Ensuring a behaviorally healthy pet-child relationship

Despite the Disneyesque images of smiling children and their pets, establishing or maintaining behaviorally healthy homes with pets and children can be challenging. Expectant parents often have questions about introducing their babies to pets. And parents who plan to add pets to their homes also have important concerns about their children's safety. Veterinarians should encourage pet owners to turn to them for expert advice and assistance. Let clients know that you, not the pet store employee or the self-proclaimed master dog trainer, are the best source for reliable behavior recommendations.

First, discuss behavior at every nonemergency appointment. Ask clients if they have any behavior questions or concerns. This is especially important if you know there are children in the house. Take a moment to discuss zoonotic diseases, such as parasite control and rabies vaccination, as well as the No. 1 risk to children from pets, bite wounds. Provide handouts and other information, such as a poster in your waiting room, describing your ability to help clients with their pets' behavior problems. Some good sources for behavior handouts are Lifelearn (www.lifelearn.com) and the Handbook of Behavior Problems of the Dog and Cat, 2nd Ed. (W.B. Saunders Co). Also see the client handout "Bringing home baby: Introducing a pet to your new arrival." In addition, carry and display humane behavior modification products, such as head collars and food enrichment toys.

Once your clients come to you for behavior advice, make sure you're prepared to answer their questions. Here are some tips about keeping the pet-child relationship a happy and healthy one.

Teach your dog well

...AND BABY MAKES FOUR

Regardless of whether a pet has previously displayed behavior problems related to children, well in advance of a baby's arrival expectant parents should start preparing their pets for the many changes a new baby brings. It is much easier for pets to begin adjusting before an infant arrives than to get used to household changes and the baby all at once. This preparation also gives owners an early chance to see how their pets are adjusting and may help owners avoid assuming that any problems seen are due solely to the new baby.

Get a historical perspective

Expectant parents may ask you if it will be safe to have their pets, especially dogs, around a new baby. To advise these parents, first find out about the pet's history with babies, toddlers, and children. If there has never been such exposure or if there has been fear or aggression in the past, advise owners to be extremely careful. In such cases, schedule an appointment with the owners specifically devoted to discussing this problem rather than trying to fit it in at the end of a 15-minute annual examination, heartworm test, and vaccine booster appointment. Even if you don't treat a lot of behavior cases, you, your clients, and your patients will be well-served if you take the time to sit down, get complete historical details about the problem, and discuss the different aspects of the situation with the owners. If your clients have already brought the baby home and cannot make an appointment with you right away, help them make arrangements to board the animal until the appointment, or advise them to keep the pet and child separated until you can talk further.

Defining what problems can occur

Most aggression to children is caused by fear. Cats may be fearful of newborn infants and usually react by hiding. With dogs, aggression usually appears when the baby becomes mobile. Even dogs that have a history of behaving well with visiting children may show some aggression to toddlers they live with. This is why it is so important to have measures in place to separate children from pets before problems arise (see "Setting up barriers" ).

Less common is aggression directed toward newborns. This type of aggression is more common in dogs, although some cats will react aggressively in response to the sound of a baby crying. These cats may direct their aggression toward the infant or the adult holding the infant, but often the cats display redirected aggression—they attack the nearest target, either a person or another household pet. Dog or cat aggression toward infants that is caused by fear can often be overcome through separation and desensitization and counterconditioning. This behavior modification involves engaging the pet in an enjoyable activity while briefly exposing it to the infant at a safe distance. Enjoyable activities include tossing treats that are kept at the changing table whenever a diaper is changed or giving a dog a prestuffed hollow toy or sterilized marrow bone before sitting down to feed the baby. Some new parents may be able to toss treats across the room to a dog while giving the baby a bottle or nursing.

