A young girl who was recently seen by Cook Children’s C.A.R.E. (Child Advocacy Resource and Evaluation) Team sat sobbing on the exam room floor, distraught after receiving a series of immunization shots.

Many of the children seen by the C.A.R.E. Team have experienced extreme trauma, says C.A.R.E. Team Medical Director Jamye Coffman, M.D., so even getting shots may cause intense anxiety. The team knew who to call for help.

Enter Kitty, a 7-year-old, silky-haired Golden Retriever and one of Cook Children’s six facility dogs, who quickly assessed the situation and knew exactly what to do. She went straight to the young girl who sat next to her sister and laid her head on the child’s lap.

“The little girl starts petting her,” Dr. Coffman says, “and her sister, who had been here before, says, ‘Just pet Kitty. It makes it not hurt as much—it’s Kitty magic.’ So, the little girl continues to pet Kitty, and the tears slow down, and she finally stops crying, and then she looks at her sister and says, ‘It did help. It is Kitty magic.’”

“Seeing is believing, right?” says Dr. Coffman, who also handles her canine helper. “Seeing how she helps bring kids down when they’re super anxious…and not only the kids, but the parents, too. They start petting the dog and the whole level in the room just comes down. It’s amazing to watch. She knows who to go to instinctively—I don’t know if it’s their smell, I don’t know what it is—but she tends to go to the most stressed person in the room. Sometimes it’s the parent, sometimes it’s the kid.”

But Kitty may not be the only one with magical powers.

Whether it’s highly trained therapy dogs, laid-back emotional support cats or pet pot-bellied pigs, animals appear to shoulder some of the emotional load as they interact with humans—and may even promote healthier mental health for their people, some researchers and animal handlers say.

So, what’s the secret behind “Kitty magic”? And could the human-animal bond make a difference for children and teens facing mental health issues, such as anxiety, depression, or suicidal inclinations—all on the rise since the pandemic began? The JOY Campaign asked experts who work with children and/or animals on a daily basis to discuss.

Kitty’s magic, as well as other animals’ abilities, may begin on the most basic level for humans, experts agree. The animals don’t judge. And that nonjudgmental approach may help those facing mental health issues.

“You can talk to your dog or your pet, and they love you no matter what,” Dr. Coffman says of the unique human-animal relationship.

“I think the biggest thing is the animal accepts you, however you are,” she adds. “They don’t see if you have disabilities. They don’t see if you have scars. They don’t see any of that. They just love you and accept you for you. And that’s it.”

For children and teens who are developmentally peer-driven during this part of their lives, that can be significant, says Dr. Janet Hoy-Gerlach, Ph.D., a professor of social work at The University of Toledo in Ohio. In June, she released the first peer-reviewed research study on the beneficial effects of emotional support animals (ESAs) for those with chronic mental illness.

“It’s a unique kind of support. It’s not an evaluative relationship in the way that humans have, especially with some of the challenges kids face with their peers during that excruciating adolescence, where it’s like hyper-judgment time,” says Dr. Hoy-Gerlach, who also co-authored a book titled The Human-Animal Interactions: A Social Work Guide. “The animal is safe. Animals aren’t making a value judgment on what they’re wearing or what they’re saying or what their hair looks like.”

With extensive work in counseling, crisis work and public mental health, she became interested in the human-animal bond and how it might help people with mental health issues after years of working as a crisis clinician in community mental health, where she conducted risk assessments of clients every day. Part of assessing people in crisis involved questioning them about what stopped them from following through on suicide to help identify their lifeline, she says, adding it’s important to figuring out “what’s keeping them alive.”

Common responses she heard were what she’d been taught to expect—usually protective factors, such as “I’m afraid about what will happen to my kids,” or “I don’t want to hurt my family,” or “I wouldn’t do that to my friends,” or “It’s against my faith, my spiritual beliefs, my religion.’ But another response she frequently heard during the assessments was one she hadn’t been exposed to in classes or training, which was “I can’t leave my pet.”

