What You Need To Know About Bullying – PediaCast 463

Show Notes


  • Dr Nkeiruka Orajiaka visits the studio as we consider the problem of bullying. How does it look and who is at risk? What signs point to this behavior? What are the consequences? How can we prevent bullying… and intervene when it occurs? Join us for answers!


  • Bullying



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Racism Links


Announcer 1: This is PediaCast.


Announcer 1: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. 

It's Episode 463 for June 17th, 2020. We're calling this one "What You Need to Know About Bullying". I do want to welcome all of you to the program. 

As you know, a lot has happened since our last time together. The tragic death of George Floyd on Memorial Day has sparked national and worldwide awareness of the many inequities and injustices that stem from racism in our homes, in our families, in our communities, and in our institutions.


Awareness, of course, is great but awareness has got to be followed by understanding an action if we are truly going to make a difference today for the generations to come. And my strong hope is that the generations who are living today, all of us, that we will take actions that really do improve the lives of generations to come. I mean, this is a defining moment for America. And may we be remembered when those living in the future look back as the people who cared and spoke up and took powerful action together. In other words, let this be our turning point. 

Now, you may be asking what does that mean for me and my family here and now? What can we do? What tangible action can families take to make a difference? 

Well, the first thing we can do is inform ourselves of the scope of this problem. Racism is a public health crisis, and we're working behind the scenes here at PediaCast to bring you an accelerated show, next week in fact, on racism as a public health crisis. We're going to take a deep dive into exactly what that means. That's coming your way next week. 


In the meantime, there are lots of resources that you can tap into now, today, to increase awareness and understanding and then translate that awareness and that understanding in the conversations with your kids. And then together, as a family, we can take actions that contribute to change. 

Again, much more on this next week, but I did want to get you started and I'm going to have all of these resources for you in the show notes for this episode, 463, over at pediacast.org.

From our 700 Children's Blog, we have an article on how to talk to your kids about racism. Another one on Caring for Children after Exposure to Race-Related Violence in the Media. And then, from the American Academy of Pediatrics, we have an article on talking to children about racism, Talking to Children about Racism, The Time is Now, bias, how we can dismantle racism at every level, that's a message from the American Academy of Pediatrics' president. 


So lots of resources from 700 Children's, from the AAP. We also have an article from Harvard on how racism harms children, one from the New York Times on talking to kids about racism. Another from Insider, that's 16 Anti-Racism Books for Young Children. New York Magazine had an article 7 Anti-Racist Books Recommended by Educators and Activists.

I'm reading one of the books on this list right now called White Fragility, Why It Is So Hard for White People to Talk About Racism, which is a very good and eye-opening read. Another resource from the Washington Post, understanding racism and inequality in America. 

And these are all resources that I have vetted that I had found to be super helpful and I'll put again put links to all of these in the show notes for Episode 463. 


But I want to stress something really important. We cannot let reading an article or an essay or a book or visiting a website, this cannot be our only response. Reading helps with understanding, but we also have to dialogue and engage with our children and families and co-workers and neighbors, and most importantly, with those who are different with ourselves. 

And then, that dialogue and engagement has got to lead to actions that bring change. Otherwise, the future looks an awful lot like the past, which has been awful indeed as it relates to racism. Again, more on this next week. 

In the meantime, please check the show notes out, 463, Episode 463 over at pediacast.org for links to all of the resources that I shared just moments ago. 


All right, so what are we talking about this week? It's another important topic, bullying. What is it, where and how does it exist, what is the scope of this problem and how can you tell if your child is being bullied or bullying someone else? Or maybe being bullied by some friends while bullying others, which is a common scenario.

We'll also consider the sometimes lifelong consequences of bullying and share tips for preventing and intervening in bullying situations. Whether you're a parent, a teacher, a coach, school official, community leader, all of us play a role in reducing the incidence of bullying, which will in turn improve the overall health and wellness of children everywhere. 

And I have a terrific guest joining me today as we consider bullying. She is very passionate about this topic and a terrific guest. And I am so happy that she was able to join us. Dr. Nkeiruka Orajiaka, she's a pediatrician with the Emergency Services here at Nationwide Children's Hospital. Really excited to share her thoughts and get information in your hands about bullying. 


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And if you have a thought you'd like to share with the show, if there's a topic you'd like us to cover, you just have a general comment, it's easy to get in touch, just head over to pediacast.org and click on the Contact link. 


Also, I want to remind you the information presented in each and every one of our episodes is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org. 

So, let's take a quick break. We'll get Dr. Orajiaka connected to the studio and then we will be back to talk more about bullying. That's coming up right after this.



Dr. Mike Patrick: Dr. Orajiaka is a pediatrician with Emergency Services at Nationwide Children's Hospital and an assistant professor of Pediatrics at Ohio State University College of Medicine. She's here today to talk about bullying and the many forms it takes at school and online. She will also share prevention tips along with the dos and don'ts of intervening when bullying does occur. 

So let's give a warm PediaCast welcome to Dr. Orajiaka. Thank you so much for joining us today. 

Dr. Nkeiruka Orajiaka: Thank you, Dr, Mike. And I'm happy to be here to have the discussion with you. Thank you. 

Dr. Mike Patrick: Yeah, really appreciate you taking time and visiting us. Let's start with just a basic definition. What do we mean by the term bullying?

Dr. Nkeiruka Orajiaka: Okay, so when we talk about bullying, we're referring to unwanted and aggressive action, or series actions which are repeatedly directed towards a person or a group of people who have a real or perceived power balance against their target, with intent to cause harm. 


So I know it's a long definition, but essentially for the definition, we want to make sure things that are considered are it's an action that is intentional, unwanted, and aggressive. It is an action that is repeated or likely to be repeated, and there is always that imbalance of power when you compare the bully and the victim, and of course, cause harms to the victims. 

