Bullying hurts. Pediatricians are on the front line of care and advocacy

According to the U.S. Department of Health and Human Services, 3.2 million children are bullied each year and an estimated 160,000 students miss school daily due to the fear of being bullied.

In 2001, the American Medical Association identified bullying as a public health problem. And although anti-bullying legislation has been adopted in 49 states, the onus to protect children from bullying and cyberbullying has historically been the responsibility of the child’s school system.

Pediatricians and pediatric health care providers are an important, front line, family-trusted group that not only detect the warning signs of victimization, but are in a position to advocate for children.

But Boston Children’s Hospital’s neurologist and director of the Bullying and Cyberbullying Prevention and Advocacy Collaborative (BACPAC), Peter Raffalli, MD, FAAP, says pediatricians and pediatric health care providers are an important, front line, family-trusted group that not only detect the warning signs of victimization, they are in a position to advocate for their patients.

“Peer victimization, specifically bullying and cyberbullying, is a prevalent public health problem with potentially serious consequences to the health and wellbeing of children,” says Raffalli. “And pediatric health providers play an important role in screening for bullying/cyberbullying in their practices and in advocating for the victims.”

This research-based philosophy is the foundation for Boston Children’s BACPAC program – an anti-bullying collaborative founded in 2009.

Sam and Raffalli

Read how the BACPAC program helped 11-year-old Samantha end the bullying.

The BACPAC clinic consists of a team of pediatric experts including Raffalli, a social worker and an education resource specialist, and is the first of its kind in the United States.

“Our goal was to establish a program where children faced with bullying and cyberbullying could come to be heard, learn their rights under federal and state laws and learn strategies that might help end the abuse,” Raffalli says.

Pediatric bullying & cyberbullying screening guide

The following is a pediatric screening guide created by Boston Children’s Hospital’s BACPAC program, in partnership with the Massachusetts Aggression Reduction Center (MARC).


Know the warning signs

Bullying can inflict physical, psychological, social or educational harm or distress on the child who is targeted, and can affect any young person.

However, research identifies the pediatric neurology patient population – typically, children with ADHD, autism and other learning disabilities, and the pediatric lesbian, gay, bisexual and transgender (LGBT) population at a significantly higher risk for peer victimization than the general population.

Warning signs include:

  • a decline in grades
  • unexplainable injuries
  • depressed mood
  • change in eating habits and sleep patterns
  • feelings of helplessness or decreased self esteem
  • increased physical complaints (headaches, stomach upset)
  • school avoidance
  • self-destructive behaviors such as running away from home, self-harm or talking about suicide


Evaluate school climate

The standard, “How’s school?” question does not invoke meaningful and open dialogue, Raffalli says. He suggests using the following questions to engage children and encourage them to openly discuss their experiences.

  • Do you like school? 
  • Do you like the people? (Sometimes this question brings kids to the “no one will be my friend…” statement.)
  • Is school a friendly place?
  • Do kids get along there?
  • Are most kids friendly? 
  • Does anyone pick on you? (Using the words, “pick on you” is an easier concept for kids to grasp.)

“Utilizing these tactics is fairly easy to do, genuinely curious and it doesn’t sound like you are trying to get someone in trouble or enter a controversial area,” Raffalli says.

If you suspect or confirm a child is being bullied, try to tease out, explore and get examples, he says. “There may be a kid, or group of kids that are consistently and repetitively harassing them.”


Identify a “safe adult” at school

A safe adult is someone chosen by the child and someone the child has unrestricted access to. The adult is aware they have been designated as a safe person and is available to advocate on the child’s behalf at the school administration level.


Be a resource and support system for the child and parents

Information sharing is critical. Visit the BACPAC program website for a comprehensive list of resources.


Communicate with the child’s school

  • If the child and family agree to your involvement, seek written parental consent to share information with the school via written report. The more details the child can provide as to who, what, where, how, the more power the school will have to act.
  • If child and/or parent will not consent to communication with school, provide advice/resource information to help the parent advocate for their child with the school.
  • Always document in your note the conversation in the office.


Separation strategies work; mediation does not

Raffalli doesn’t recommend bringing the victim and bully together for mediation because this can significantly increase stress for the victim. It is extremely important that adults get involved immediately and continue to follow up separately with both the victim and the bully(ies).

Reaching out to the BACPAC program

The BACPAC team is available when your patient needs us. During a patient appointment, our team listens to the child and offers strategies to combat bullying, which include:

  • educating the family about the child’s rights under federal and state laws
  • providing strategies to help end bullying situations and bullying-prevention advice for the future
  • offering empowerment strategies on how to develop a network of adult staff at school that could be available to the child and who could advocate for the child at the level of the principal’s office when reporting bullying
  • offering ways to improve friendship groups as a strong friendship group (this has been shown to be an insulating factor against bullying)
  • education regarding their rights under the Massachusetts anti-bullying legislation
  • a list of various state agencies that could be called upon if the family feels the school is not adequately troubleshooting the situation
  • reports/documentation and recommendations to share with the school in the hopes that the suggestions could be used by the school to protect the child/victim

“We at BACPAC are hopeful that our initiative at Boston Children’s Hospital will lead others to start similar programs, support victims of bullying and advance research into the causes of bullying and cyberbullying and find solutions to the problem,” Raffalli says.

Learn more about Boston Children’s BACPAC program.