“I guess I had two reactions to that. One was on a personal level as somebody who has lived with animals my whole life and loved them tremendously. Like I totally got that response. It just made sense to me on a human-to-human level,” Dr. Hoy-Gerlach says. “As a clinician, it really hit me that this was something really overlooked. People were literally saying the reason they were alive was because of their animals.”

“And this was something that had never been talked about,” she says. “I was like, how are we missing this strength? This protective factor that many people have in their lives, and we don’t ask them about it. We don’t talk about it. And we certainly don’t support them, like help them keep the animal in their life if they’re facing a barrier or struggle.”

So began Dr. Hoy-Gerlach’s journey to merge a personal passion for animals and professional passion for mental health. Much of her work since has been focused on educating others, such as social workers, mental health workers and health care workers about the benefits of relationships with animals for human wellbeing, she says, adding she also supports a more intentional approach to using those benefits in how we help people stay healthy.

Dr. Hoy-Gerlach’s recently published study focused on 11 adults with stable, chronic mental illness—ranging from anxiety to depression to schizoaffective disorder—who were matched with a shelter cat or dog through the Hope and Recovery Pet Program, a community partnership between The University of Toledo, Toledo Humane Society and ProMedica. (Six adult cats and five dogs were involved in the study.)

Using saliva tests, researchers studied the participants’ biomarkers, such as cortisol, alpha amylase, both stress indicators, and oxytocin, known as the hormone that bonds mothers to babies. During home visits, the participants took saliva tests after focused interaction with their animal for 10 minutes at one month, three months, nine months and a year.

“What we saw, while not statistically significant in this study, was a visual pattern in oxytocin going up and cortisol going down,” she says. There was no significant rise or fall of alpha amylase.

Initially, several participants mentioned an adjustment phase where they experienced a bit of stress from their routines changing with a new animal. But after that, the participants “overwhelmingly talked about an improvement in their mental health, generally and with their symptoms,” Dr. Hoy-Gerlach says.

“They talked about their animal helping or distracting them from symptoms and being a source of comfort for them,” she says. “Those probably are the two things we heard most.”

While her study focused on adults, most of the results are still relevant to youth, she says, because we’re all humans and similarly hardwired for connection.

For example, in the case of ESAs or companion animals for children and teens, it’s looking at the benefits the animals can offer in everyday interaction based on whatever impairments need to be addressed, Dr. Hoy-Gerlach says. Unlike service or therapy animals, ESAs and pets aren’t trained to do special things.

“So, if a child has a lot of anxiety, physical contact with an animal who enjoys that could be a source of regulation that could help downregulate their stress responses,” she says. “It’s not that the animal is doing anything except typical friendly dog or cat behavior, like ‘I want to sit on you.’ But for somebody who has trauma, for instance, that can be grounding. I’ve talked with people who like the cat’s purr, the feel of the fur, the warmth of the body and pressure of their weight on them.”

“It’s multisensory, plus there’s comfort in the relationship. So, it’s thinking about the ways the animal can help, based on the evidence we have on how living with companion animals can benefits humans, then looking at the child’s specific symptoms and issues,” Dr. Hoy-Gerlach says.

Other groups are also following the human-animal bond and its advantages, especially during the pandemic, which has left many Americans of all ages feeling isolated, lonely and stressed.

As part of its “COVID-19 Pulse Study,” the American Pet Products Association (APPA) reported that 11.38 million households in the United States welcomed a new pet during the pandemic, according to an October 2020 article in Today’s Vetinary Business. And three out of four pet owners said spending time with a dog, cat or another animal species “helps reduce their stress and increase their sense of well-being during COVID-19,” the article stated.

In May 2020, the Human Animal Bond Research Institute (HABRI) along with Mental Health America (MHA) released a report stating pets not only “help alleviate stress, but they also improve owners’ moods and help fight depression.” In their survey, 74% of pet owners reported mental health improvements from having pets, and 75% said a friend’s or family member’s mental health improved. The report also mentioned 96% of pet owners agreed their pet has a positive impact on their life, based on a survey conducted by Nationwide and HABRI.