In other cases, dogs show true predatory behavior toward infants. This behavior is less common in cats because movement is such a strong trigger for feline predatory behavior, and newborns just don't move that much. These dogs will not show any of the typical signs of fear or anxiety, such as flattened ears, tucked tails, yawning, or lip licking. Instead they tend to be aroused and focused on the baby. These dogs are showing the early stages of prey acquisition—focusing on the prey and beginning to stalk it. Some of these dogs are determined to get at the "prey item" that has entered their homes. This situation is dangerous, since a predator's goal is the kill. These dogs must be kept strictly separated from the infant. They may be able to be reintroduced to the child once the child is old enough to act like a person (e.g. sitting upright, walking). Until then, access to the child is not allowed. A similar approach can be used with cats showing this sort of hunting behavior toward a newborn.

Making introductions before baby comes

Expectant parents may ask you about preparing a pet for the arrival of a baby, often wanting specific advice about introducing pets and babies. But there is often a lot more than just the infant that the pet will need to be introduced to. Baby paraphernalia such as strollers, swings, and noisy toys should be introduced before a baby arrives. This way, if the pets are a little fearful, owners will have a better sense of whether it is the baby or an inanimate object that is scaring the pet.

Some dogs may be anxious about things that roll or may try to bite at wheels (e.g. herding breeds), so parents who plan to take family walks should start walking such dogs with a stroller before the baby is born. This training may elicit some stares and comments from the neighbors, but it will be worth it when the parents, baby, and pet can enjoy fresh air and exercise because of a previously established positive experience.

If pets are extremely sensitive about sounds, expectant parents can work on desensitizing their pets to baby sounds by playing recordings of baby sounds. But not all animals respond to recorded sounds, so before embarking on a course of desensitization, the owners should test a pet's reaction by first playing the sounds at a real-life volume. If the pet shows any signs of arousal, fear, anxiety, or aggression, then desensitization should be undertaken. The owners should start by playing the sounds at a volume low enough that no reaction is shown. While the sounds are playing, owners should use positive reinforcement techniques, such as giving treats, feeding meals, playing with toys, or petting or brushing the pet. Over several sessions, the owners should very gradually increase the volume until the pet has no reaction to the sounds at normal volume.

Sit, Rover, sit

One of the most important things to teach dogs is not to jump up onto people—both people who are standing and people who are sitting on furniture. Ideally, all dogs should learn this, but it is even more important when there will soon be an infant in people's arms or on their laps. Preventing this behavior can be fairly easily accomplished by teaching and reinforcing, using reward-based methods, an alternative behavior such as sit. A reward-based method is much more effective with most dogs than punishment-based methods such as kneeing the dog in the chest or squeezing the dog's paws. In addition, a reward-based method does not carry the risk of evoking pain- or fear-based aggression.

Using a program of affection control (also called nothing in life is free, no free lunch, and learn to earn) in which a dog learns to perform a calm, controlled behavior such as "sit" or "down" before it gets anything (e.g. petting, play, doors opened, invited onto furniture, food, treats) can be very useful. These programs can be presented to expectant parents as good practice for when they will be teaching their children to say "Please" if they just think of sitting as a dog's way of saying "Please."

Cat-specific changes

For cat owners, preparing for a new baby often involves moving food dishes and litter boxes. Owners often want to move litter boxes to out-of-the-way locations such as basements, small closets, or laundry rooms. Owners also want to switch from open litter boxes to covered ones in an attempt to limit children's access to the boxes, despite the fact that most cats prefer open boxes. To have an open litter box that is accessible to a cat but not a child, owners could put litter boxes in child-free rooms (e.g. home offices) and install a pet door or prop the door to the room open wide enough to allow only a cat to get inside. Regardless of the changes made, if owners wait until the baby is born to make litter box changes, they may assume that any housesoiling problems that develop have occurred because of the baby, when the problem is actually the new litter box location or type of litter box.

Cat owners should also prepare comfortable areas, such as cat trees, window seats, or even folded towels on top of cabinets or on bookshelves, where cats can get away from eager toddlers.

Expectant parents may be worried about cat hair in the nursery or that the cat will "suck the life out of the baby." Although the latter is an old wives' tale, there is a slim risk of a not-so-slim cat smothering a newborn infant if the cat tries to cuddle with the baby. Solutions to this problem include putting up crib tents (netting tents that stretch over cribs, keeping the baby in and all else out) or installing a screen door in the nursery so the parents can still hear the baby, but curious cats can't enter.

