Pediatric health care providers are an important, front line, family-trusted group that can not only detect the warning signs of victimization, but are also in a position to advise parents and advocate for their patients. It is important for health care providers to be prepared to screen and counsel children for bullying during both routine health maintenance exams and illness visits.
More than one in four children in America says he or she has experienced being bullied, but only 20-30% of those children ever report it to an adult. This startling statistic can be troublesome for parents, leaving many to wonder how to know if their child is being bullied and what steps they should take to relieve that stress. Pediatricians can remind parents to be vigilant regarding changes in their child’s behavior or mood and keep channels of communication open.
Some signs that may point to a bullying problem include:
- Unexplained injuries
- Frequent headaches, stomachaches or feeling sick
- Changes in mood – a previously happy and agreeable child becoming difficult, withdrawn or angry
- Changes in eating habits, either skipping meals or binge eating
- Difficulty sleeping or nightmares
- Declining grades, loss of interest in school, or not wanting to go to school
- Sudden loss of friends or avoidance of social situations.
Bullying has long been considered a ‘rite of passage,’ something to be endured during middle and high school. Schools have taken steps in recent years to address the issue of bullying as a behavior that impedes learning. With an estimated 20% of youth reporting being bullied in school, translating to millions of youth being impacted across the country each year, bullying has become a public health crisis. Children who are perceived by their peers as being different such as having a disability, practicing their religion, or identifying as lesbian, gay, bisexual, or transgender (LGBT) – are at a higher risk of being bullied. Physicians should address this public health issue with the children and youth they see every day.
For example, in a 2012 survey of Muslim students across 21 counties in California, 50% reported being bullied because of their religion, and 21% reported being cyberbullied because of their religion. In another study – PDF, 85% of LGBT students reported being verbally harassed, 40% reported being physically harassed and 19% reported being physically assaulted at school in the past year.
Teachers and administrators should work to prevent bullying before it starts, and to stop it when it does occur. Students who feel disconnected or alienated from the school environment will lack confidence, suffer academically, and fail to fully invest in their future. School staff should work to establish a culture of acceptance to create a safe learning environment for all students, particularly those at greater risk of being bullied.
As physicians, we often see how problems and issues present in the society as a whole also have a profound impact on the physical and emotional well-being of the children. The consequences of bullying at school are numerous and the impact of bullying has been well documented in pediatric scientific literature. Research has shown that being bullied during childhood and adolescence has long term consequences such as depression, anxiety, and alcohol or drug abuse in adulthood.
What PEDIATRICIANS can do:
- Become familiar with Connected Kids: Safe, Strong, Secure, the American Academy of Pediatrics’ primary care violence prevention protocol.
- Conduct specific screening of patients to determine if bullying is a concern. Be especially attentive to the concerns of those patients who appear to be demonstrating psychosomatic illnesses or have factors that are known to contribute to being bullied (e.g., being part of a marginalized group)
- Institute a network-wide bullying screen as part of every Electronic Health Record (EHR). This will make asking about bullying a standard part of the care that all patients receive at every health maintenance exam.
- Counsel patients and their parents on strategies to reduce emotional distress. Refer for counseling when appropriate.
- Become part of the overall community effort to prevent bullying, by raising awareness wherever possible and getting involved in more comprehensive efforts at a local and state level.
Pediatricians can coach PARENTS to
- Build a relationship of trust with their children so they feel comfortable telling them about their problems.
- Look for signs that their child is being bullied: bruises, scrapes, change in behavior, anxiety about attending school, etc.
- Notify the school in writing of any bullying complaints immediately. Never ignore or downplay the importance of such complaints. Do not attempt to confront the bully or his or her family directly.
- Keep a record of incidents and always follow up with school administrators.
- Report to authorities and advocacy groups as needed to help navigate.
- Help their child to form and nurture strong friendships.
- Discuss safety plans for their child if he or she feels unsafe/harassed.
- Ensure that the child understands that it is not his or her fault and he or she has nothing to be ashamed of.
- Consult StopBullying.gov on bullying and effective communication between children and supervising adults and parents, so that they can be better advocates.
America’s greatest strength is her diversity with a fusion of cultures so exceptional that citizens can be just as proud of their ancestral cultural heritage as they are to be an American. Each of us bears the responsibility of protecting our children and serving as guardian of the diversity of this country.
Dr. Wahida Abaza is a pediatrician, an advocate for Muslim children’s physical and emotional health and well-being, and an associate at The Family and Youth Institute. She was born and raised in Chicago, IL and now lives with her family in Dublin, Ohio.