Management of pediatric snake bites: are we doing too much?

J Pediatr Surg. 2014 Jun;49(6):1009-15. doi: 10.1016/j.jpedsurg.2014.01.043. Epub 2014 Feb 10.


Background: The optimal management of children with snake bite injuries is not well defined. The purpose of this study was to review the use of antivenom, diagnostic tests, and antibiotics in children bitten by venomous snakes in a specific geographic region (Southeast Texas).

Methods: This is a retrospective single-center review of all patients with snake bite injury from 1/2006 to 6/2012. An envenomated bite was defined as causing edema, discoloration of the skin, necrosis, or systemic effects. The severity of injury was scored using a novel 4-point scale based on initial physical examination alone.

Results: One hundred fifty-one children (mean age 8.4±4.3years) were treated for a snake bite. There were no mortalities. Lower extremity injuries were most common (60%). Most bites were from copperheads (43%). Envenomation was evident in 82% (average wound score: 2.61±0.81). The median hospital stay for admitted patients (79%) was 2days (range 1-7). Four patients required surgery for complications of the snake bite. Fifty-two children (34%) received CroFab, with one allergic reaction. 22/135 (16%) had evidence of coagulopathy. Seventy-two children (48%) received IV antibiotics.

Conclusion: Despite a high rate of envenomated bites in Southeast Texas, significant morbidity is rare. Children with an envenomation score of 1 or 2 are unlikely to be coagulopathic, suggesting that laboratory investigation should be reserved for patients with higher scores. The indications for the administration of CroFab deserve further prospective study.

Keywords: Animal bite; Antivenom; Envenomation; Pediatric; Snake bite.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Antivenins / therapeutic use*
  • Child
  • Disease Management*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Length of Stay / trends
  • Male
  • Retrospective Studies
  • Snake Bites / epidemiology
  • Snake Bites / therapy*
  • Texas / epidemiology


  • Anti-Bacterial Agents
  • Antivenins