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Childhood Bullying

Vol. 10 •Issue 8 • Page 31
The Learning Scope

Childhood Bullying

Nurses can help address the problem in schools and communities

This offering expires in 2 years: March 31, 2010

This goal of this continuing education offering is to educate nurses about three roles children may play in their daily lives: interpersonal roles of the bully, the bullied and the bystander. After reading this article, you will be able to:

1. Discuss the prevalence of bullying in the U.S. today.

2. Compare and contrast the bully, the bullied and the bystander.

3. Describe a multilevel approach to combat bullying.

You can earn 1 contact hour of continuing education credit in three ways: 1) For im-mediate results and certificate, go to Grade and certificate are available immediately after taking the online test. 2) Send this answer sheet (or a photocopy) along with the $8 fee (check or credit card) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.

Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 008-0-07), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).



For some youths, attaining the American dream of cultivating friendships, receiving a solid education and acquiring a sense of belonging often may be intercepted by nightmarish taunting. Taunting can promote a feeling of being ostracized and may cause fear for one's physical safety. This badgering generally is due to culture, gender, physical appearance, disability, ability and intellect.

The National Education Association estimates 160,000 children skip school each day for fear of harassment or victimization. One out of seven children has experienced some form of bullying.1 Data show bullying begins to increase during third and fourth grades as children become aware of their position and status in the social group. A 2001 Kaiser Family Foundation study of 755 preteens found bullying was a common occurrence at school. Eighty-six percent of children ages 12-15 reported being bullied at school, making this issue more prevalent than smoking, alcohol, drugs and sex for that same age group.2

Parents and teachers greatly underestimate the frequency of bullying compared to student responses.1 The CDC reported high school students are increasingly likely to miss school because they feel unsafe. The CDC analyzed data from the 2003 National Youth Risk Behavior Survey, where one in three students reported involvement in a physical fight and one in 10 reported being threatened or injured with a weapon on school property within the previous 12 months. Truancy due to safety concerns rose from 4.4 percent in 1993 to 5.4 percent in 2003.3 According to the U.S. Department of Health and Human Services, boys identified as bullies in middle school were 4 times as likely as their non-bullying peers to have more than one criminal conviction by age 24.4

Long-term consequences of bullying result in emotional and physical trauma, depression, stress-related illnesses, suicide and violence toward others. Additionally, inconsistencies with children not receiving an adequate education impact our long-term economic development.

Caste System

After the 1999 shootings at Columbine High School in Littleton, CO, a caste system was revealed at the high school. Athletes or "jocks" were at the top of the pyramid. Students viewed as outsiders because of their lack of athleticism, diverse interests and dress were told they did not fit in and were not a part of any group or clique.

Eric Harris and Dylan Klebold were two such outcasts. Many targets of these two gunmen were students on athletic teams. Those outside the cliques, left alone and stranded by friends, feel at a loss to control something. Pushed to the edge, many take the lives of those tormenting them or their own lives, seeing no resources or alternatives to assist them.

Families, communities and schools often unsuspectingly support these cliques and caste systems, viewing them as a rite of passage through childhood and the teen years. Unknowingly, many adults support a bullying atmosphere, dismissing bullying incidents as "kids will be kids"; "he doesn't mean it"; "it's a phase"; "ignore her." The seriousness and lasting impact of being excluded through the formative years has not, until recently, been considered an area where communities need to strengthen their resolve to eliminate bullying and restore character education within various support settings.

An FBI study to determine the profile of a shooter found all culprits were tormented and bullied through their school years. This compelling evidence supports the implementation of a multilevel strategy built on a community uniting to educate, communicate and offer mediation.


Education is the first step, and parents, educators, nurses and other support services need to have access to the same information. What do the terms bully, bullied and bystander mean?2 How do we recognize them? What strategies can we use to reduce the behaviors and actions of the bullies, increase the capabilities of the bullied and discourage the participation of the bystanders?

Bullying is acting in ways that scare or harm another person and can take on many forms, including physical (tripping, hitting or shoving) and emotional harm (name-calling or criticizing). It can be relational whereby a child may not be allowed to join a group (forming cliques, instigating the isolation of another child or spreading rumors). Emotional and relational bullying is more common among girls while physical bullying is more common among boys. With the latest form of bullying, cyberbullying, pictures and blogs are posted on the Internet, where hundreds of children can potentially shun the bullied child.

The Bullies

Bullies usually are bigger, stronger, older, verbally adept, higher up on the social ladder and often of a different race or gender than the one bullied. The intent is to harm, not tease, by inflicting emotional or physical pain and taking pleasure in witnessing the hurt. Characteristically, they show an absence of empathy and signs of future aggression.

If you suspect a child is bullying, Table 1 lists significant indicators parents and adults can look for.

The Bullied

Those who are bullied are singled out, viewed as different, and demonstrate characteristics such as being sensitive, socially withdrawn, quiet, insecure, self-conscious and passive, allowing others to control situations and not standing up for themselves (see Table 2).

The bullied are more likely to get depressed than those not subjected to bullying.5 The highly publicized accounts of school violence we have seen are bullied children who act out their own frustration on others and, in some instances, themselves as well.

The Bystanders

Bystanders are the unwitting accomplices, circling the playground brawl to observe the fight. The common denominator is no one defends the one being bullied because of either an allegiance to the bullying group or merely out of fear of drawing attention to themselves. Speaking up could draw attention away from the victim and direct it to you.