Dr. Mike Patrick: Yeah, and I think you raised a good point because we just throw around the term bullying and if we don't like a particular interaction with a person or we have a disagreement with them, it may end up being called bullying. But according to the Centers for Disease Control and Prevention and the US Department of Education, they kind of put their heads together to come up with a definition in 2014, and it has those three core elements that you mentioned, unwanted aggressive behavior, repetition of the behavior or it's highly likely to be repeated, and then observed or perceived power imbalance. 


And with power imbalance, when you think about power imbalance, you think well, is it like a teacher and a student or a boss and their subordinate? But even there can be power imbalances within social groups, right?

Dr. Nkeiruka Orajiaka: Exactly, definitely. 

Dr. Mike Patrick: So you have one person who's very popular with a lot of kids. And this other person sort of wants to be in that group, but they don't have any position of power within that social group. And then, bullying can arise out of that, right? 

Dr. Nkeiruka Orajiaka: Yes, yes. So when you talk about balance of power, it might be something physical in terms of being bigger, or in terms of strength. Or it may be numbers because you may just have one person as against three other people being the bullies. 

And then, like you mentioned, it might be social skills, social status, someone being able to manipulate another one, that's considered an imbalance of power, too. 

Dr. Mike Patrick: Yeah. And then some behaviors that are not considered bullying. So there are some misconceptions of when people just throw out that term. What are some examples of things that aren't really bullying? 


Dr. Nkeiruka Orajiaka: So let me just make a comment before we continue. So I would get to that in the end, but when it comes to bullying behaviors, it is recommended not to label people as victims, bullies, and bystanders. Instead to say, this is a person who's been bullied. This is a person who's bullying, and this is one standing around. 

But for the purpose of our discussion, just to make it a little bit easier for our listeners to differentiate who we're talking about, we may be using those terms called victim, bully, and bystander. But it's not recommended to label kids.

Dr. Mike Patrick: You raised a really good point there too, because in a lot of instances, someone can be bullied but bully others. 

Dr. Nkeiruka Orajiaka: Exactly.

Dr. Mike Patrick: And so, you don't necessarily want to put that label on someone as that's the defining portion of their personality because it's not always over. There's subtle bullying that can happen, too. And all of us have been bullies and all of us have been bullied to one degree or another. So yeah, the label thing is not very helpful. 


Dr. Nkeiruka Orajiaka: So back to the question about when they are not considered bullying. So when you have single episodes of rejection or maybe single episodes of an aggression between one child to the other, or maybe mutual disagreements between peers or friends, or conflicts between friends, in as much as these are still like unacceptable behaviors between kids, because they're single, they're not repetitive, they still technically do not meet the criteria to be called bullying. 

Dr. Mike Patrick: Okay, so just if you have a disagreement with someone, you have a one-time argument, not someone picks an argument with every single thing that you say, and that is now repetitive and there's probably some power imbalance there. 

Dr. Nkeiruka Orajiaka: Exactly.

Dr. Mike Patrick: But if it's just a disagreement, even an online argument, a one-time physical fight. I mean, these things would not really be considered bullying.

Dr. Nkeiruka Orajiaka: Exactly. No, they will not. 


Dr. Mike Patrick: Now, bullying comes in lots of different flavors. What are some of the different modes and types of bullying? 

Dr. Nkeiruka Orajiaka: So yes, interesting you call it flavors. So when we talk about modes, we're talking about how is this act communicated to the victim. So if you're talking about one, so in modes, you talk about direct and indirect bullying. For direct, we mean acts that are directly communicated to the person, things that are physical or verbal to the person. 

And when we talk about indirect, these are things that are not technically, directly communicated to the youth or to the kid. But then, few means the same things, things like social and relational bullying. 

And that kind of ties it down to the types because when we come to the types of bullying, then we talk about physical bullying, verbal bullying, social and relational, of course, cyberbullying, too. 


Dr. Mike Patrick: Lots of different ones. And so, the bullying can be directed immediately at that person or it can be indirect, just like even spreading rumors. 

Dr. Nkeiruka Orajiaka: Exactly, exactly. 

Dr. Mike Patrick: And then, we also want to differentiate when bullying crosses the line into criminal actions. So things like harassment, assault, hazing, those sorts of things. Then, we're going to step up our response and we're going talk more about what you do in a bullying situation. But you really do want to pay attention to, "Hey, is this criminal behavior?" Because then, you're going to want to definitely get, you know...

Dr. Nkeiruka Orajiaka: Law enforcements involved, yes.

Dr. Mike Patrick: Yeah, absolutely. And then, what constitute cyberbullying? So, we hear that term a lot. What is cyberbullying? 

Dr. Nkeiruka Orajiaka: So cyberbullying essentially means when you have the same aggressive acts, repeated acts happening online. So this is electronics, this has happened over phone, over the Internet, everything that has to do with bullying that happens online or in technology, that we call cyber-bullying.

Dr. Mike Patrick: Okay, so it involves a digital device, then that's what it is.

Dr. Nkeiruka Orajiaka: Yes.


Dr. Mike Patrick: Then what about the experience of boys versus girls in bullying. You talk about the different modes and the different types, are those more prevalent when we talk about boys versus girls? Or does everyone have the same experience?

Dr. Nkeiruka Orajiaka: So not really. I think one of the misconceptions we have or most people have is that boys are the only ones that are bullied. So that's not correct, because the only reason we think this is because boys are more involved with physical bullying. These are the ones that are noticed more because they get more involved with destroying property or maybe been physically fighting with all the people. 

But girls actually tend to be more involved with social, relational, and cyberbullying. So they do more of the social exclusion, removing someone from their friend group or spreading rumors, or are ganging on someone in cyberbullying. So that's the main difference why boys may be more involved with direct. I mean, they do a little more of indirect too, but mostly physical bullying. And girls do more of social and relational bullying, so that's the main difference between both groups.


Dr. Mike Patrick: Yeah, of course, anything can happen in any group. We're just talking trends in what maybe you're more likely to see and sort of the things to look out for. I also think that's important, because if we just think about boys being bullies and thinking about the physical aspect of it, and not necessarily the social aspect, if your radar is not up for girls participating in social bullying, you might not notice it and be able to intervene and help someone. 