The scientific research showed the human-animal bond supports better mental health and “indicates pets can make a difference for those facing mental health concerns, including anxiety, depression, loneliness and stress,” according to HABRI’s report.

About three months ago, APPA launched a “Pet Feels” Campaign in conjunction with Mental Health Awareness Month that highlighted the advantages of pet ownership as part of its Pets Add Life (PAL) program. The campaign, posted with links on the APPA website, uses a series of videos that demonstrate the way pets help people cope with everyday stressors while also giving love and support during challenging times.

Despite promoting relationships with animals, Dr. Hoy-Gerlach cautions that they’re are not always for everyone. They shouldn’t be brought into a home if there’s a history of animal violence, extreme fear of animals, severe allergies or if a family member is unable to safely interact with an animal or vise-versa.

Laura Sonefeld, “Sit…Stay…PLAY” facility dog program coordinator and child life specialist at Cook Children’s Medical Center, often is approached by families who are considering getting a pet after watching their children interact with facility dogs at the hospital. The team of six dogs—Kitty, Steve, Neely, Chanel, Zuni and Brienne—are trained to work alongside a healthcare worker to provide comfort and socialization with patients and families in a hospital setting.

Sonefeld, who handles Steve, a 3-year-old Golden Doodle on the canine team, says she frequently is asked, “How do we get a dog like your dog?” She makes sure they understand the difference between service, therapy and support animals.

The first question she asks is “Are you wanting a dog to be able to bring to the hospital with you or one for emotional support and comfort at home?” That helps her determine the type of animal they’re looking for.

Most people want a pet, not a service or therapy animal.

“They say, ‘We’ve seen the benefits on our child when they’re here and interact with one of the facility dogs, and we want that at home, too,’” she says. “And I say absolutely. You get a pet. I feel like all animals have that potential to provide therapeutic support for families.”

Whether dogs, cats or other types, animals might help the entire family, not just an individual child.

“I highly recommend it, just for that everyday stress that all of us feel because we’re human,” Sonefeld says. “It doesn’t have to be someone that’s had a huge hospital experience. It could be someone simply dealing with everyday anxiety of school, of work, of making friends. I feel like the dogs help build that confidence and remind everybody that they are loved and special—that they deserve to feel that from people they interact with, too.”

Sometimes the entire family isn’t on board with getting a pet, Sonefeld says. It might be the mom or dad who is hesitant to take on more responsibility by having an animal.

But it seems the mysterious “Kitty magic” might work on that, too.

“Whoever the one is that’s not totally convinced usually ends up being the one who loves the dog the most,” Sonefeld says with a laugh. “Once they have had the experience, they’re like, ‘Oh, OK, I get it now.’”

The dog, a pitbull, was impounded. Later in the day and less than a mile away, The Dallas Morning News reports a 5-year-old boy was attacked by a neighbor's pit bull.

According to the American Academy of Pediatrics, bites occur more often from animals that children are familiar with than wild animals.

Of the 800,000 ED visits annually, 44 percent involve children under the age of 14. The injury rate is highest for children 5 to 9 years of age and the injury rates decrease the older the child.

Last year, Cook Children' Trauma registry reported 57 dog bites. The most occurred during July with 12. 

In May 2017, 4 children were seen for dog bites and another two were treated for cat bites by Infectious Diseases at Cook Children's. This month, 7 kids have been treated for dog bites and one for a cat bite. All of those children followed Cook Children's rabies protocol.

"If the child gets bitten by a dog, or any other animal, parents should take their child to the Cook Children's Emergency Department or the emergency room in their area," said Kate Polentas, clinical coordinator for Infectious Diseases at Cook Children's. "At Cook Children's, we will evaluate the child and treat the wound with antibiotics. The child will also receive the first dose of the rabies vaccine."

At that point, Cook Children's contacts animal control about the dog bite. Stray animals will then be quarantined and evaluated for rabies.

