Abstract
Bullying among children is an important concern for parents. In one study of parents of children 2–17 years old, bullying was one of the top ten health concerns for children and adolescents. Multiple professional medical societies have issued policies or recommendations regarding bullying and the healthcare provider’s role in bullying prevention and intervention. American Academy of Pediatrics Bright Futures guidelines recommend that pediatricians inquire about bullying, beginning with the 5-year-old well-child visit, and continuing through adolescence. There is little information on evidence-based bullying-prevention interventions in the clinical setting. The majority of adolescents access social media sites daily, with more than one out of five adolescents accessing these sites more than ten times a day. There are some unique strategies that can be used for cyber bullying.
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Appendices
Practical Strategies for Parents
Warning Signs of Victimization from Bullying:
Sad, depressed, anxious moods; avoiding school; drop in grades; physical complaints (abdominal pain, headaches, trouble sleeping); torn clothing or bruises
If Your Child Is Being Bullied:
Acknowledge your child’s distress
Speak with your child’s teacher or school counselor (or adult in charge at the location the bullying is occurring)
Role-play with your child about how to be assertive in possible bullying situations, responding firmly to the bully, with confident body language
Remind your child to stay with friends as much as possible at, to, and from school, especially when there are no adults around
Enroll your child in extracurricular activities that he/she enjoys to help make friends and build self-esteem
Keep a written record of bullying incidents and submit them in writing to the teacher/counselor/adult in charge; document concerns and events in detail (date, description, location, students involved, and whether school staff was aware)
If Bullying Persists
If no response from the teacher or counselor, escalate to principal, school board, or state Department of Education; submit request for intervention in writing
Be aware of your state’s bullying laws and your child’s school’s anti-bullying policy
Request class or seat changes if needed
If your child is having depression/anxiety or physical complaints, visit your health care provider. Your child may benefit from mental health services to help with coping skills and assertiveness training
Stop Bullying website: www.stopbullying.gov
National Crime Prevention Council: www.ncpc.org/topics/bullying
Cyber Bullying Website: www.cyberbully411.org
Ophelia Project (parent advice, videos): www.opheliaproject.org/parents.html
Healthy Children Website (Available in Spanish): www.healthychildren.org/english/safety-prevention/at-play/Pages/default.aspx
Practical Strategies for Clinicians
Screening
Screen all patients briefly using questions such as, “How are things going at school?”, “Do you have friends?”, “Is anyone mean to you or picking on you?”
Get a sense of whether they spend lunch/recess with friends or alone
Be cautious about asking children if they are being “bullied” given the stigma associated with the term
If the child seems withdrawn from peers, probe further about teasing, name calling, exclusion
Pay special attention to those with warning signs, special health care needs (e.g. autism, ADHD, obesity, learning disorders), or at high-risk (e.g. LGBT youth)
Always screen children presenting with somatic complaints (e.g. headaches, abdominal pain, sleep problems, bed-wetting)
Initial Management
Acknowledge the child’s distress, and reinforce that bullying is not ok, it’s not the child’s fault
Teach the child to speak calmly to the bully, walk away, and tell a teacher or parent
Encourage parents to practice role-playing with the child to project confidence, and consider enrolling the child in extracurricular activities
Recommend that parents speak with the child’s teacher or counselor, document all bullying incidents in detail, and for cyber bullying, print out emails or web posts
If Bullying Persists
Escalate to principal, school board, or state Department of Education
Remind parents to review state and school bullying policy
Recommend that parents request change of classroom or seat, or more supervision during or between classes
Clinicians may be able to help by obtaining parental permission and contacting the school by phone, or by writing a brief letter documenting the concerns
Evaluation and Referral
Evaluate children involved in bullying for depression, anxiety, suicidal ideation, drug or alcohol use, other aggressive behaviors, conduct disorder
Consider referral for mental health services, assertiveness training, coping skills
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Shetgiri, R., Espelage, D.L., Carroll, L. (2015). Clinical Management of Bullying. In: Practical Strategies for Clinical Management of Bullying. SpringerBriefs in Public Health(). Springer, Cham. https://doi.org/10.1007/978-3-319-15476-3_7
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DOI: https://doi.org/10.1007/978-3-319-15476-3_7
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