Dr. Nkeiruka Orajiaka: Definitely true. Definitely true. I mean, again, I don't think boys are typically bullied by boys, and girls are typically bullied by both boys and girls. But anything can happen, too, but that's the more common trend that we see. 

Dr. Mike Patrick: Yeah, good to know. Now, how common is bullying? 

Dr. Nkeiruka Orajiaka: So this is pretty common thing that happens in school. And I think, over time, people have kind of grown with different when we were younger and just assumed that's possible growing up. 


So there was an interest in data that was done by the National Center for Education and Statistics, the NCES, and it showed that one in five children, which is about 20% of kids between the ages of 12 to 18 report being bullied in the school year. So that's huge, right?

Dr. Mike Patrick: Yeah, yeah. And so we're not talking like bullied once in your lifetime, like 20% of kids in any given year are bullied. 

Dr. Nkeiruka Orajiaka: Yes, yes. And this one is there when you talk about the areas, so I saw that in rural areas, it goes up to 27% so which is a little bit higher. But then, they just took an average because in rural areas, it's 27% and in urban areas, it's about 18%. So 20% is just like an average. 

Dr. Mike Patrick: And the numbers that you mentioned, they also asked kids in questionnaires, usually anonymous, so the answer didn't go back to that child. But they asked him, have you ever felt like you bullied someone? And 30 % of students admitted that they take in bullying of other kids. 

Dr. Nkeiruka Orajiaka: I know. 


Dr. Mike Patrick: And so, it's common, we're talking 20%, 30% in any given year of all kids. And so, if you're listening to this, and even more common if you take all of childhood. So maybe you were bullied in the second grade, but that still didn't count as when you look the overall experience that kids have. So a lot of parents who are listening to this right now, your kids, whether you know it or not, it's very likely that at some point, they have or will be either bullied or bullies. 

And so you really want to kind of pay attention to what's happening in relationships that your kids are having, right? Because if you're not looking for it, you will not be able to help out. 

Dr. Nkeiruka Orajiaka: You will not. You'll probably not even know it's happening until it becomes very destructive. But yes, we have to pay really good attention. 


Dr. Mike Patrick: Now, I also just want to, as before we move on, we don't want to paint a picture of someone who is a bully. There's a lot of complex issues that go along with someone who then bullies others, right? So we don't only want to help those who are being bullied, we want to help the bullier, too, correct? 

Dr. Nkeiruka Orajiaka: Oh yeah, so we want to help who's involved in the scenario, including the victims, the bystanders and the bullies because they've all been noted to have some form of mental health effects or mental negative effects from this. So yes, everyone needs some form of help when they're involved in bullying. 

Dr. Mike Patrick: And that goes again why we want to avoid labels and we really just want to help folks who are impacted by this. What age groups do we typically see bullying? This kind of surprised me a little bit as I researched it.

Dr. Nkeiruka Orajiaka: So I think one of the questions that how people ask is how early does bullying start? So when we have the younger ages around kids start between two to four, it's hard to know if this is bullying versus a kid just being generally territorial, defending their property and friendships. But that's when you can see subtle signs of bullying kids when you want to start talking about it. 


And then when they get older, when they get to around four to six, they start becoming more prominently aggressive that you want to actually nip it in the bud. But intensifies in primary school, but it's worst in middle school. Around the sixth grade, eighth grade, that's when bullying gets worse, up to 29% in the sixth grade.

Dr. Mike Patrick: Yeah, and that surprised me for some reasons. It's really a bell-shaped curve.

Dr. Nkeiruka Orajiaka: Yes.

Dr. Mike Patrick: Middle school is at the top of the curve and it ramps up as soon as kids have social relationships and are engaging and are interacting with one another, you can start to see it. And again, it peaks at middle school and then still present in high school, but not to the degree that it is at those earlier ages. 


Dr. Nkeiruka Orajiaka: Exactly. I was surprised myself, too. I just assumed it's high in high schools, but then it actually starts declining towards 11th to 12th grade. It's lower compared to middle schools, and I was like, "Wow, okay, that's good to know." 

Dr. Mike Patrick: Now, what are risk factors for being involved in bullying? So what groups are most at risk for this happening?

Dr. Nkeiruka Orajiaka: So I think first of all, it's important for us to know that there is no typical victim on this, no typical perpetrator. Or there's no typical bully. Like you mentioned, roles can change in different situations, but there'd been groups that have, unfortunately, been perceived as being more at-risk factors either because of appearance or looks, which is the one of the commonest reasons why kids get bullied. Or maybe if there's a difference in socioeconomic status with them and their peers. 

Another group is children with disabilities. They're actually twice more likely to be bullied than kids without. So we're talking about if it's physical disabilities or Down Syndrome or autism spectrum disorders or things like economic, emotional. Any kid that need extra or special needs are more likely to be victims of bullying. 

And another group is minorities, anything related to minorities as regarding like race, language, religious beliefs, that's also predisposing factor why people may perceive them as group of people that may be target. 


And another interesting one is the LGBTQ, which is a lesbian, gay, bisexual, and transgender queer group. Nine out of ten of them have actually been harassed with their sexual orientation. So that's a huge group, so that becomes a target or been victims. 

Dr. Mike Patrick: As I listen to you go through all of those high-risk groups, one common theme kind of jumps out of me, and that those who are different from the majority of their peers, and whether that difference is because of their race, because of their sexual orientation, because of chronic disease, it can be something as simple as being overweight or underweight, wearing glasses, wearing different clothing. Maybe your family are unable to afford cool things, being new to the school.


So as you think about, and we really want to teach our kids to embrace diversity and embrace kids being different. So this is really a place where parents intervene before bullying even happens to teach our kids that diversity is a good thing.  

Dr. Nkeiruka Orajiaka: Yes, it is. 

Dr. Mike Patrick: And so, but if your kids are different in some way from others at school, then maybe even more so have that on your radar, that this could be something that's going on with your kids, that's affecting them that you don't know about. 

Dr. Nkeiruka Orajiaka: Yes, yes. 