“It's really important for families to know that if it's a family dog, they need to speak up," Polentas said. "Families are afraid if they report the family dog bit their child, the dog will be put to sleep. The dog would actually be placed in quarantine for 10 days to monitor it’s health status. If the dog remains healthy throughout it’s quarantine, then the child can avoid receiving the remaining vaccine series. It's important to know the status and history of the dog.”

Daniel Guzman, M.D., a doctor in the Emergency Department at Cook Children's, says most dogs never bite people, but under the right circumstances any dog is capable of inflicting harm. In a presentation he does on dog bites, Dr. Guzman lists the following breeds as examples of less aggressive or family dogs:

• Boxer
• Dalmation
• Labrador Retriever
• English Setter
• Golden Retriever
• Irish Setter
• Spaniels
• English Springer

Dr. Guzman gives these tips on dog bite prevention:

• Don't disturb a dog who is sleeping, eating or caring for puppies.
• Don't pet a dog without allowing it to sniff you first.
• Avoid humanizing dog (sleep on furniture, beg for food).
• Both little and dogs and big dogs can be great pets. But regardless of the size, they can also bite your child and do harm.
• Avoid treating dog as a child. 
• Do not play aggressive games with your pet.
• Properly socialize and train dog entering household.
• Immediately seek professional help if dog shows aggressive behavior.
• Consult with a professional on dog breeds.
• Avoid dogs with history of aggression.
• Be sensitive to cues given by children (fear).
• Never leave infants/children alone with any dog.
• Spay/neuter all dogs (frequently reduces aggression and pet population).
• Do not hug and kiss dogs. Be careful about getting face to face with pet.

While children need to put these rules into practice, adult supervision around all animals is also a key component to protecting your kids from animal bites.

Kat Davitt, a Child Life specialist at Cook Children’s and the handler for Chanel, one of the professionally trained therapy dogs in Cook Children’s Sit … Stay … PLAY program, says having a pet can be rewarding, but families should take the necesary precuations before owning one.

“There’s so much to think about before you bring a pet home,” Davitt said. “You know your family’s lifestyle and you know your children. Think about the temperament of your family and your pet. If you have really active lifestyle, you may want a dog that enjoys the outdoors or can run with you. If you have a busy lifestyle or away from home a lot, you may want a dog or a cat that may not want as much attention .”

Click here for advice from Clear the Shelters on finding the right dog for your lifestyle.

"Owning a pet teaches children responsibility and that first pet is a special friend, a child will never forget," Davitt said. "But, we also have to take precautions to teach children not only love for their animals, but how to respect them and care for them properly.”

Click the following information from Clear the Shelters to learn so much more:

• Cleartheshelters.org
• Finding a participating shelter near you
• Clear the Shelters: How to Prep Your Home, Family for a New Pet
• Why you should consider adopting an older pet
• Should you adopt a dog? This flowchart will help you decide
• Tips for training your new pet

1. Save your bark for when you really need it. One afternoon when Ralph and I were on a walk through our quiet neighborhood, we were mutually startled by a big dog with an even bigger voice, sprinting back and forth behind a fence, barking ferociously at us. I squeezed the handle to his leash tightly for fear that he may want to take part in conversation with the barking dog. To my surprise, he did nothing but tilt his head, study the dog for a moment, and keep on his way. I was struck with the realization that Ralph barks so sparingly, that surely he is saving his bark for when he really needs it. In life, a lot of dogs are going to bark at you, and a lot of them are trying to get you to bark back, but maybe it's better to tune them out and just enjoy your walk. You can always bark when it's really necessary.

2. Meet people where they are. When I first returned to work with my new constant companion, I felt reasonably unsure of his ability to read the room in an unfamiliar environment. I worried when we were called to see very young patients, I worried when we were called to see very fragile patients, and I worried when we were called to see patients with conditions or diagnoses that changed their appearance. It turned out, of course, that my worry was for nothing. Ralph showed me that he instinctively knew to mourn with families who needed to mourn, to be very gentle with children who were critically ill, and to play with children who wanted to play. He showed no judgment to any child, only the love and reassurance they were looking for. I strive to be as unwaveringly accepting as Ralph has proven to be.

