Pediatrics Book


Aka: Bullying
  1. Epidemiology
    1. Incidence of Bullying concern ages 12-18: 4%
    2. Bullying associated with weapons in school Grades 6-10
      1. Bullies: 500% more likely to bring weapon to school
      2. Victims: 60% more likely to bring weapon to school
      3. Nansel (2003) Arch Pediatr Adolesc Med 157:348-53 [PubMed]
    3. School violent deaths often caused by Bullying victim
      1. Anderson (2001) JAMA 286:2695-702 [PubMed]
  2. Definition
    1. Aggressor repeatedly, intentionally intimidates victim
    2. Common forms of Bullying
      1. Harassment or threatening behavior
      2. Name calling, teasing, racist or sexual remarks
      3. Bully circulates rumors
      4. Bully takes victims belonginings
      5. Physical harm (hitting, kicking, slapping)
      6. Isolation from group or manipulation of friends
  3. Characteristics: Bully
    1. Bully characteristics
      1. Aggressive behavior with teachers, parents, siblings
      2. Impulsive and easily frustrated
      3. Dominant personality
      4. May witness Violence as used at home
      5. May lack parental nurturing and supervision
      6. Normal or over-inflated self-esteem
    2. No anxiety or insecurity over behavior
      1. Do not relate to emotional experiences of others
      2. Use Violence as tool of power and domination
      3. Reinforcement: Control, prestige, material goods
    3. Associated psychiatric illnesses
      1. Antisocial Personality disorder
      2. Oppositional Defiant Disorder
      3. Attention Deficit Hyperactivity Disorder (ADHD)
      4. Major Depression and Suicidal Ideation
      5. Substance Abuse
      6. Truancy
      7. Criminality
  4. Characteristics: Bullying victim
    1. Victim characteristics
      1. Victim perceived as unable to defend self
      2. Victims sense weaker, helpless position
      3. Physically smaller and weaker than peers
      4. Sensitive, quiet children who are socially isolated
      5. React to Bullying with crying and withdrawal
      6. Child feels like a failure and are ashamed
      7. Poor self worth: Believe they are stupid or ugly
    2. Provocative victim characteristics
      1. Victim as above, but are more aggressive
      2. Tease bully to incite more Bullying
    3. Risk factors for victim of Bullying
      1. Chronic illness or physical deformity
      2. Learning Disorder
      3. Behavioral disorder
      4. Children in special education classes
      5. Children with difficult social skills
      6. Clumsy children
  5. Symptoms (victim of Bullying)
    1. Insomnia
    2. Depressed mood
    3. Nocturnal Enuresis
    4. Somatic symptoms
      1. Recurrent Abdominal Pain
      2. Headache
  6. Associated conditions (victim of Bullying)
    1. Low self esteem
    2. Social isolation and loss of friends
    3. School avoidance or truancy
    4. Decreased school performance and poor grades
    5. Anxiety Disorder
    6. Major Depression
    7. Violent retaliation by victim
  7. Prevention
    1. Screen for Bullying at routine clinic visits
      1. Are you ever teased at school?
      2. What have you been teased about?
      3. What do you do when you are teased?
      4. Have you told anyone about this? What happened?
    2. Victims and their families
      1. Reinforce supportive environment
        1. Caring adults with close family relationships
      2. Role play on projecting sense of confidence
        1. Stand straight and make eye contact
        2. Arms and hands should appear relaxed
        3. Use strong voice to sound secure
      3. Participate in activities that promote confidence
        1. Activity should be free of Bullying
        2. Child should have interest in activity
        3. Examples of positive peer groups
          1. Drama club (may also learn to act confident)
          2. Sports participation
      4. Respond to Bullying event: Talk, Walk, Squawk
        1. Talk briefly to bully with confidence
          1. Example: "You don't scare me"
          2. Do not provoke further Bullying
        2. Walk (not run) away from the scene
        3. Squawk to an adult about event
          1. Adult should be pre-identified to speak with
          2. Tell about event when it happens
    3. Bullies and their families
      1. No tolerance policy
      2. Eliminate reinforcements (power and social influence)
      3. Consider school psychologist involvement
      4. Provide strong role models with positive attitudes
    4. School-wide program development
      1. Olweus Bullying Prevention Program (Norway program)
  8. Resources
    1. U.S. Dept Health and Human Services
    2. National Bullying Prevention Resource Kit (HRSA)
    3. National Education Association on Bullying
  9. References
    1. Glew (2000) Pediatr Rev 21(6):183-9 [PubMed]
    2. Lyznicki (2004) Am Fam Physician 70:1723-30 [PubMed]
    3. Pearce (1998) Arch Dis Child 79:528-31 [PubMed]

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