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The question: Our 10-year-old daughter is being bullied at school, and we don't know what to do. She doesn't want us to tell the school (she fears the bullying will get worse), and we're worried how this terrible experience is affecting her health. Is there anything our doctor can do to help us?

The answer: This is a question that a family in my clinic recently brought to my attention. They have kindly given me permission to share their question to help other families who may be struggling through similar situations. Violence is a public-health issue, and doctors can help families of both children who bully and who are bullied by providing another trusted adult for kids to talk to. With the heightened awareness in the media of the potential tragedies that occur due to bullying, this is an important moment for schools, parents and all others who care for children to discuss bullying with a view to prevention.

I last saw this family four months ago during a routine check-up of their 10-year-old daughter. She was cheerful and talkative, and she was getting good grades. There had never been any concerns with mood or behaviour; her home life was happy and she shared that she had good friends at school.

Her parents brought up their concerns because of changes in her behaviour since she started school in September. She became withdrawn, frequently complained of stomachaches and was more irritable at home. They were confused – why was this happening? – until she disclosed that she had been pushed in the playground. On further discussion, it was clear that she had been bullied from early September. There was name-calling, rumours being spread and then the recent playground incident. This was devastating to her parents, who felt that they had somehow failed to protect her.

With her parents' permission, I called their daughter after school that day. After she excitedly shared details of her Halloween costume, we talked about her relationships with friends at school. Initially she was hesitant, but then she disclosed that she was struggling with the kids being "mean." She felt sad and lonely at school. We talked about how it was wrong to be treated this way. I also reassured her that it was important that she had shared this with her parents. After some gentle discussion, she agreed to let her parents speak to the school about establishing an intervention plan. I then booked her an appointment with me so that I could find out more about her changes in mood and behaviour.

It is important to act early: Bullying consolidates over time, with repeat incidents increasing the likelihood that it will continue. Interventions need to happen at home and in school to increase awareness that bullying is wrong, decrease power differentials and teach the importance of building empathy for healthy, respectful relationships.

Our role as physicians who care for kids is to screen, advocate and intervene early if bullying is a concern. With every routine check-up, we should ask about their various relationships to see if any issues can be resolved before they escalate. According to the Canadian Family Physician, it is important to identify children who are at high risk of bullying. Children with physical or developmental disabilities, those who identify as gay or transgendered and those who are overweight are at higher risk than others. Children who witness or experience domestic violence are twice as likely to bully other children.

It is well recognized that children who bully and those who are bullied tend to have worse health outcomes in terms of physical functioning and psychological changes. They can struggle with asserting themselves. They may withdraw from social situations. As in the case of my patient, sometimes children display subtle symptoms: Unexplained headaches or tummy aches, sleep disturbance or nighttime bed-wetting can be clues to problems at school or home. For children closer to their teenage years, there can be an increased risk of substance abuse, such as alcohol or drugs, to cope with the bullying. There is generally fear or embarrassment when kids try to speak up about these issues, which can leave problems undetected for some time.

Remember, children who bully are also in need of support, and until we recognize their needs, bullying will continue. They bully due to complex social dynamics such as lack of confidence, poor development of positive relationship skills, or even other relationships where they themselves are being bullied.

The parents in my practice also wondered about counselling. This can be incredibly helpful, but it's important to not make a child feel like something is wrong with them and that is why they are being bullied. Counselling should focus on building skills to cope with the bullying, increasing self-confidence and reinforcing the importance of respectful relationships.

The potential impact of bullying is devastating and we all have a responsibility to our children to act. Bullying is complex and difficult to stop, but we can start by taking more notice of the subtle behaviour changes our children can display. We can speak out and intervene early. We can work together to protect children and emphasize positive, respectful relationships. An excellent resource for families regarding violence can be found at

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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