3. A little encouragement goes a long way. In a hospital that has four adorable golden retrievers on staff (who are often confused for each other), Ralph has become known as the one with the silly tricks. In teaching him to do new things, I have seen very clearly the difference between what happens when I am unenthusiastic and directive, versus when I am excited for him, cheer him on, and let him know I believe in him. He now recognizes the words, "you can do it" and "you got it," and when he hears those words, he almost always tries again (usually with more "umph!"). Maybe we should practice that with each other. Maybe we should pay attention to the difference it makes to our family members, our friends, our coworkers, even our pets, when we cheer them on. Sometimes all it takes is one voice saying what you already know deep down: you got it.

4. Seize every opportunity you possibly can. While at times Ralph has seized opportunities I am not as proud of (like helping "clean up" spilled food off the floor), he also seizes opportunities to find joy and make a difference. He beelines in the hallway to people I haven't noticed, who he somehow knows need him close. He photobombs families capturing a memory here at the hospital and by doing so, causes an eruption of laughter. He finds patches of dirt to roll in immediately after his bath. And he literally always stops to smell the roses. To Ralph, an elbow resting on the edge of a table is not an employee paying close attention to their work, it is an opportunity for a nose-nudge to initiate petting. To Ralph, unless it's nap time, every passing moment is an opportunity for something. Thinking about that makes me wonder how many opportunities I miss when I think I'm too busy to notice them.

5. Last but certainly not least, don't take yourself so seriously. I knew from the very beginning that Ralph had excellent comedic timing. One night while still in Georgia for training with Ralph, I was laying with him and telling a story. He reached his long arm out into the air and dropped his paw directly over my mouth, as if to say "shhhhh." He has been making me, and everyone else, laugh ever since. From perfectly-timed audible groans during long meetings, to prancing so wildly that he trips himself, Ralph is one funny dog. And even though he has an incredibly important job, he knows not to take himself so seriously. It's as if no amount of accolades, photos taken or articles written could ever make him arrogant. He does what he does because it is fun and joyful and it matters. It's as simple as that. Oh, and around 4:45 p.m. every day, you can find him rolling on his back care-free in the grass outside the south tower, reminding me as I stand there and laugh, to stop taking things so seriously. 

About the author

Kizzy Marco is a certified Child Life Specialist and the Facility Dog Program Coordinator at Cook Children's. She is Ralph's handler. Ralph came to Cook Children's with his sister Chanel. He is known for his big personality and many tricks! A warm and fuzzy hug can help anyone feel better. A dog's healing presence is known to have a positive influence on wellness. That's the driving force behind Sit...Stay....PLAY, the resident dog program at Cook Children's. Click to learn more about the program.

The statement from the city says "there is no reason to expect a widespread appearance of rabies, however it is extremely important that anyone exposed be identified and examined right away.If you know of a child who fits this description, please contact Ethel at Animal Services right away at 972.219.3478."

The staff at Cook Children's Infectious Diseases has treated its share of kids for rabies through the years, and bats are a frequent cause for rabies exposure. Infectious Diseases offers these seven helpful tips to protect them:

1. Rabies is a deadly disease. Spread of the disease occurs when the saliva containing the rabies virus is introduced into an opening on the skin, usually via a bit (or possibly a scratch) of a rabid animal.
2. If you have a suspected animal, whether it’s a stray or a family pet, it should be taken to the vet or animal control for a confinement of 10 days. If the person who has been exposed to the animal is immediately treated with the vaccine and the animal does not show signs of rabies, it will not have to be euthanized.
3. Bats are extremely dangerous. Not all bats have rabies, but most human cases of rabies in the U.S. are caused by bat bites.
4. If you aren’t sure you’ve been bitten, go to the doctor immediately. Bats are tiny and can leave tiny bites or scratches that humans may not even notice, until it’s too late. If you come in close contact with a bat, go to the Emergency department immediately.
5. If bitten by an animal, wash the wound with soap and water and seek medical care immediately.
6. Protect your pets and farm animals from rabies by making sure they are vaccinated. Talk to your veterinarian for more information.
7. Cook Children’s is prepared and experienced when it comes to caring for children and rabies. Cook Children’s has been very invested in making sure that the vaccinations are in stock. The caregivers are specialized in treating children, including Child Life specialists who can help the child throughout the process. Adult hospitals may not be equipped to treat pediatric rabies cases.

