Children should not be left alone to play with man's best friend and should be taught how to approach the animals, British doctors say.

Last year, 4,133 people in Britain were admitted to hospital for dog bites — almost double the number treated in 1996. More than one-fifth of the victims were children under nine.

In Saturday's issue of the British Medical Journal, medical microbiologist Marina Morgan and plastic surgeon John Palmer of Royal Devon and Exeter Foundation Trust in the UK reviewed dog maulings.

They concluded that children should be taught not to tease dogs or approach unfamiliar pooches.

Instead, children should:

• Treat dogs with respect.
• Avoid direct eye contact.
• Let dogs sniff them before petting them. 
• Be closely supervised when playing with any dog.
• Not disturb dogs that are eating, sleeping or caring for puppies.

The review also advises doctors on how to examine and treat someone bitten by a dog, including looking for infection such as rabies and when to refer the case to a specialist.

Dog owners also need to change their behaviour, pediatrician and dog owner Rachel Besser said in an accompanying article.

"We must stop placing blame on the dogs themselves and focus attention instead on who holds the lead at the other end — or who isn't holding the lead, as the case may be," Besser wrote.

"Most dog bites to children at home happen when the child interacts with the dog in the absence of adult supervision.

"Just as some parents are obliged to take parenting classes, I would like to see equivalent mandatory classes for expectant dog owners, to teach them about the responsibilities of dog ownership."

Veterinarians could also advise dog owners about bite prevention and doctors could promote prevention when treating bites, Besser said.