KidsMD Health Topics


  • From school shootings to highly publicized suicides among young people—like that of Massachusetts teen Phoebe Prince—bullying has been at the center of some of the most tragic (and transformative) news stories of the past decade. In 2001, the American Medical Association officially declared bullying a public health problem; and in Massachusetts, all school districts are now required to have a plan in place to address bullying incidents.

    The issue has become so heated that even the President and First Lady have taken a stand: In March 2011, the Obamas joined the U.S. Departments of Education and Health and Human Services in hosting an unprecedented conference on bullying prevention.

    Rather than the “no big deal” rite of passage it was once regarded as, educators, clinicians and parents have come to recognize bullying for what it really is—a serious societal issue that can have severe, long-lasting consequences for victims and perpetrators alike.

    Bullying is any kind of physical or verbal abuse that:

    • happens more than once
    • involves an imbalance of power (the victim is unable to, or afraid to, defend himself)
    • is done on purpose, with an intent to cause harm

    Types of bullying include:

    • physical attacks (for example, shoving into lockers, punching or kicking)
    • verbal attacks (calling names, making cruel remarks or “making fun” of someone)
    • social attacks (spreading rumors, sabotaging friendships or deliberately excluding others)
    • online attacks, or cyberbullying (texting, emailing or posting on a website anything that is cruel, untrue or otherwise harmful about a person)

    But there is good news, and cause for hope: The current focus on identifying, addressing and preventing bullying means that children who are being victimized—or are bullies themselves—have new options for getting help.

    How Boston Children’s Hospital Boston approaches bullying

    Boston Children’s Department of Psychiatry has long been at the forefront of providing expert, compassionate care to children and adolescents who are struggling with mental health issues, including depression and anxiety related to bullying.

    As one of the largest pediatric psychiatric services in New England, Boston Children’s has a team of expert psychiatrists, psychologists and social workers ready to help your child cope with bullying. We’ll work closely with her—and with you and your family—to:

    • devise a plan for stopping the abuse
    • help your child rebuild her self-esteem
    • teach her new, constructive thought patterns to help her succeed in the present and plan for the future

    And in addition to the mental health care we deliver in the hospital setting, our Children’s Hospital Neighborhood Partnerships provides a range of services to children at 15 Boston-area schools and five community health centers.

    Tackling bullying from another, equally important perspective, Boston Children’s has also launched BACPAC (Bullying And Cyberbullying Prevention & Advocacy Collaborative)—the first multidisciplinary anti-bullying collaborative based at a U.S. pediatric hospital. BACPAC:

    Bullying: Reviewed by Peter Raffalli, MD, and Shella Dennery, PhD, LICSW
    © Boston Children’s Hospital; posted in 2011

    BACPAC (Bullying and Cyberbullying Prevention & Advocacy Collaborative) 

    Boston Children's Hospital 
    300 Longwood Avenue
    Boston MA 02115


  • The statistics on bullying are sobering:

    • 70 percent of all high school students say they have been bullied. (source: American Psychological Association)

    • 90 percent of all fourth through eighth graders have been bullied. (National School Safety Center)

    • Approximately 160,000 U.S. students miss school each day because they are being bullied.(National Education Association)

    • 42 percent of children have been cyberbullied and 53 percent admit to cyberbullying someone else. (i-SAFE Inc.)

    • 9 in 10 lesbian, gay, bisexual or transgender (LGBT) students have experienced some form of bullying at school. (It Gets Better Campaign and Stop Bullying Now!)

    • Victims of bullying are up to 9 times more likely to contemplate suicide. (Yale University)

    Here are some of the specifics about what bullying entails, and what makes it very different from typical childhood “growing pains”:

    What is bullying, exactly? How is it different from the scuffles and disagreements all kids get into from time to time?
    Bullying can be physical or verbal, and it can take place in person, behind someone’s back or on a phone or computer.