If expectant parents have concerns about an overly friendly or needy cat jumping into their laps while they are holding a baby, a similar approach to what is recommended for dogs can be used. Before the baby is born, the owners should teach the cat to wait for an invitation to hop up by standing up and dumping the cat out of their laps every time the cat jumps up on its own. The cat can then be taught a jump-up command, possibly using a treat as a lure, so it learns that there are times when it is OK to sit in a person's lap.

Homecoming

When a new mother first comes home and greets her pets after the baby is born, she should be empty-handed. Advise owners to find a time when they're not busy with the baby and can devote all their attention to the pets, especially dogs, before introducing them to the baby. Make sure at least two adults are present—one to supervise the baby and the other to supervise the pets. Dogs should be wearing leashes, but it may be acceptable to have them drag the leashes. Owners shouldn't force an introduction, just let the pets be around the baby.

Owners should allow their pets to politely sniff at the baby, but if the pets seem interested in lots of sniffing or licking, the owners should draw their attention away with another activity such as playing with toys. If a dog seems overly fearful or rambunctious or shows any aggression, the adult supervising the dog should calmly, without scolding or yelling at the dog, pick up the leash and walk the dog away from the baby.

Setting up barriers

As stated above, most of the problems seen between pets and babies involve crawling children (e.g. 6 months and older) and toddlers, not immobile infants. Once the pets adjust to the owners' new focus on this other creature in the house, they usually ignore the baby. So it's a good idea to advise expectant parents to look ahead to things that may change (e.g. the addition of baby gates) as the baby begins to crawl and walk, since this time comes faster than they may anticipate.

Dogs and cats should be fed in locations where it is easy for parents to monitor what is in their bowls and if children are nearby. This may mean feeding behind barriers and switching from free-choice to meal feeding. If there has been any history of the pet aggressively guarding food from other animals or people, feeding should be behind a barrier, and long-lasting treats (e.g. rawhides, stuffed hollow toys, marrow bones) must be available only when the pet is physically separated from the child.

During car rides, owners should also keep their babies separated from pets. I recommend that pets, especially dogs, be secured in a carrier or by a barrier or a safety harness and seat belt whenever they are in the car, which also protects them in case of an accident.

If clients have any thought about co-sleeping with a baby, the pets should get used to sleeping away from the owners' bed before the baby arrives. They should also provide resting areas that allow the pets to get away from curious children.

In general, pets, especially dogs, should learn to be separated from their owners. No dog should ever be left alone with a small child. Essentially, this means that either a parent must always be holding the baby or there must be barriers set up so parents can safely allow infants to spend time in an apparatus such as a bouncy seat or a swing. Dogs should get used to having the owners around but not having access to them. They should be rewarded for being good and quiet on the other side of a barrier from the owners (e.g. behind a baby gate or in a crate). These rewards can be active (tossing treats to the dog or walking over and petting the dog) or passive (giving a food-dispensing toy to the dog when the separation begins).

A BOY AND HIS DOG

Having pets in the household can help teach children responsibility and compassion for animals, and pets can be wonderful companions and playmates for children. But as veterinarians, we've all seen examples in which an adult's behavior toward animals teaches children to be neglectful, or a child's or a pet's behavior makes for a serious mismatch. Not every household is right for every pet and not every pet is right for every household. On the contrary, the presence of young children in a home is a risk factor for relinquishment of dogs to shelters.1

Occasionally, parents will turn to you for advice on pet selection, but usually you are presented with a pet that is already in the home. Ideally, parents will come to their pets' veterinarian for assistance as soon as they notice behavior problems. Instead, you may be faced with the unenviable task of raising questions about the pet's behavior toward children based on exam-room observations.

To avoid problems, children must be taught how to handle pets gently. They must also be taught that not all animals are alike. Just because their family's dog tolerates being climbed on, poked, and prodded, it does not mean that this is safe behavior with any other dog. Parents need to be taught not to encourage children to treat any animal in this way, regardless of whether the pet tolerates it and regardless of whether it is the family pet. Often the children who get bitten are those who live with an incredibly tolerant pet. These children don't learn how to behave appropriately around pets and are bitten at a friend's or relative's house where less-forgiving animals reside.

