Bullying and Victimization | Pediatric Collection
A 12-year-old patient presents for a routine follow-up of a moderately increased BMI. You are thrilled to note that her weight has dropped slightly, but she appears withdrawn when you come into the room. During your conversation, the patient mentions that some of the girls bully her at her new junior high school. They don’t include her at the lunch table. She says they tease her about her clothes, her accent, and her weight. Her mom talked with the school principal, and he talked to the other girls’ parents, but nothing changed except that now the other girls are mad at her. Her mother reports that her daughter comes home after school and goes straight to her room. Her eyes seem red and puffy when she checks on her, and her appetite is poor. Her mom is worried that the girls may be bullying her on Snapchat. She is frightened after hearing about a recent suicide attributed to online bullying and asks you what she should do.
Bullying has long been an accepted experience of childhood—a metaphorical bump along the road to adulthood. It is likely that many pediatricians still struggle to accept the characterization of bullying as a public health crisis affecting children in our clinics and communities. Yet rising recognition of the long-term consequences of bullying on the physical and mental health of children and youth compels a shift in these attitudes. Bullying fits solidly into the framework of recurrent traumatic experiences in childhood. It shares a spectrum of physiologic, psychologic, social, and cognitive outcomes that are associated with experiences of child maltreatment or family violence.1 Like childhood traumatic experiences, there remain significant gaps in our understanding of the underlying etiologies, effective prevention strategies, individual lived experiences, and appropriate societal responses to childhood bullying.
The articles included in this collection on bullying provide a wide lens through which to view this complexity. Waasdorp et al present a 10-year perspective on the prevalence of bullying, documenting an encouraging decline in the proportion of children reporting any one of multiple forms of bullying in the past month from 28.5% in 2005 to 13.4% in 2014.2 As noted by the commentary that accompanies the article, however, the findings should not invite complacency—40% of children still report witnessing an episode of bullying in the school and almost half report that bullying remains a problem.3
Subpopulations of children experience disproportionate rates of bullying, including—but not limited to—those youth who identify as sexual or gender minorities in their communities.4 Additional articles in this collection highlight the longitudinal outcomes associated with bullying, from depressive symptoms to substance abuse and suicidal behaviors.5,6 The narrative of bullied adolescent turned school shooter, present in the public imagination since Columbine, is thoughtfully examined by Pham et al in a study that identifies 3 risk factors that identify those victims of bullying who are most likely to carry a weapon onto school grounds.7 The collection acknowledges the circular relationship between a history of victimization and emergence of violence and aggression, highlighting the challenge of drawing a bright line between victim and perpetrator in bullying in many cases.8 Despite these complexities, this collection insists that pediatricians embrace bullying as an ethical duty to confront and to chip away at the social hierarchies contributing to power differentials, economic inequalities, and health disparities that are increasing across the country.9 Even in the midst of a busy clinic day, Lantos and Halpern make an impassioned argument for a moral obligation to address the needs of both the victim and the perpetrator of bullying.
All of this may be much more than your 12-year-old patient—or her mother—needs to hear on a Friday afternoon. It’s true that there are some practical pearls for a busy clinic day tucked away in these articles. There are prompts to help open up a child’s experiences with bullying, questions to identify the child at high risk for self-harm or for harm to others, and links to evidence-based programs that teach coping skills and reduce aggressive behaviors for both individual patients and institutional settings. There is not, however, a tidy algorithm for the care of the bullied child. More than anything, these articles will inspire you to sit down and dig into the messy complexity of childhood aggression, bullying, and traumatic experiences in your clinic, your community, and your investigations.
Kristine A. Campbell, MD
University of Utah, Department of Pediatrics
Primary Children’s Hospital Center for Safe and Healthy Families
Salt Lake City, UT
A print version of this collection will be available on shopAAP in November.
National Academies of Sciences, Engineering, and Medicine. Preventing Bullying Through Science, Policy, and Practice. Washington, DC: The National Academis Press; 2016. https://doi.org/10.17226/23482. Accessed October 8, 2018
Waasdorp TE, Pas ET, Zablotsky B, Bradshaw CP. Ten-Year Trends in Bullying and Related Attitudes Among 4th- to 12th-Graders. Pediatrics. 2017;139(6):e20162615. doi:10.1542/peds.2016-2615
Leff SS, Feudtner C. Tackling Bullying: Grounds for Encouragement and Sustained Focus. Pediatrics. 2017;139(6):e20170504. doi:10.1542/peds.2017-0504
Earnshaw VA, Reisner SL, Juvonen J, Hatzenbuehler ML, Perrotti J, Schuster MA. LGBTQ Bullying: Translating Research to Action in Pediatrics. Pediatrics. 2017;140(4):e20170432. doi:10.1542/peds.2017-0432
Earnshaw VA, Elliott MN, Reisner SL, et al. Peer Victimization, Depressive Symptoms, and Substance Use: A Longitudinal Analysis. Pediatrics. 2017;139(6):e20163426. doi:10.1542/peds.2016-3426
Holt MK, Vivolo-Kantor AM, Polanin JR, et al. Bullying and Suicidal Ideation and Behaviors: A Meta-Analysis. PEDIATRICS. 2015;135(2):e496-e509. doi:10.1542/peds.2014-1864
Pham TB, Schapiro LE, John M, Adesman A. Weapon Carrying Among Victims of Bullying. Pediatrics. 2017;140(6):e20170353. doi:10.1542/peds.2017-0353
Austerman J. Violence and Aggressive Behavior. Pediatr Rev. 2017;38(2):69-80. doi:10.1542/pir.2016-0062
Lantos JD, Halpern J. Bullying, Social Hierarchies, Poverty, and Health Outcomes. PEDIATRICS. 2015;135(Supplement):S21-S23. doi:10.1542/peds.2014-3549B