    Unlike the occasional shoving match or argument, bullying is harmful behavior toward another individual that:

    • is not an isolated incident

    • involves a perpetrator (who has more power in the situation) and a victim (who has less). Bullying can also involve multiple perpetrators.

    • is done deliberately

    What is cyberbullying and why is it getting so much attention nowadays?
    We live in an era characterized by readily accessible digital technology, and children of all ages spend a lot of time using cell phones and computers. As a result, cyberbullying has become the most prevalent type of bullying behavior.

    Cyberbullying means that a child or teen is subjected to text messages, emails or online posts (on Facebook, Twitter, blogs or other websites) to and/or about them that are any of the following:

    • cruel
    • threatening
    • defamatory (saying things that aren’t true)
    • deliberately misleading (for example, claiming to be from someone other than the actual sender)

    Cyberbullying is widespread partly because it seems more “stealthy” from the bully’s vantage point. (It’s also much easier to taunt someone from the perceived distance of sitting behind a computer or phone, compared to face-to-face.) The good news is that cyberbullying virtually always leaves a digital fingerprint that is traceable by law enforcement back to the perpetrator.

    Can bullying be prevented?
    While there is no way to guarantee that your child will never be bullied (or be a bully), some measures have proven very effective in reducing bullying on a broader scale:

    • Parents should start talking to their children about bullying—including why it is wrong and hurtful, and what to do if they see someone else being bullied—at a very early age.

    • Parents should strive to create an atmosphere of tolerance, respect and compassion at home.

    • Schools should increase adult supervision (especially on the playground, on the bus and in the hallways between classes).

    • Schools should get parents involved in bullying prevention discussions and initiatives.

    • Schools, school districts and legislators should work together to create—and enforce—clear, strict anti-bullying policies. For example, Massachusetts now has a law that requires all school employees, from teachers to support staff, to report any incident of bullying to the school principal. Principals are also required to report any potentially criminal behavior to law enforcement officials.

    Bullying: Why do parents miss it?

    "What really worries me is that, most of the time when a kid tells me they are being bullied, their parents had no idea.” Read more from Claire McCarthy, MD, a primary care physician and Boston Children’s medical communications editor.

  • What can a pediatrician do to determine if a child is being bullied?

    Asking children specifically about problems with bullying during routine office visits—“Is anyone being mean to you?”—is the first and most important step. Pediatricians should also be on the lookout for signs of stress, such as:

    • a sudden decline in grades

    • school refusal

    • an abrupt change in sleep patterns

    • unexplained weight loss or weight gain

    • frequent visits to the school nurse’s office

  • How does Boston Children’s Hospital help children and families who are dealing with bullying?

    Boston Children’s uses a multidisciplinary approach to support children and families affected by bullying.

    A groundbreaking collaborative: BACPAC

    BACPAC (Bullying And Cyberbullying Prevention & Advocacy Collaborative) is a multidisciplinary anti-bullying collaborative based at Boston Children’s Hospital—the first hospital-based program of its kind anywhere in the U.S.


    • serves as a source of expert information on bullying for schools, families and other healthcare providers

    • operates a clinic that performs comprehensive evaluations of children with neurodevelopmental disorders (like ADHD, Tourette’s disorder, intellectual disabilities, Asperger’s syndrome and autism) who are affected by bullying, either as victims or perpetrators

    • provides customized guidance and recommendations to meet the needs of the individual child

    • works in partnership with each child’s family, school and primary care provider to resolve the issue

    If your child is seen by BACPAC:

    • The doctor will typically start out by asking:
      • “So, what grade are you in?”
      • “What school do you go to?”
      • “Do you like school?”
      • “Do you have friends?”
      • “Is making friends easy or hard?”
      •  “Is anyone being mean to you?”
      • “Are you having trouble with any bullies?
    • If your child is being bullied, the doctor will get as much detail as possible, including:
      • What does it entail?
      • Where is it happening?
      • How often is it occurring?
    • Next, the doctor will talk to you and your child about whether anyone at the school has been alerted to the problem, and if so, what their response has been.
    • If the bullying is still going on, the doctor will offer to write a letter to the school to let them know about the situation. Emphasis will be placed on spelling out the problem and offering specific recommendations for fixing it.
    • Once the school has been informed about the bullying, BACPAC will give your family (as well as your primary care practitioner) detailed recommendations for next steps.
    • If applicable, BACPAC can also refer your child to specialists who can help her manage:

