by Nisha Wadwha, MD PGY 1
As the final days of summer approach us and a new school year sets in, parents, teachers, and students are beginning to gear up for classes, homework, and extracurricular activities. This exciting time is also an important opportunity for the community to think about and engage with the issue of bullying, which is broadly defined as intentional, repeated, negative behavior directed towards those who have difficulty defending themselves. Bullying comes in different flavors, and can be as obvious as physical or verbal aggression, but can also be insidious “relational” bullying in the form of gossip, slander, or deliberately excluding others. As social media becomes an increasingly ingrained feature of our culture, cyber-bullying (threatening, taunting, and embarrassing others using an electronic medium) is an emerging form of mistreatment kids and teens are contending with.
While it is estimated that one in three children in the US are affected by bullying, prevalence rates vary by area and by how bullying is defined. Physical and cyberbullying peak in the middle school years and then decline by high school, where verbal bullying may continue to increase. Participants in these behaviors are categorized into victims, bullies, and bully-victims; each of these groups have been shown to have adverse downstream effects. Children who are bullied have increased rates of depression, anxiety, decreased school performance, as well as physical symptoms (abdominal pain and headaches). Importantly, bully-victims, who react aggressively in response to bullying are at higher risk of perpetrating violence themselves—the extreme example being carrying out school shootings. Bullies have been shown to go on to have higher rates of substance abuse, intimate partner violence, unemployment, and criminality.
These serious consequences serve as a reminder of the importance of early intervention—bullying is a multifactorial problem that will require the involvement of a number of disciplines to bring about change. Clinicians, partnering with teachers and parents, can help mitigate the effects of bullying. For pediatricians, this begins in the clinic with simple screening questions, especially important to ask children who have changes in behavior, new school aversion, or psychosomatic symptoms with an unclear cause. Questions to ask include:
•Do you feel safe at school?
•Who are your friends?
•Have you ever been bullied at school?
•What do you do when you see another child being bullied?
When bullying is identified, anticipatory guidance to families about fostering healthy responses to anger or conflict, as well as reminding children to get adult help if they are being victimized, are simple but key interventions. For more information about bullying and how to be an advocate for children regarding this important issue, visit www.stopbullying.gov, and consider connecting with your AAP state chapter or becoming familiar with your state laws/ public policies addressing bullying in order to identify gaps and offer your expertise—you can make a difference!
Shetgiri R. Bullying and Victimization Among Children. Advances in pediatrics. 2013;60(1):33-51. doi:10.1016/j.yapd.2013.04.004.