David Fagan, MD, FAAP
BULLYING: WHAT PEDIATRICIANS, CAREGIVERS AND PARENTS NEED TO KNOW
From parental vaccination and smoking cessation to mental health screenings and checking for food insecurity, general pediatricians are required to do more and more with less and less time. This month’s INSIGHTs Into CHILD HEALTH discusses practical ways pediatricians can screen for bullying, why it is important and how to best help children who may be reluctant to discuss these issues.
Chapter 2 (Brooklyn, Queens, Nassau and Suffolk) of the New York State American Academy of Pediatrics organizes an annual Anti-Bullying Conference to inform and educate middle school children about bullying.
The fact is that because the prevalence of bullying is so high, every pediatrician (regardless of practice), teacher, parent or adult who works with children will encounter a bullied child. Here is what we can do to identify children who have been bullied, why the stakes are so high for the child and what we can do to help them.
How do we define bullying?
“The biggest misconception in this country is that bullying is “normal” behavior. “Kids being kids and that it really is no big deal,” – that quote is from Dr. Joseph Wright, lead author of the AAP’s 2009 Policy Statement on the Role of the Pediatrician in Youth Violence Prevention. Bullying is unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance. It is a form of aggression in which 1 or more children repeatedly and intentionally intimidate, harass, or physically harm a victim who is perceived as indefensible. Bullying includes verbal bullying, social bullying, physical bullying and cyber bullying.
What are the signs of bullying?/ What are the long-term effects of bullying?
Victims may present with school phobia, depressive and suicidal symptoms, vague somatic complaints, malingering, nightmares or disordered sleeping. While older, popular images of bullying bring to mind a school bully beating up smaller kids for lunch money, the most commonly recorded health outcomes associated with bullying are psychosomatic. Much less common are physical injuries.
What can pediatricians do to see if kids are being bullied?
Asking about bullying is one of the pediatrician’s (or anyone who works with children) best ways to help bullied children. Pediatricians should try to routinely screen children and teens for bullying during well visits. Pay special attention to vulnerable children (those with Attention-Deficit Hyperactivity Disorder, special needs, and extreme shyness).
Elicit some information from either the parent or the patient. Ask parents what they are most happy about or proud of in their child’s life and follow this with an open-ended inquiry into areas of trouble. Gentle probing of a child’s school performance, school attachment, and peer relationships can provide an opportunity to discuss conflict resolution or bullying.
Some things you might ask:
- Have you been in any pushing or shoving fights? – (If the answer is yes, it is important to determine what role the child is playing: instigator, bully, bullied, or bystander.) Focus on helping the child and the parents deal with the situation.
- What do you usually do to avoid getting into a fight?
- Are you afraid of being hurt by any other children?
- Do you feel bullied by other children?
- If you see other children in fights or being bullied, what do you do?
Pediatricians should encourage parents to talk to their children about bullying even if their child isn’t being bullied, isn’t a bully or witness to bullying.
What community resources are there for pediatricians who notice someone is being bullied?
All pediatricians should know about the New York State Dignity for All Students Act (DASA) which went into effect July 2012. DASA bans harassment and discrimination against students based on their sexual orientation, gender identity and expression, race, color, weight, national origin, ethnicity, religion or disability. The law requires NYS school districts to adopt anti-bullying policies and mandates each district appoint a staff member per school to implement anti-bullying techniques and methods.
DASA further mandates administrators report incidents of bullying or bias-based harassment to the New York State Department of Education. So if you have a patient who is being bullied, you should call the school and ask as the child’s pediatrician, “What is the school doing about the situation?”