Back to school brings, as it does every year, an increased focus on school issues. Parents and children may feel uncomfortable discussing many of these concerns or may not realize that their pediatrician can be a source of help and support. One topic in particular, bullying, is an important and difficult issue that affects a large number of children and adolescents, yet unfortunately, often goes undetected.
More than half of teens have been either the victims or perpetrators of some type of bullying; for one in five, this takes the form of actual physical bullying or violence. Bullying can happen to anyone, from any socioeconomic status, in any school or neighborhood. Even children who are seemingly well adjusted and “popular” at school can be victimized. The dramatic increase in technology use, smartphones and social media only increases the vulnerability of youth to bullying – cyberbullying can be incredibly damaging and difficult to detect and address.
©monkeybusinessimages/Thinkstock.com
Bullying can happen to anyone, from any socioeconomic status, in any school or neighborhood.
Pediatric providers can help in many ways. First, don’t hesitate to bring up the issue of bullying during well visits or sports physicals when discussing school performance or school readiness. While I admit – given the large range of topics that need to be covered – I don’t discuss this at every visit, I often do ask about friendships at school and have a low threshold for bringing up the issue of bullying with families.
Second, be alert to possible signs that your patients may be bullied. Nonspecific symptoms – such as headaches, stomach pains, fatigue, or behavior or mood changes – can be manifestations of the distress associated with being bullied. When evaluating children for these concerns, it is important to take a detailed history that includes potential psychosocial stressors or changes, such as bullying. Equally as important is to approach this history-taking in a culturally sensitive and trauma-informed way and to recognize that your patients may not immediately disclose concerns. However, by demonstrating that you are a trusted source of support, you can open the door for future conversations.
Lastly, be prepared to respond in a nonthreatening and nonjudgmental way when concerns arise. These are very challenging situations, and it is important to engage families – and the child or teen – in the best way to address them. Youth may feel a great loss of control in the bullying relationship, and thus, to avoid further trauma, it is critically important for their family and professionals to give them as much control as possible in dealing with it. Of course, there are times when the child’s safety could be compromised, and more directive intervention is needed, but even in those situations the provider and family can help by being open and communicative.
Typically, other support systems will also need to be involved – for example, the school (if that is where the bullying is taking place) or trained mental health providers. Families may need help thinking about the best way to approach or initiate these discussions, especially as they themselves may be angry or in denial. Providers can even serve as a resource to schools and communities in thinking about the best way to prevent and address bullying, either in individual situations or more generally. The U.S. Department of Health & Human Services offers comprehensive resources to providers and families faced with the issue of bullying (www.stopbullying.gov).
As partners with the family, patient, and community, pediatric providers can play an important role in preventing and addressing bullying, which can have a lifelong impact on the health of a child.
Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, both in Washington.