About the source

Cook Children's Infectious Disease is dedicated to providing excellent, patient-centered care, as well as access to the most up-to-date therapies and leading-edge clinical research.

Here's why:

There has been an outbreak of severe flu among dogs in the Midwest. Cases of the H3N2 strain have now been seen in dogs in Texas.

Most dogs have cough, runny nose and fever, but it has been severe and resulted in death in some.

So you may be wondering, “Is my child at risk if our dog has this flu?”

The answer, according to the CDC:

“To date, there is no evidence of transmission of canine influenza viruses from dogs to people and there has not been a single reported case of human infection with a canine influenza virus.”

That’s fortunate, but what are some health dangers associated with pets?

Bites

I’ve seen too many severe dog bites in my training to not mention bites first. The most common statement I hear about the dogs who bite is, “We just never thought he/she would do that.”

Dogs can be a great addition to a family but use caution:

• Be careful of rough play. Even a playful snip can be dangerous if it happens near the eye or a fingertip.

• Stay away from dogs when they are likely to be defensive: when they are eating, sleeping or taking care of puppies.

• Stay away from unfamiliar dogs or dogs that seems scared or anxious.

Here are some more tips from the ASPCA on how to avoid dog bites.

Allergies/Asthma

This is actually one of the most common questions I get regarding animals. It’s very intuitive. People can be allergic to dogs and cats, so wouldn’t owning one increase my child’s risk for allergies?

I have seen several studies that suggest the exact opposite. Often by having animals in the house early, kids may have slightly decreased risk of developing allergies. That said, if your child has frequent allergy and asthma symptoms, it may be reasonable to attempt to isolate the animal from the child for a bit to see if symptoms improve.

Infections

Infectious diseases are transmitted through animals frequently; think about the number of diseases that tics and mosquitoes can carry. Although it can happen, they are less frequently transmitted from pets.

Here is a list of pets and some of the diseases they can transmit:

Cats

Cat-scratch fever:

This disease is caused by bacterial infection (Bartonella) of an open wound or a bite that results in the breaking of skin. It is more commonly transmitted by kittens than older cats. Symptoms of the infection in humans are fever, headache and fatigue. There is often a large and tender lymph node near the site of the bite.

Toxoplasma:

Toxoplasma is usually a foodborne illness, but can be transmitted from cat feces. In people with normal immune systems, there are often no symptoms of toxoplasmosis. Pregnant women (and fetuses) are especially susceptible and, for that reason, should not handle cat litter boxes.

Dogs

Hookworms:

Dogs infected with hookworms can have bloody stools; which in severe cases can lead to anemia. Humans are infected by walking barefoot on contaminated soil and develop an interesting rash which consists of red, squiggly lines where the larvae have migrated under the skin.

Reptiles

Salmonella:

Salmonella is one of the most common pet-associated infections. It is estimated that 70,000 people will contract salmonella from pet reptiles. Salmonella generally causes bloody stools but in children and in people with weakened immune systems can be serious. The CDC recommends that houses with children less than 5 and with any household members with weakened immune systems not own reptiles as pets.

Many Animals

Campylobacter:

Ingesting food contaminated with the bacteria transmits most infections of campylobacter, but cases can occur from the handling of dog or cat feces. The main symptom of campylobacter infections is diarrhea (which can be bloody) and usually lasts about one week.

Ringworm:

The fungus that causes can be transmitted from many different animals but most commonly occurs from puppies and kittens. The appearance of the rash on human skin is a circular rash with a raised edge. It can be difficult to distinguish from eczema which sometimes causes circular patches as well.

Pets can be great additions to your family and, in most cases, will not cause any harm to your children. Be aware of the specific risks associated with certain types of pets and take caution to protect your children when appropriate.