Are Dogs an Anxious Child's Best Friend?

Laurie E. Scudder, DNP, NP; Anne M. Gadomski, MD, MPH

Editor's Note:
Pets are an important part of many families, and pediatric providers are often queried about the pros and cons of animals for children of all ages. Although multiple reports over the years have documented health benefits of human-animal interactions, much of that research has been conducted in adults rather than children. However, a recent study,^[1] published in Preventing Chronic Disease, examined the health effects of dog ownership in a group of preschool- and elementary school-aged children and concluded that children whose families owned dogs had a statistically significant reduction in the incidence of anxiety. Medscape spoke with Anne M. Gadomski, MD, MPH, principal investigator in this study, about this research and asked her to summarize the current state of evidence that addresses this important question: Can pets provide an important strategy to promote mental and physical health in children?

Children: The Understudied Population

Medscape: Why have the health effects of interaction with animals not been examined more rigorously in pediatric populations?

Dr Gadomski: Human-animal interaction studies have been done in children and adolescents but mostly in other countries, such as the United Kingdom, other countries in Europe, and Australia. Not much has been done in the United States. The exception is in the psychology disciplines. Gail Melson at Purdue University and others have done a lot of work regarding how pet dogs affect children from a socioemotional standpoint.^[2] The other perspective on this, which is not related to pets, is animal-assisted therapy (AAT). AAT relates to the therapeutic effects that animals can have on humans and is used in the field of psychotherapy. Boris Levinson is a founder of AAT.

Why have the studies been conducted mostly in adults? It's easier to study adults, but we are missing some important effects in young children. I have been a pediatrician and child health researcher for more than 30 years, and in that time I have been impressed by the importance of pets in children's lives. One of the first words that babies speak is the name of the family pet. Parents are a little chagrined when their child says the name of the family pet before saying "mama" or "dada." But that's a fact of life. Kids learn a lot from their pets. They refer to them as friends or family members. It's an interesting research area, although it is not yet well explored in the United States.

Pets and Children's Health

Medscape: Most of the research seems to be on the mental health advantages of having pets. Can you review what is known about the effects of pet ownership on physical health?

Dr Gadomski: We know that adults who have dogs walk those dogs, and they can form a mediator between physical activity and weight status or disease outcomes. That's why the American Heart Association^[3] and the Centers for Disease Control and Prevention (CDC) have recommended getting a dog to encourage more physical activity for an adult, which in turn can prevent cardiovascular disease. And although dog walking has health benefits, it also poses opportunities for increasing social interaction. Taking the dog out is a magnet for conversation or interaction with other people. Many factors influence how much owners walk their dogs, so dog walking may have variable results.

Dog ownership has improved adult physical activity in some studies,^[4,5] but less is known about how pet dogs affect child health, which is why we did this study. In Australia and the United Kingdom, dog ownership has been associated with increased physical activity among children in the 5- to 12-year range. One study^[6] in Australia showed that having a dog was associated with a lower likelihood of younger children being overweight or obese. Those countries promote walking and active play with dogs to help increase children's physical activity and prevent overweight and obesity. But such studies have not been done in the United States, so we need more evidence to support whether having a dog actually increases a child's physical activity.

Medscape: Your study was one of the first to examine, in a quantifiable fashion, the mental health effects of pets, specifically dogs. Can you summarize the methodology and key findings of your study?

Dr Gadomski: We asked parents of children ages 4-10 years to complete a comprehensive screener (using a tablet device) about their child's health while waiting to be seen for a well child visit. This included mental health screeners and a pet module that asked the type of pet in the home. If the family had a dog, more specific questions followed having to do with the amount of time the child spent being physically active with the dog and the level of the child's attachment to the dog. As part of the well child visit, we collected the child's weight and height data that enabled us to look at associations between having a pet dog and the child's weight status.

These are just screening tools; they don't allow us to make a formal diagnosis. The purpose of screening in primary care is to identify children who may benefit from further assessment. In this primary care population, we used these tools as a first step to identify subthreshold, subclinical, or undiagnosed conditions and address them early. Examples of this type of tool include the SCARED questionnaire for anxiety-related disorders or the Strengths and Difficulties Questionnaire. When we apply those screening tools, we can look at the mental health status of the children participating in the study. We included 643 children, ages 4-10 years (mean age about 6 years) in the final study population.

Our key findings were that having a pet dog in the home was associated with less child anxiety as measured by the SCARED-5 screen for anxiety. Among children whose SCARED score exceeded 3 (the point at which further diagnostic workup is indicated for anxiety), 12% did and 21% did not have pet dogs. We also found that higher levels of child attachment to the pet dog as measured by a separate instrument—the Companion Animal Bonding Scale—were associated with more time spent being physically active with the dog. That's intuitive—if you are more attached to your dog, you are going to spend more time playing with or walking that dog.