The same goes for teaching children to leave pets alone when they are eating, sleeping, or quietly playing with toys (e.g. chewing a bone). Likewise, pets must be taught how to eat, sleep, and chew on toys by themselves and be provided with opportunities to do so. Usually this means getting the pets (most often dogs) comfortable being physically separated from people, such as in a crate or behind a gate. For many animals, once they learn that this separation keeps them safe from children's unwanted advances, it becomes a good thing.

Encourage parents to have realistic expectations. The adults in the house must bear the ultimate responsibility for a pet's care. Not all children are responsible enough or interested enough in pets to be really involved in activities such as feeding, grooming, walking, and cleaning up after them. Likewise, not all pets are comfortable enough with children to form their strongest bond with the children in the household.

FOLLOW-UP

When giving a behavioral treatment plan, note your specific recommendations in the pet's record instead of just writing "behavior advice given." As with any behavior problem, it is a good idea to follow up with owners about two or three weeks after the initial appointment. In a call or e-mail, ask the owners specific questions about the treatment plan implementation, such as how the dog is responding to the introduction to the stroller or if the cat has exhibited any housesoiling since the litter boxes were moved. This approach is much more likely to open up a dialogue and allow you to really help than just asking, "How is everything going?"

REFERRAL

There may be situations when you or your clients think that a more in-depth approach is needed or that the problems are beyond your comfort level. This is the time for a referral to a board-certified veterinary behaviorist. You can find a list of diplomates of the American College of Veterinary Behaviorists (acvb) at www.dacvb.org. If no behaviorist is in your area, you can contact the American Veterinary Society of Animal Behavior through its Web site at www.avsabonline.org for information about veterinarians in your area who have an interest in behavior but may not be board-certified.

Although there may be a temptation to refer to trainers or other laypeople calling themselves behaviorists, this may not be your best option. If you do not refer to a boarded specialist, you may be held responsible in a situation of liability or malpractice. So if you refer to a trainer, you retain primary responsibility for the case and should follow up with the owners and be fully aware of the training techniques being used.

DIFFICULT DECISIONS

In some situations, no matter whether your clients have just introduced a baby into their home or just added a pet to the family, if serious behavior problems arise between the pets and the children, rehoming or euthanasia may be the best or only option. Although these are unfortunate situations for the pet, in some cases there is no reasonable way to manage the level of supervision or separation that would be required to keep the child safe. This may be because of a pet's inability to cope with separation, a child's inability to follow instructions involving the pet, or an adult's inability to maintain a safe environment. It can be especially difficult to achieve the proper balance between what is needed to keep everyone safe as well as happy when the pets have multiple behavior problems, such as fear or aggression issues and separation anxiety.

Most owners would prefer to rehome their pets than to contemplate euthanasia. Often, these animals make wonderful pets in child-free homes. This may be possible for pets that only have issues with infants or children and no other behavior problems. However, owners should be aware that truly child-free homes are often hard to find. Depending on the level of risk to children, child-free may not just mean no children living in the home but may also mean no visiting children (e.g. grandchildren) and no children in the neighborhood.

Unfortunately, the reality of the situation is that appropriate homes may not exist for some of these pets. In those situations, euthanasia should be sensitively discussed. If pets are extremely fearful or anxious around strangers or if a dog has severe separation anxiety, the options of rehoming or separating from the child may be deleterious to the animal's welfare. In these situations, euthanasia is not a matter of convenience but takes into account human safety, the stress that all family members—human and nonhuman—experience, and the pet's quality of life. ?

Laurie Bergman, VMD, DACVB

University of California Veterinary Medical Center

San Diego Behavior Service

10435 Sorrento Valley Road, Suite 101

San Diego, CA 92121

REFERENCE

1. Duxbury MM, Jackson JA, Line SW, et al. Evaluation of association between retention in the home and attendance at puppy socialization classes. J Am Vet Med Assoc 2003;223:61-66.