Dr. Mike Patrick: Now, this is a much more difficult question and I'm not sure that there is a right or wrong answer. Why, why does bullying happen? 


Dr. Nkeiruka Orajiaka: I like that mentioned a very old question. So I like to look at it as something very multifactorial. Like we mentioned, I mean, especially with conversations that's going around, as we go to racism being a learned behavior. Bullies actually are learned behavior. Babies are not born to hate, they are born to love. But then they kind of mimic or experience or manifest based on relationships and experiences they've been through. 

So let's say, for instance, a child may have been exposed to something in the family or through media or through other children, maybe behaviors that have been directly impacted on them, or someone in their loved ones. So they learn that. So it's either they're manifesting that on other people or they're generally more self-isolated, more self-conscious and have the lowest self-esteem and end up being victims.

And when a let's say, for instance, a bully notices, "Oh, this is a target that I think I may have a higher power over," and they commit the first act, and do maybe something that are aggressive to the victim. And the victim responds by crying, shying away, and running away. Then, because the victim always has satisfaction from bullying other people, they hinge on to that and then the bullying cycle continues. 


So it's a multifactorial thing, that ends up being the response they get. Also contributing factors from the bystanders, then it becomes a bullying cycle that becomes repeated because someone has responded negatively to an act. 

Dr. Mike Patrick: Excellent point. So we talked about risk factors for being bullied, but now you're mentioning risk factors for being the bully. So if you are well connected to your peers and you have social power, and you're getting positive reinforcement out of that bullying behavior, you're getting something out of it. Maybe you're being elevated in terms of your status. 

You already have some concern about your popularity. And so this helps boost your popularity. Or you may just like feeling dominant or in charge. And maybe at home, you have the opposite, where you really may be sort of the equivalent of being bullied or there may be physical or emotional abuse or neglect at home. And so, then when you're out with your peers, you may want to have control because you don't have it in your other social places where you are.


Dr. Nkeiruka Orajiaka: And that's where the bully victims come in place. So they've been bullied at home and they are victims at home. So they come in and becomes bully victims. So that's a dynamic that can also play a role in why that continues happening in schools. 

Dr. Mike Patrick: And then, as we mentioned earlier, the individual kid can be bullied and be the bully at the same time. And it helps explain why we see that. From a parent standpoint, it's kind of how you ask your kid, "Hey, are you being bullied?" They're probably not going to say yes. They'll kind of look at you like you're an alien. 

What are some signs that parents ought to keep in mind that would raise their level of suspicion that maybe their child is involved with bullying?


Dr. Nkeiruka Orajiaka: So I mean, good thing you said, I mean, you ask your kid are you being bullied, they don't tell. Twenty to 30% of kids that have been bullied actually say something. So the other 70%, you just have to figure out yourself, right?

And when it comes to bullying, especially when it's nonphysical, you may just see subtle sign of changes of behavior in your kids. So in the victim as regards physical, you may notice unexplained injuries, you may notice your child is frequently having unexplained sick symptoms, headaches, belly pains. But they mostly complain when it's time to go to school. So you may want to ask, "What's going on? Is there a reason why on Thursdays, maybe gym day, they don't want to go to school?

That's actually an example of a patient that I saw in the emergency room whom I had seen twice in a row every Thursday. Mom was like, "I'm not sure why he keeps complaining of things on Thursday." And speaking to this child alone, he mentioned oh, because at gym, there is this one kid that always bullies him on Thursdays. So he does not want to go to school on Thursdays. So these are subtle signs you want to always consider.  


Other things you may want to look at is if your child is coming home with destroyed property, the bags in school or school bags, books, electronics without any explanation. Maybe there's something going on. Or they're losing interest in school, losing interest in sports because there's something also called sports bullying. So all of a sudden, the sports they enjoy going to did not interest anymore. Or interest in friends, changes in behavior, being withdrawn, not wanting to eat their school lunch because they don't want to go to cafeteria.

So these are subtle signs you may see. It's only in severe cases when they end up with destructive signs like self-harm, running away, drugs and alcohol, and then talking or writing about suicide, then it may become more obvious, which is a little bit too late.


Dr. Mike Patrick: We definitely want to catch it sooner than those things are happening. And so, some of these is subtle and you have to not only think about changes in your child's behavior, but really didn't start digging and probing. And that may be a conversation that happens overtime, right?

If your child is involved in power imbalance at school and then there's bullying going on, of course, as we said, you can't just say "Are you being bullied?" But it also it may take you some time to figure that out, but you just have to be persistent and probe when you do notice changes in your child's behavior. And that maybe also getting the school involved and talking to teachers and coaches and school counselors because they maybe witnessing things and relationship stuff that you aren't privy to.

Dr. Nkeiruka Orajiaka: Yes, yes. And I wanted to talk about, we know we always talk about subtle signs we seen victims. But then you can notice some signs on the bully too, right? You notice they're becoming more aggressive or getting more involved in fights. Or maybe you notice they're getting sent to detention all the time. The school calls you, "Oh, your son or daughter got sent to detention again." Or maybe they're having extra money, extra property. 

You have to ask, "Where is this coming from? Are you obtaining this from someone else at school?" Those are things you may want to check out to make sure your child is not doing the bullying in school or anywhere else.


Dr. Mike Patrick: Yeah, absolutely. Now, the reason that we are talking about this is, one, it's not fun to be bullied. And it's not good to be the bully, obviously, in that moment. But there are other consequences of bullying just in general? What are some of the mental health consequences that can arise from bullying?

Dr. Nkeiruka Orajiaka: So this is actually one of the reasons why I got a little bit more interested in bullying. Especially working in the emergency room, we've seen medical and patient come in for mental health concerns. There are so many other risk factors and this is why they come in. But I noticed bullying seemed to be like a trigger. Either they came in because they didn't want to go to school or got sent for fighting in school, and that's what got me interested.


So bullying is actually a traumatic event and can be considered as what we call an adverse childhood experience cases. And studies have shown that being involved with bullying in any form, being a victim, being a bully, being a bystander can have different negative effects, which can be internalizing when we talk about depression, suicide or psychosomatic. Having like multiple medical complaints that no one can know why it's happening. Or just like academic too, right? Your school grades are dropping. You're not concentrating in school. 