    Treating disorders that increase the risk of being involved in bullying (either as a bully or a victim)

    Learn more about Boston Children’s approach to treating:

    Treating related depression and anxiety

    Knowing that your child is struggling with her thoughts and feelings is an upsetting experience for any parent—but you can rest assured that at Boston Children’s Hospital , your child and your family are in good hands.

    Our team of psychiatrists, psychologists and social workers can help you, your child and your family by:

    • tailoring therapy plans according to your child’s age, specific symptoms, family and school situation and overall medical history

    • using psychotherapy (which is also referred to as “talk therapy”), or a combination of medication and therapy, to help your child feel and function better


    Psychotherapy, or “talk therapy,” is designed to help your child identify, express and manage her feelings about being bullied. It will also teach her important new skills for overcoming those feelings, rebuilding her self-esteem and feeling optimistic and confident about the future.

    Your child may receive individual therapy, or may participate in group sessions with other kids working through similar issues. We also offer family counseling, which allows parents, siblings and other family members to take part in a child's therapy sessions and learn new strategies as a team.


    If your child’s depression, anxiety or stress do not adequately respond to psychotherapy, your clinician may recommend adding an anti-anxiety or antidepressant medication to his treatment plan. These medications can help your child feel more relaxed and comfortable while he is working on learning and practicing coping skills in therapy.

    Here at Boston Children’s, we never prescribe mental health medication as a standalone treatment. Instead, we always consider medication as part of a two-pronged approach, with psychotherapy as a necessary component. Our Psychopharmacology Clinic can help determine whether medication might be a useful addition to your child's talk therapy.

    Help at schools and in the community

    Children’s Hospital Neighborhood Partnerships (CHNP) is the community mental health program in the Department of Psychiatry at Boston Children’s Hospital.  Established in 2002, CHNP places Boston Children’s Hospital clinicians in 15 Boston-area schools and 5 community health centers to provide a comprehensive array of mental health services to children and adolescents where they live and learn.

    Consistent with Community Systems of Care principles, Boston Children’s Hospital embraces community settings for mental health service delivery. By offering high-quality services in environments that are convenient and familiar to children and their families, CHNP hopes to play an important role in improving the health and well-being of children in Boston’s most underserved communities. 

    Learn more.

    Preventing depression and suicide

    The Swensrud Prevention Initiative includes the prevention and promotion components of the CHNP School-Based Program.  The Initiative also fosters the development, implementation and evaluation of innovative prevention strategies having the potential for far-reaching public health impact, such as raising awareness of depression and suicide among teens through the Break Free From Depression program.

    This program is specially designed for use in schools. It applies an innovative and engaging format and proven cognitive behavioral techniques to teach young people how to effectively cope with difficult life circumstances, how to identify signs of depression in themselves and their peers and how to seek help.

    Parental bullying and overweight kids

    Overweight kids can fall victim to all kinds of bullying. From name calling to playground confrontations, studies show heftier kids are more likely to be the target of bullying than children with smaller body sizes. But what’s a kid to do when he or she is feeling bullied at home because of their weight? Read more.

  • At Boston Children’s Hospital, we’re dedicated to proving the effectiveness of our treatment approaches through rigorous scientific testing. Our research program is one of the largest and most active of any pediatric hospital in the world.

    Each day, we work to propel new advances in preventing, diagnosing and treating mental and behavioral health disorders. This research reinforces our ongoing commitment to enhancing mental health care for all children and adolescents.

    Here are some of our latest research projects with implications for bullying prevention and intervention:

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO