Pediatricians' Role in Bullying Intervention

Bullying is a pervasive problem that children may encounter, either as perpetrator, victim or bystander. The National Institute of Child Health and Human Development found that at least 30% of children have either been bullied or bully others. Additionally, only 20% to 30% of children who are bullied ever report it to an adult. These statistics are concerning given that bullying increases the risk for many physical, psychological and social problems including truancy, academic decline, somatic problems, anxiety, depression and suicide attempts.

So what is the role of pediatrics in bullying intervention? Below are practical guidelines for pediatricians regarding discussing and defining bullying, advising parents who are concerned about bullying and additional resources on how to address bullying.

Talking to patients about bullying

For screening and treatment of bullying, the American Academy of Pediatrics (AAP) encourages pediatricians to start the conversation broadly, opening the discussion with the following statement: "We have a better understanding today of the negative effects that exposure to violence has on children and adolescents, such that I now talk to all of my families about exposure to violence." Additionally, the following questions are helpful guides in directly assessing bullying among patients and parents:

• Sometimes kids get picked on at school. Does this happen to you/your child? Has the child heard of or seen incidences of this?
• Have there been any problems at school with behavior?

Defining bullying for parents and kids

Many parents have trouble distinguishing between normative conflict, teasing and bullying. Providing the following information can be helpful in clarifying what qualifies as bullying:

• Bullying is an intentional act to hurt, harm, or humiliate another person physically, emotionally, and/or psychologically.
• Bullying is based on power differentials. Most simply stated: Children who are bullied feel that these experiences make them feel like less of a person.
• Bullying can take many forms and happens in-person or online. Some examples of cyberbullying include sending hurtful text messages or sharing embarrassing pictures or videos of another on social media.
• Cyberbullying has the potential to be more destructive than in person bullying as it can occur anytime, reach a broader audience, allow the perpetrator to remain anonymous, and be difficult for adults to monitor.

Warning signs of bullying

Spotting warning signs as early as possible is one of the most effective forms of bullying prevention. Potential warning signs or effects of bullying that pediatricians should share with parents include:

• Unexplained injuries
• Frequent headaches, stomachaches or feeling sick
• Changes in mood (e.g. a previously happy and agreeable child who has become difficult, withdrawn or angry)
• Changes in eating habits (e.g. 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

Advising parents with bullying concerns

Parents often are uncertain what to do when they learn their child is involved in bullying. The following directions might be helpful for parents:

• Identify trusted adults who can be allies.
• Talk with your child about the experience. Having just one person listen can help them handle the situation in a healthy way.
• If the child is a victim of bullying, let the child know they should not be treated this way.
• If the child is the perpetrator, clarify that this behavior is not acceptable.
• Know the school policy on bullying and share key information with families.
• Help parents build resiliency in their child by encouraging them to increase positive emotions and quality family time.

Special considerations for cyberbullying

Cyberbullying is a new landscape and may require a different approach:

• Advise parents not to threaten or take away devices or eliminate online time. Doing so makes children less willing to discuss cyberbullying.
• Most social media platforms have a process for reporting bullying behavior. Cyberbullying should be reported to school, the media platform where it was posted and to police if threats of physical harm occurred.
• Encourage families to visit the AAP website and develop a family media use plan.

Bullying intervention resources for parents

Provide parents resources for addressing a variety of topics and concerns related to offline and online bullying. Helpful sites that provide a variety of valuable resources for parents include:

• SafeKids
• The American Academy of Pediatrics
• StopBullying.gov