So a whole lot of the mental health effects can happen on general. Actually there was a meta-analysis that was done, which is what we consider one of the highest forms of research, that showed that being involved in bullying may actually increase risk of suicidal ideation and suicidal behavior for all the groups involved.


Dr. Mike Patrick: So anxiety, depression then can escalate to self-harm and suicide. And these are all things that we worry about. Also physical complaints, just chronic headaches, parenting, fatigue. A lot of our mental health and our physical health can actually be intertwined together. And then, the extreme violence, school shootings, a lot of times we look at those, the kids that are involved in that and you find that there were instances of bullying. And these consequences can even extend into adulthood, right?

Dr. Nkeiruka Orajiaka: Yes. So that's pretty common especially with bullies and bully victims because they become a little more aggressive, they are more prone to violence, more drug abuse, more addictions. And because they just continuously become aggressive and violent, and no one actually helps them out, it continues into adulthood and they are unable to function fully to the maximum potential. So, yes, it is very possible.

Dr. Mike Patrick: We've kind of centered this on the mental health outcomes associated with bullying. But there's also as you talk about ACEs, adverse childhood experiences, we know that, and we've talked about this on PediaCast before, that when you have the ongoing over a long period of time, your stress levels, you actually have cortisols and steroids and there's chemicals in your body being released in response to stress that can contribute down the road especially if that's happening over and over a long period of time. 


At that point, we call that toxic stress. And that toxic stress is then related to obesity and diabetes and hypertension and heart disease. And so, now suddenly something that was happening from a behavior standpoint is impacting physical health that can impact your physical health into adulthood. And so, just more and more reason to identify cases of bullying and intervene when we can.

Dr. Nkeiruka Orajiaka: Yes, yes, definitely. Also, I know we mentioned this already about missing and skipping school and not wanting to go to school. There's an interest in data itself from CDC about 160,000 teens skip school daily as a result of bullying. So that's always something to consider. There's a reason why your child is refusing to go to school. You want to probe more if that becomes something very consistent. 


Dr. Mike Patrick: Yeah, and then not going to school. You may end up dropping out completely, your grades aren't as good, you may not be able to get grants or scholarships in order to attend college. And so, then the opportunities that you have as an adult are different than they would have been without those instances of bullying in your life. So again, just more reason to have awareness about this and help kids out, whether they're being bullied or being the bully or both, just because it can really impact their whole life.

Dr. Nkeiruka Orajiaka: Yes, yes, certainly.

Dr. Mike Patrick: I don't think I'm overstating that, right?

Dr. Nkeiruka Orajiaka: No, you're not. We need to say this over and over again. 


Dr. Mike Patrick: Absolutely. Then, the big question becomes if this is such a potential life-altering experience, especially when there's really a lot of it in a kid's life, what do parents do? If you suspect that your child is involved with bullying, whether it be on either side or both sides, what do you do?


Dr. Nkeiruka Orajiaka: So I think for bullying, the general note should always be prevention before it starts happening. So we want to prevent bullying from happening before it starts and once it starts immediately, we want to stop it before it gets worst. And mentioning suspicion, because we did list most of the signs as subtle, you may not be able to tell if your child has it or not. If you're not having routine conversations with your child, you ask him how are things going in school today? How are your friends doing? Do you have any friends? Does anything differently happen in sports? Does anyone get picked on or bullying? 

I feel like some children, when you ask them directly, "Are you being bullied?" they will not tell you the truth. So you want to stop from asking how everything else is happening. And doing that in a routine basis might help you know when things are changing. One, also leaves a channel of communication between you and your child, so you know when things changes. 


So just having like a really index of suspicion. So when it comes to what parents can do, the aim is one, educate yourself first, right? You want to know what bullying is, you want to know how to solve problems of bullying, you want to know what x lengths you can go. And you want to also empower your child, just to kind of help them know when to advocate for themselves. Because you may not be there all the time, so you want to empower them to make sure "Hey, learn to stand tall and stay calm, learn to know when to walk away, and when to tell an adult." 

Because sometimes, student always feel, "That's okay, I can sort it out. I don't have to tell anyone." But let them know when to ask for help, because they have to ask for help, especially when it's happening immediately.


Dr. Mike Patrick: Absolutely. And the help also can come from all sorts of places, right? And can be from their friends, help can be from school, from teachers, from coaches, counselors, other families. Maybe, of course, not now in the days of COVID but at some point, kids will be playing at each other's houses again and talking to the other parent. You do want to sort of give them permission to have that voice to reach out and ask for help.

Dr. Nkeiruka Orajiaka: Yes. And then, when it comes to bullies, I think because we mentioned that the mental help effects and also medical health effects of both the victim and the bully, it's good to understand that your child being superior or bullying other people is not a good thing. Don't see it as "Oh, my child is fine, he's a superior person in school." That's not okay. 

You have to know when to have a firm and consistent conversation about your child, how to treat other people, about disciplining for said behaviors, not necessarily making it very punitive but make sure you're consistent with what you want to do. You're talking about, "Hey, you're not getting recess today," or maybe, "Hey, you're not getting the devices. You have to treat people more nicely and more respectfully." 


You want to also have that conversation with your bully, and also ask is there a reason why this is happening? Maybe your child is also a bully who's crying for help. Maybe they're bullying other people because they're going through so many emotional or other experiences that they're overwhelmed with. So this may just be a cry for help from your child, too, and they're bullying other people just to kind of channel that anger toward something else. 

Dr. Mike Patrick: It's so easy for some families to then look at the fact that your child is bullying others, to look at that as a sort of badge of honor, that they're not bullying. You make excuses for it, like they're being assertive, they're taking care of their own needs and looking out for themselves. But in doing that, even though that may give you a sense of pride, that may really be harmful for your child down the road.