Multilevel Approach

Proactive methods are necessary to prevent bullying in playgrounds, buses and schools. A multilevel approach begins with:

  • parental awareness and involvement;

  • advocating for programs in schools and providing appropriate role modeling and coping mechanisms that help children manage stressful interpersonal situations;

  • a commitment on the part of schools to provide character education, supervision and conflict resolution as part of the curriculum; and

  • a commitment on the part of teachers to learn and recognize warning signs of bullying.

    Historically, children and their families depend on the school system to offer activities promoting academic achievement, success, social growth and development. Because school is not expected to be the place for open displays of aggression, harassment and stalking, resources are critical for parents and schools. Parent associations need to provide information on bullying to parents and guardians, including signs and symptoms, plus advice for parents who want to change their child's behavior (if they are aggressive) to instill a sense of self-worth, empathy and compassion.

    In her book, The Bully, the Bullied and the Bystander, Barbara Colorosa advises zero tolerance is not the answer. Removing a child from the class or the school does not resolve the issue with control and behavior. Rather, it transfers responsibility for the same behavior onto another organization.

    Instead, she recommends teaching a child the three Rs: restitution (an apology), resolution (ways to prevent the behavior from recurring) and reconciliation (making amends with the person harmed).1 As the school system is an integral part of a child's development, a supportive environment - one willing to identify and confront the issue of bullying - is needed where students can learn effective communication strategies.

    Effective Partnerships

    Community involvement requires necessary resources be made available to children. Community partnerships that link resources - such as professional organizations, local college programs and neighborhood schools - can provide opportunities to meet the psychoeducational needs of today's youths, parents, educators and healthcare providers.

    Nurses, healthcare professionals and social service providers skilled in health promotion and disease prevention can offer their services to the community to support character education. Active case finding for early intervention is essential, and many healthcare professionals are willing to collaborate with educators to promote healthy living and character education.

    Creatively exploring ways to use skilled professionals without additional funds is possible. Parents, educators, community activists and healthcare professionals can combine efforts to develop a strategy to reduce the lasting destruction that occurs with bullying. Local government officials, law enforcement, civic organizations, nonprofit groups, philanthropic contributors, and youth and church groups can collaborate to develop a model that encourages problem-solving without bullying in the school community. Many schools use these community services for other forms of enrichment.

    Creative, Cost-Effective Strategies

    Within our local school district, in one elementary school in particular, we found ways to increase the children's sensitivity to bullying and encourage character building. Discipline was a major concern for both parents and school personnel. Together, we teamed to provide the multilevel approach.

    The school approached character building through education and enrichment by providing reading assignments for each grade level that covered an important character trait each month. Programs promoting children to give back to their community were introduced, and children were encouraged to apply for a spot on these committees. The interview helped increase their self-esteem and solidify their role in encouraging moral character in school and respect for one another.

    The concept of "peaceful playgrounds" was introduced; positive playtime was encouraged and monitors (upperclassmen) trained in identifying potential problems assisted with early mediation by offering peaceful solutions. Along these lines, baccalaureate senior nursing students were prepared at Wagner College, Staten Island, NY, to teach lessons in character education building to fifth graders at the local elementary school.

    Bullying creates challenges for healthcare professionals. Case finding in the private practitioner's office, early identification of physical symptoms by the school nurse, repeated visits to emergency departments and other behaviors may be dismissed by the unsuspecting nurse unaware these children are manifesting physical and emotional fears. Early intervention may promote a healthier lifestyle and decrease the burden these children place on the healthcare system.

    A multilevel approach may offer comprehensive resources to promote healthy coping styles and assist children lacking the support systems to develop the character necessary to achieve the American dream.


    1. Coloroso, B. (2003). The bully, the bullied and the bystander. New York: Harper Collins.

    2. Stickle, F. (Ed.). (2006). Adolescent psychology (5th ed.). Boston: McGraw-Hill.

    3. CDC. (2005). National Youth Risk Behavior Survey: 1991-2005. Retrieved March 20, 2007 from the World Wide Web:

    4. Parker, S., Zuckerman, B., & Augustyn, M. (2005). Developmental and behavioral pediatrics (2nd ed., pp. 141-144). Philadelphia: Lippincott Williams & Wilkins.

    5. van der Wal, M.F., de Wit, C., & Hirasing, R.A. (2003). Psychosocial health among young victims and offenders of direct and indirect bullying. Pediatrics, 111(6), 1312-1317.

    Margaret M. Governo is associate professor, Wagner College Evelyn L. Spiro School of Nursing, Staten Island, NY, and associate NP, pediatric adolescent medicine, Coney Island Hospital, Brooklyn, NY. Marianne Howard Siewers is vice president of clinical programs, Epicare Associates, West Caldwell, NJ; adjunct faculty at Kingsborough Community College, Brooklyn, NY; and former director of behavioral health nursing at Coney Island Hospital.

    Table 1: Potential Signs & Traits of Bullies2,4

  • Have extra money, new toys and clothes

  • Use cruel, mean language when talking about other children

  • Exclude other children from activities

  • Enjoy dominating others

  • Only see a situation from their point of view

  • Use other people to get what they want

  • View weaker siblings or peers as prey

  • Use blame, criticism and false allegations to project their own inadequacies onto their target

  • Crave attention

  • Lack foresight into consequences

    Table 2: Signs of Being Bullied5

  • Poor sleep/exhaustion

  • Frequent somatic complaints - headaches, stomachaches

  • Bruises

  • Refusal to attend school

  • "Loses" clothing, lunch money

  • Withdrawn, spends a lot of time in room

  • Fewer phone calls, less going out

  • Changes route home

  • Rushes to bathroom when comes home

  • Urinary tract infection/constipation

  • Uncharacteristic aggression

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