Texas Health and Human Services / Texas Health Steps

Is This Child Being Bullied?

Because bullying is a form of aggressive behavior, it can be traumatizing and negatively affect children’s development, social functioning, educational performance, and mental and physical health. U.S. Department of Health and Human Services, 2021

Bullying among youth “is widespread in the United States” (Centers for Disease Control and Prevention, 2021). “It is a form of youth violence and an adverse childhood experience.”

Nationwide, nearly 1 in 5 high school students reported being bullied on school property (Ibid.). When cyberbullying (electronic bullying) is factored in, nearly 1 in 3 female and 1 in 4 male high school students experience bullying.

Youth bullying has serious health consequences that can result in:

  • Physical injury
  • Social and emotional distress
  • Self-harm
  • Death

Bullying also can increase risk for:

  • Depression
  • Anxiety
  • Sleep difficulties
  • Lower academic achievement
  • Dropping out of school

Bullying negatively impacts all youth involved, including individuals who are bullied, individuals who bully others and individuals who witness bullying. An estimated 80 percent of bulling incidents are witnessed by others.

Primary care providers can identify and intervene in bullying by “focusing on prevention, screening early for bullying, recognizing signs of bullying, and supporting patients who are affected by bullying and their families” (American Family Physician, 2018).

Best practice clinical guidelines

  • At every annual Texas Health Steps preventive checkup for children ages 4 years and older, ask patients or families if bullying is a concern, especially when children present with multiple somatic problems, school avoidance or incidents of self-harm.

  • Use indirect, open-ended questions to increase the identification of children who are bullying, being bullied or witnessing bullying.

  • Question children about their online lives when taking their history.

  • Screen for psychiatric comorbidities when children experience any role in bullying.

  • Refer for counseling when appropriate and advocate for the child with school teachers.

What would you do?

Vera 14 years

Vera, age 14, is in her first year of high school. During her annual Texas Health Steps preventive medical checkup, you ask a simple open-ended question: “How is school going this year?” Unexpectedly, Vera begins to cry and says, “I wore the wrong outfit one time and now I’m paying the price for it. There’s even a picture of me going around.” Vera’s mother is stunned.

What are your next best steps?

Ask Vera about what happened and whether she told an adult at school.

Offer comfort and support to Vera and her mother by explaining that bullying is unacceptable, that Vera is not at fault, and that you will work with them and the school to protect Vera’s safety and well-being.

Use a validated mental health screening tool to screen Vera for depression and thoughts of suicide.

Provide Vera and her mother with bullying prevention resources, including the federal government’s StopBullying.gov website.

All of the above.

Why it matters

Bullying among U.S. youth is pervasive. Yet less than half of high school students who are bullied report it to an adult at school (HHS, 2021.) Screening for bullying at every preventive medical checkup is of utmost importance. Primary care providers who screen and intervene for bullying can help stop aggressive and traumatic behavior that could negatively impact the health and well-being of a child or adolescent, both immediately and long term.

Explore More

Bullying: Screening and Intervention

References

Centers for Disease Control and Prevention. (2021). Fast Fact: Preventing Bullying.

Liang, K., Chi, X., Chen, S. T., Clark, C. C. T., Zhang, Y., & Wang, J. (2021). Food Insecurity and Bullying Victimization Among 170,618 Adolescents in 59 Countries. Frontiers in Psychiatry, 12:766804.

SchoolHouse Connection. (2021). Student Homelessness: Lessons from the Youth Risk Behavior Survey (YRBS).

Stephens, M. M., Cook-Fasano, H. T., & Sibbaluca, K. (2018). Childhood Bullying: Implications for Physicians. American Family Physician, 97(3):187-192.

Texas Health Steps. (n.d.). Anticipatory Guidance Provider Guide.

U.S. Department of Health and Human Services. (2021). StopBullying.gov.