Dr. Nkeiruka Orajiaka: Yes, definitely. Just about the victim before I forget, I wanted to mention one thing else, I know a few of us had gone through the bullying cycle, maybe harmful, maybe not. But there's some things you don't want to tell your child. Don't say, "Just toughen up. I went through it, you can figure it out."

Don't shut them down because they will never come back to you again to give you another chance to help them figure it out. Just don't say, "Oh, go do whatever you want to do in school." No, we have to be very supportive of them. Otherwise, it may just be an opportunity lost to solve a really big problem. 

Dr. Mike Patrick: And I think you bring up an excellent point, just regarding communication. And the kind of communication that allows you to figure out that your child is involved in bullying really has to start early. And so, making conversations between yourself and your child as safe zone, you can talk to me about anything. I think starting at an early age is so important because otherwise, kids don't feel comfortable talking to mom and dad about this. 

Dr. Nkeiruka Orajiaka: Yes, yes. 


Dr. Mike Patrick: Yeah, really important. What about from the standpoint of kids and teenagers? Either they're being bullied, or they witnessed bullying. Because you may think, okay, my kids are not being bullied, they're not bullying others, but they're probably witnessing it. So what should parents talk to their kids about in terms of what do they do as kids when they see bullying happening or they're involved in it themselves?

Dr. Nkeiruka Orajiaka: So, I think before we talk about that, I wanted to talk about something called the circle of bullying. Have you heard about that before? 

Dr. Mike Patrick: No, no. 

Dr. Nkeiruka Orajiaka: Okay, so it's an interesting concept that researchers, especially there's a professor who's done a lot of research when it comes to bullying, called Professor Olweus. I hope I'm saying his name right, but he's done a lot of work when it comes to work and bullying.

So the concept of circle of bullying, it just talks about all the people involved in bullying. So there's always a victim who seems to be in the middle. And I know, we're not labeling but I'm going to label all of them just to make it kind of easier for us to understand. 


And there is a bully who is a person that perpetuates or initiates the action. But then, you also have a whole lot of other children, a whole lot of other people who are involved in this cycle. 

So we have the followers who are called the henchmen. So this one's never start the bullying act, but once they start, they join in. So if it's physical, they are throwing punches. If it's verbal, they're throwing taunting names and cursing out, too.

And then, we have the supporters who are people, they don't join in but they're actively cheering off and laughing and encouraging the whole act. So they are part of the circle. 

And then, we also have the passive supporters. So this one's not actively making, they're not actively cheering, but they like the bullying act because it might just be like one of the fun shows in school. So they may be smiling under their breath, they just don't give open support. 


And then, we have another group who are called disengaged onlookers. So they're in some area when bullying is happening, but I don't think it's their business, so they don't get involved. They may be on one side, not participating, not seeing anything. 

And then, we have who we call the possible defenders. So they don't like what's happening to the victim and they think they're supposed to intervene. But for some reason, maybe they don't think they're strong enough, but maybe they don't think they have a say. They actually don't intervene. 

And then, we have who we call the defenders or the upstanders. So these are the people, they don't like the bullying act and they are the ones that intervene and say, "Hey, guys, stop." Or maybe they go call a teacher, call the coach, call a teaching aide to actually intervene. 

So when we look at the whole cycle, if there's ever a bullying act, we want every other child who's in the same location to be a defender, to be an upstander, to stand up and say stop. Because one of the studies actually done in 2001 had shown that 57% of the bullying act stops if a peer intervenes within ten seconds of the act. So we want everyone to be a defender or upstander. 


Dr. Mike Patrick: I think folks should rewind this podcast.


Dr. Mike Patrick: And just listen to that again. Because there is a lesson on how social groups engage and interact with one another that it extends even beyond bullying. As we think about racism today, you could use those same labels for the interactions that happen in big groups. Does that make sense?

Dr. Nkeiruka Orajiaka: Yes, it does, definitely, yes. Because you can just be standing and doing nothing, you're involved actively or passively one way or the other. So the whole idea is stand up and say something, get help, just don't stand there and say I like it or not. Intervene immediately.

Dr. Mike Patrick: Yeah, and I think that's something that we all are learning as we go along in life, that silence is being a part of the problem, that we really do need to speak up in order to make a difference. And we frame bullying to our kids that this is something, and you have to do this in a way that is developmentally appropriate for your child, a way that they're going to understand.


Dr. Nkeiruka Orajiaka: Understand, true. 

Dr. Mike Patrick: But to try to get the point across that this is something that when you see this at school and you don't be a part of the solution, then the kids who are bullying and the ones who are being bullied, that's going to affect them their whole life. 

Dr. Nkeiruka Orajiaka: Exactly. 

Dr. Mike Patrick: I don't know how you get that across to kids without scaring them. But letting them know this is an important thing and you don't want to put yourself in danger, but there's safety in numbers. And if you and some of your friends are feeling like a bullying situation is wrong, maybe you as a group saying something about it to the teachers or sticking up for a kid in the moment. But you want to be safe too, because you don't necessarily as the only person who's standing up don't want to get punched yourself, right?


Dr. Nkeiruka Orajiaka: Exactly, yeah, definitely. And then, mentioning how to describe it to children to understand. So the circle of bullying has so many pictures on the Internet that they have one that's kid friendly that shows a different picture. It may be a good way to just kind of show them the picture. Some kids have sad faces, some have happy faces from laughing. 

And just kind of show them and see how they react. I mean, it depends on how old the child is, but just to kind of see the reaction in the kids' faces and say "Hey, this is where you want to be." Just to kind of give them a visual too of what should be happening. 

Dr. Mike Patrick: Yeah, absolutely. So there's so many ways that kids can help each other through this and certainly defending and being the act of bystander. But even when bullying is not actively happening, there's ways that you can be a friend to another kid who you see who's being bullied, right?

Dr. Nkeiruka Orajiaka: Yes, yes. So in addition to telling an adult, you also want to like social exclusion, spreading a rumor, you want to refuse to spread a rumor. When they sent you that message to forward to everyone else, say no. And actually go report it to authorities and say, "Hey, this has been circulated by someone, but I want to make it stop."


