Childhood Bullying: Implications for Physicians

 

Am Fam Physician. 2018 Feb 1;97(3):187-192.

  Patient information: A handout on childhood bullying is available.

Author disclosure: No relevant financial affiliations.

Childhood bullying is common and can lead to serious adverse physical and mental health effects for both the victim and the bully. In teenagers, risk factors for becoming a victim of bullying include being lesbian, gay, bisexual, or transgender; having a disability or medical condition such as asthma, diabetes mellitus, a skin condition, or food allergy; or being an outlier in weight and stature. An estimated 20% of youth have been bullied on school property, and 16% have been bullied electronically in the past year. Bullying can result in emotional distress, depression, anxiety, social isolation, low self-esteem, school avoidance/refusal, and substance abuse for the victim and the bully. Preventive measures include encouraging patients to find enjoyable activities that promote confidence and self-esteem, modeling how to treat others with kindness and respect, and encouraging patients to seek positive friendships. For those who feel concern or guilt about sharing their experiences, it may be useful to explain that revealing the bullying may not only help end the cycle for them but for others as well. Once bullying has been identified, family physicians have an important role in screening for its harmful effects, such as depression and anxiety. A comprehensive, multitiered approach involving families, schools, and community resources can help combat bullying. Family physicians are integral in recognizing children and adolescents who are affected by bullying—as victims, bullies, or bully-victims—so they can benefit from the intervention process.

Bullying, a common experience for children and adolescents, has gained increasing attention over the past three decades as its long-term implications and lasting consequences have become more apparent. Key elements that define bullying include an unwanted, aggressive attack or intimidation tactic that is intended to cause fear, distress, or harm to the victim; an imbalance of power between the bully and victim; and repetitive occurrences of the behaviors.16 Bullying can be direct (physical or verbal), indirect (relational/social, social exclusion, spreading rumors, psychological/stalking), or cyberbullying (performed via electronic or digital means).7,8 In cyberbullying, the element of repetition does not need to be present because a public post on social media can potentially be seen by many individuals.810

WHAT IS NEW ON THIS TOPIC

Childhood Bullying

An estimated 20% of youth have been bullied on school property in the past year, and 16% have been bullied electronically.

The American Academy of Pediatrics suggests introducing the concept of bullying to parents during the six-year-old well-child examination.

The use of electronic psychosocial assessment tools, such as myAssessment or the Rapid Assessment for Adolescent Preventive Services, to identify high-risk behaviors may increase rates of disclosure and be a time-saving step for busy clinicians.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Physicians should ask about bullying when children present with multiple somatic problems, school avoidance, or incidents of self-harm.

C

1, 9, 16, 23

Physicians should use indirect, open-ended questioning to increase the identification of children who are bullying or being bullied.

C

2, 10, 20

Questions about their online lives should be included in the history of children and adolescents.

C

10, 23

Patients who are being bullied or are identified as bullies should be screened for psychiatric comorbidities.

C

2, 10, 20


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Physicians should ask about bullying when children present with multiple somatic problems, school avoidance, or incidents of self-harm.

C

1, 9, 16, 23

Physicians should use indirect, open-ended questioning to increase the identification of children who are bullying or being bullied.

C

2, 10, 20

Questions about their online lives should be included in the history of children and adolescents.

C

10, 23

Patients who are being bullied or are identified as bullies should be screened for psychiatric comorbidities.

C

2, 10, 20


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

The Authors

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MARY M. STEPHENS, MD, MPH, is faculty in the Department of Family and Community Medicine at Christiana Care Health System, Wilmington, Del....

HAZEL T. COOK-FASANO, LCSW, is a senior social worker in the Department of Family and Community Medicine at Christiana Care Health System.

KATHERINE SIBBALUCA, LCSW, is program manager in the Department of Family and Community Medicine at Christiana Care Health System.

Address correspondence to Mary M. Stephens, MD, MPH, Christiana Care Health System, 1401 Foulk Rd., Suite 110B, Wilmington, DE 19803 (e-mail: mastephens@christianacare.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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