• Bullying can have long-term effects on children’s health and wellbeing.
• Seth J. Scholer, MD, MPH, FAAP, shared a one-minute intervention for pediatricians to address bullying during clinic visits.

SAN DIEGO — Because bullying can have a profound impact on a child’s health, pediatricians play an important role in preventing and addressing it in clinical practice, according to a presentation at the AAP National Conference & Exhibition.

“Bullying is common, but that doesn’t mean we should be ignoring it and allowing it to happen or think about it as a rite of passage,” Seth J. Scholer, MD, MPH, FAAP, professor of pediatrics at Vanderbilt University Medical Center, told Healio in an interview. “It needs to be addressed.”

Bullying is associated with adverse outcomes for victims and perpetrators, Scholer said. Children who are victims of bullying are at an increased risk for depression, anxiety, sleep problems, lower academic performance, reduced lifetime wealth and suicidal ideation. Children who are engaging in bullying are at risk for future aggressive or delinquent behavior, conduct disorder, antisocial personality disorder and criminal offending, according to Scholer.

“That is the crux of why general pediatricians should be paying attention to this important topic, because it affects health,” he said.

Scholer recommends pediatricians take a systematic approach when address bullying in the clinic.

“Think about how to identify and screen for it in clinic, how to gather more information that might be associated with the bullying and provide some intervention,” Scholer said.

Two common screening tools that Scholer recommends are the AAP Bright Futures Questionnaires and the HEEADSSS Assessment. However, Scholer said children may not admit to being bullied or engaging in bullying behavior. Instead of directly asking about bullying, he asks open-ended questions about their experience at school.

“I recommend using screening questions that don’t use the word ‘bully’ because some children don’t understand what the definition of bullying is,” he said.

It is also important for pediatricians to be on the lookout for symptoms that could be warning signs of bullying, including somatic symptoms, school absenteeism, falling grades, behavioral issues and suicidal ideation. For children who are bullies, the warning signs include using verbal or physical aggression during conflict, blaming others for their behavior or taking items that do not belong to them.

If a pediatrician suspects that a child is being bullied, the next step Scholer recommends is gathering more information by asking how it is affecting them socially, physically and academically. It is also important to identify risk factors that may increase their likelihood of being bullied — Scholer said this could be anything that makes the child different from their peers — as well as protective factors such as parental support and school environment.

It can seem difficult for pediatricians to intervene when they learn a patient is being bullied because they may not have time for a lengthy conversation. That is why Scholer developed a one-minute intervention that he uses in his clinical practice, which includes offering support, encouraging school involvement, providing resources and requesting a follow-up. During the follow-up visit in 1 to 2 months, pediatricians can screen and refer as indicated for conditions that might be contributing, such as anxieties, ADHD, poor social skills and autism.

 

If there is time for a longer discussion, Scholer suggested helping the patient build skills to respond to bullying by learning to firmly say “stop,” and identifying an adult they can talk to.

For children who are bullies, Scholer stresses to their parents the importance of being positive role models and avoiding unhealthy discipline like corporal punishment. He has also found martial arts and sports to be great outlets for these children to express their emotions in a productive manner.

Finally, Scholer recommends pediatricians consider implementing bullying prevention strategies in their practice. This could include the AAP Family Media Plan, which reduces media use and cyberbullying, anticipatory guidance for parents before their child reports being bullied or screening families for unhealthy parenting behaviors, which Scholer said are a predictor of childhood aggression.

“If we screen for those types of potentially unhealthy parenting strategies, then we might be able to prevent bullying from even happening,” Scholer said.

Seth J. Scholer, MD, MPH, FAAP, can be reached at seth.scholer@vumc.org.