So don't actively forward the message and expect that's it'd die down because you already did it. No, you're not tattletaling, because some kids always think, "Oh, I'm going to be the tattletale." No, you're helping another person out. So get them involved, don't socially exclude, be nice to people, ask them what's going on. So just kind of generally respecting and being nice to other kids, too. 

Dr. Mike Patrick: Absolutely. And really checking yourself, like think about are there any situations that I'm in where I might be bullying someone else but not even have been aware that that's what it was. So as we educate our kids on what bullying looks like, then they may discover bullying within themselves that they didn't even know was there. 

Dr. Nkeiruka Orajiaka: Exactly. Exactly. Definitely.


Dr. Mike Patrick: And then I think it is important to point out that, again, you want to let someone know but if a crime has been perpetuated, then you would want to contact law enforcement. If there's an immediate risk of harm, call 911 if you have to. And then, if you or a friend is thinking about suicide, make sure that you let someone know, so important. 

And of course, the National Suicide Prevention Lifeline is an important resource and I'm going to put a link to that in the show notes along with their phone number for this episode, 463, over at pediacast.org. That's something that you would want to take very seriously. 

Dr. Nkeiruka Orajiaka: Safety is very important, for the victim, for the bystanders, for the bully. It's definitely very important for all of them.

Dr. Mike Patrick: When will the teachers and coaches in schools play in all of these? 

Dr. Nkeiruka Orajiaka: So I think they play a huge role because this is where most of the children spend most of their days of the school and even summer. I mean, except this is COVID-19 year, so everything is completely different this year. But then, this is where most of the kids spend their time. 


And I know I may be sounding like a broken record saying this all over again, prevention is always better than cure. You want to prevent this before happening. And I wanted to talk about the sports and the coaches first before I go to the teachers and the school, if that's okay. 

Dr. Mike Patrick: Yeah, yeah, absolutely. 

Dr. Nkeiruka Orajiaka: Because I think sports bullying is, I mean, all bullying is important, but sports is one that I find some are devastated. Especially with parents and kids who decide to enroll their kids in after-school activities only for them to realize, hey, their child is not doing so well, or maybe he's getting bullied and being picked on. 

And this can be happen by the teammates or even the coaches because teammate bully might be one you can easily see. And then coaches might just be misunderstood as maybe a coach is trying to push my child to understand. Or maybe trying to put my child to go further. 


If a coach is humiliating your son or daughter in front of others and shouting or maybe swearing and yelling consistently or making jokes at your child's expense, especially like a child just recently getting into the sports and learning, that will be considered bullying. So don't think he's giving your child a push. It may be considered bullying. 

If your child is being unnecessarily excluded from playing a game only because the coach thinks he's not competitive enough or they can't win a game if he's playing, you may want to ask again, because yes, a child is there to learn how to play and is there to be in a team. So you want to make sure, they're having that discussion to say, "Hey, is there a reason why my child can't play?"

So these are subtle things I wanted to mention when it comes to sports bullying. And when it comes to the role that coaches can play, I think it's important for every youth sports group or children's sports group in the niche of setting of what a team is for, and then discuss what acceptable and unacceptable behaviors are. Make it clear, "Even if you can play better than the others, we're all here to be a team and be respectful of each other." 


This is acceptable, this is not. Decide what the discipline will be for unacceptable behavior. So you make it straight across boards. So you don't have a bias on telling this person, "You don't play now versus that happens." 

And you also want to make sure, you have room for confidential reporting, so don't feel like, "Oh, if I tell the coach, then I'm out of the team. Or maybe tell the coach, other people will feel like I'm bad." So it's just like they play a huge role. And they are models, too. You can't tell a child you can bully others and then you're actively bullying  a child because children learn from every adult and everyone around them. So you have to be consistent and be careful what you model to them. 

Dr. Mike Patrick: Absolutely. And then, teachers play an important role on all of this, too. 

Dr. Nkeiruka Orajiaka: Yes, so the same thing about being consistent with teaching about prevention, teaching them what bullying is, handling scenes of bullying, reporting, and how to handle cases of bullying that's happened. It's actually recommended that teachers actually, and maybe readable cards, like older kids do presentation on what bullying is, have role plays in terms of teaching. 


And when a child reports an act of bullying, make sure you're consistently handling it in the way everything else is being handled, not necessarily saying, "Hey, I don't believe this child or believe this or the child." You have to do a real investigation. And of course, if you're not sure, you can always consult the school or the appropriate authorities. 

And I think one thing I wanted to also mention is you don't want to bring the victim and the bully together in the form of mediation because it's not recommended. Because it's through that imbalance of power, the victim may still be feeling humiliated or self-conscious, they may not necessarily want to tell you what's going on. So you don't want to bring them together in the same place. 

Dr. Mike Patrick: And this is really an example where it's best when schools and families work together to identify this and to come up with solutions. 

Dr. Nkeiruka Orajiaka: Yes, yes, definitely important.


Dr. Mike Patrick: So we have a lot of pediatric medical providers, pediatricians, family practice doctors, nurse practitioners who listen to this podcast. We will do replay in all of this as pediatric providers. One, of course, is awareness and getting folks talking about it. But in the exam room, what's our role as pediatric health care providers in stopping bullying? 

Dr. Nkeiruka Orajiaka: So I think we need to play a more active role in terms of, because I feel... In residency, I can't remember asking a child about bullying. not as much as we're supposed to be asking. So I think pediatricians or pediatric providers, NPs, nurses, we have to play roles of identification in terms of asking these questions in well visits, sick visits, especially for a child who's coming back to you with repeated symptoms that you can't seem to understand on the same day.

We have to play a role in counseling. You wanted to ask them, "How you are doing with emotional stress? This is what you can do to stop bullying."  Knowing fully well when to refer them to a specialist, if you think they're having more mental health concerns. 


We have to empower the parents, right, because we have to be the ones to teach these parents, "Hey, this is how you can view the relationship with your child. These are the signs you can look for. This is how you can notify the schools or the gyms." Because, yes, schools have policies but not every parent knows what the policies are. So you have to empower these parents to know how to do it. 

And in such a scenario, like I have had parents tell me, "I've tried the school, they're not responding," pediatricians or pediatric providers have to know when to advocate for the parents all the way into the school and community. Because as pediatric providers, we have to know what the policies are in our district, in our school environment, just to know how to help them because they see us has a really big role.

So we have to know when to actually send emails to the school, so that they can say, "Hey, I'm having this problem, we need to know when to solve it." So we have an active role that we need to play in all of this setting. 


Dr. Mike Patrick: Yeah, absolutely. And the degree in which we get involved is really going to be different from family to family. And if you really feel that this is an issue for the kid that you're taking care of, it may mean sort of being a proxy for the parent and getting the school involved. 

Dr. Nkeiruka Orajiaka: Yes. And AAP actually has a good resource for violence. It's called Connected Kids, Safe, Strong and Secure, which is like a comprehensive approach how kids can integrate violence efforts through anticipatory guidance in helping parents and families. So I think it's one that every provider has to look at. It doesn't talk about only bullying, but then it has dating violence, or alcohol, but it's a really good resource that every pediatric provider has to get their hands on. 

Dr. Mike Patrick: And we'll put a link to that in the show notes for this episode, 463, over at pediacast.org so folks can find that easily. We're going to have actually a lot of resources in the show notes this week. Stopbullying.gov just has tons of information really for everyone, for kids, for parents, for educators, for health providers, what kids can do if they're bullied, standing up for kids, what teens can do.


There are educational videos, there are social media resources. So I would definitely recommend that folks check out stopbullying.gov. That's a great site, right? 

Dr. Nkeiruka Orajiaka: Yes, it is. I love it. If you're confused, just go there and type in parents and it will bring  you like a whole lot of things. I definitely agree with that. It has a lot of resources. 

Dr. Mike Patrick: And then, here at Nationwide Children's Hospital, we have a program that is kind of paused right now because of the pandemic. But it's called It's Not Cool to Be Cruel. Tell us about that. 

Dr. Nkeiruka Orajiaka: So it's actually a resource, I think one that's very important too, especially in Columbus and other places, which kind of tells, it's trying to show kids how to be compassionate and caring, and just trying to identify. Because when we talk about what are the negative behaviors, what are things that children shouldn't do, we also has to teach the kids what they should do, right? Positive behaviors that they have to emulate.

And I think it targets the age between the fifth and the seventh or eighth grade or towards the area where you can learn what you're supposed to do, what you're not supposed to do, what act, how to be respectful, just kind of showing things how to be a little more caring and cooperative, and nicer to each other. 

Dr. Mike Patrick: And we'll put a link to the It's Not Cool to be Cruel program, which eventually I'm sure will be back and running once we get through this COVID pandemic. 

And then, Cap4Kids has some great bullying resources. We'll put a link to that in the show notes as well. 

And then, the Substance Abuse and Mental Health Services Administration, they have a mobile called KnowBullying, and I'll put a link to this as well. But that's for parents, caregivers, educators, that includes conversation starters, prevention strategies, helps you recognize bullying, and then it has some tips on intervening when bullying occurs. So that's a great app just to have on your phone and ready to go when the need arises. 


Dr. Nkeiruka Orajiaka: Yes, definitely. 

Dr. Mike Patrick: And I'll put links to all of these resources again in the show notes for Episode 463 over at pediacast.org. 

Dr. Nkeiruka Orajiaka: And I think one more group, this is a larger group, like the community involvement. I feel the community involvement is very important too to make it feel like, oh, adults are actually are actually concerned about what's happening to us, because even outside of schools and outside of sports, kids go to places at YMCA. They go the library, faith organization. These are the whole group that needs to be involved when we're talking about managing bullying, preventing bullying, district organizations. 

The media, too, because if it's not in the media, people won't know it's a problem. So it's a whole umbrella of groups that has to come into partnership, especially it has to be like different districts and decide "Hey, we have a problem here that we have to solve." And they can come together and find out how to advocate, how to talk about the policies that will help the schools. So that's like a really big umbrella I also wanted to mention about. 


Dr. Mike Patrick: Yeah, really important. And that's a place where as a parent, even if your kids are involved in bullying but you're just interested in public health, you may be the agent of change within your community in terms of raising awareness about this and getting help for kids who need it. 

Dr. Nkeiruka Orajiaka: Certainly.

Dr. Mike Patrick: All right. Well, we appreciate you stopping by so much and again, lots of information that we've shared. And there's going to be even more resources available in the show notes over at pediacast.org in Episode 463. 

Dr. Nkeiruka Orajiaka, pediatrician with Emergency Services at Nationwide Children's Hospital, thanks once again for stopping by today. 


Dr. Nkeiruka Orajiaka: Thank you. I'm so happy I came in here to talk to you. Thank you for  inviting me. 


Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. 

Also, thanks to our guest this week, Dr. Nkeiruka Orajiaka, pediatrician with Emergency Services at Nationwide Children's Hospital. Really appreciate her stopping by and sharing her expertise. 

I mentioned all of those links for you in the show notes. Also, we're going to include a link to the circle of bullying site that Dr. Orajiaka was talking about because it really is a nice visual look at bullying. Again, that's what I said, please pause the podcast, rewind and listen to it again. If you want a visual of that information, we'll include a link to that in the show notes as well. 


And then, don't forget about all of those links I mentioned in the introduction to today's program, How to Talk to Your Kids About Racism, Caring for Children after Exposure to Race-Related Violence in the Media, Talking to Children About Racial Bias, Talking to Kids about Racism: The Time is Now, Dismantle Racism at Every Level, How Racism Harms Children, Talking to Kids About Racism from The New York Times, 16 Anti-Racism Books for Young Children, 7 Anti-Racist Books Recommended by Educators and Activists, and Understanding Racism and Inequality in America.

So just lots of vetted, good resources for you to get information. And then, that will give you some context and some background as we gather together again next week and talk about racism as a public health crisis. That's coming your way here very soon. 


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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.


Announcer 1: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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