Unfortunately, we didn't see an association between the child's weight status (body mass index) and having a pet dog, unlike the study^[6] in Australia that found an association with pet dogs and weight status.

Dogs vs Other Pets

Medscape: Your study focused on dogs as pets. Why dogs and not other kinds of animals?

Dr Gadomski: Dogs are the most common pets in this area, making it much easier to achieve the sample size we needed. A lot of literature supports the fact that dogs are more attuned to human social cues other than other species, which is more likely to help the child's emotional and mental health. Some literature suggests that dogs are more empathic with humans than other animals. This is just a first cut of this study. There might be ways to interact with cats and other pets that achieve the same thing.

Gail Melson had a nice quote about this: "Dogs who have shared a common environment with humans for at least 10,000 years are highly attuned to human social cues and emotions."^[7] We have domesticated these animals, and they can tell and read our expressions, our activities, and our language. That kind of interaction is more accessible than, say, a goldfish in a fishbowl or a chinchilla running around the house. It just makes more sense.

Medscape: What about animal interactions in younger vs older kids, girls vs boys, or developmentally delayed children vs children without such delays? Are there special populations that may particularly benefit from pet ownership?

Dr Gadomski: I don't think that we can say that yet. Some researchers have used AAT for a long time to study such specific conditions as attention-deficit/hyperactivity disorder, autism, or seizure disorders (in which the dog can sense that the child is going to have a seizure).^[8-10] Many small studies show positive effects of therapy dogs even for short periods of time. Our study was different in that we looked at essentially well children to see whether there are any opportunities for prevention with pets. The distinction that we have to make is treatment with a therapy dog vs prevention with a companion animal or pet. We are not able to answer that question because we didn't specifically study clinical subsets of children with chronic conditions. I am aware of a lot of literature on AAT with children who have various health conditions. That body of literature is out there. I can't comment from the perspective of our study.

The Downsides of Pet Ownership

Medscape: What are the negative aspects of pet ownership—injury, infection, grief reactions following the inevitable loss of a pet? Are there any conditions that should exclude pet ownership, such as asthma or cystic fibrosis? Are there children in whom the negative effects might outweigh any benefits of pet ownership?

Dr Gadomski: A pet is not ideal for children with specific allergies to dog or cat dander. But the other downside is animal bites. Everyone who has encountered dog bites knows that they can be very devastating. Children are primarily bitten by dogs that they are familiar with. It speaks to the need for parents to be responsible dog owners and closely supervise young children when they are around dogs, particularly when dogs are eating or in a threatened position. Teaching children how to read signs that the dog is irritated or how to safely approach dogs is very important, as well as avoiding high-risk dogs that are chained up in a yard. Different programs are available, like a YouTube video sponsored by the American Veterinary Medical Association that teaches children how to read the signs that a dog may be giving. Running that video in a clinic or waiting room would be ideal. The approach to preventing dog bites is incredibly important in conjunction with looking at the benefits of pet dog ownership. The other issue is the expense of taking care of a dog and paying for dog food and veterinary care.

A lot of information has been published about what infections dogs might transmit to humans,^[11,12] and what is interesting is that it goes in the opposite direction. If a child or a family member has methicillin-resistant Staphylococcus aureus, it is not often transmitted by the dog to the humans, but the dog can get infection from the humans.^[13] Data from Finland and other European studies show that exposure of babies to dogs at a young age reduces the risk for infections and allergies in those children.^[14,15] It's not clear whether this is mediated by the dog's microbiome or whether the dog goes out and brings in allergens from the outside to the child, who then has appropriate allergic responses, somehow modulating the child's allergic reactions.

Medscape: Do you have any other advice for families, particularly those with very young infants and children, who would like to add a pet to the household?

Dr Gadomski: Given the cross-sectional nature of this study, the results really can't translate into a recommendation that parents should be putting puppies under the Christmas tree to treat anxiety in their children. Even though CDC is promoting pet dogs for improving adults' physical and mental health, I think that we need a little more evidence from a variety of fields before we understand the pros and cons of promoting pet ownership to improve child health. The directions that those recommendations may be coming from are fairly varied now and include asthma/allergy prevention, maybe an effect on the microbiome, mental health, and prevention of childhood obesity. We need more work on this to come up with a reasonable recommendation or set of guidelines.

It would be premature to make a specific recommendation right now to go out and get a pet dog to interact with your child to make your child less anxious. The same goes for acquiring a dog in order to promote active play as a means to increase physical activity among children because that still needs to be shown. A dog is not going to be a magic bullet for these things, but that doesn't mean that we can't look at it a little more closely and understand the benefits.

Medscape Pediatrics © 2016  WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Are Dogs an Anxious Child's Best Friend? Medscape. Jan 13, 2016.