • Whether or not the animal is available for testing or quarantine

Do not attempt to capture a wild or sick-appearing animal that has bitten your child; animal control officers should be notified.

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