Published: September 23, 2026
Bullying is one of parents’ top health concerns for their children, according to Norton Healthcare’s 2024 Community Health Needs Assessment. Pediatric bullying ranked fourth among responses from nearly 2,500 parents — ahead of childcare, poverty and chronic illness — yet fewer than half of bullied students will tell an adult at school.“Pediatric bullying itself is not a diagnosis, but a psychosocial exposure that drives conditions providers do diagnose and treat: depression, anxiety, somatic complaints, sleep disturbance, self-harm, disordered eating and school avoidance,” said Erin R. Frazier, M.D., pediatrician with Norton Children’s Medical Group, affiliated with the UofL School of Medicine. “Your task is to detect the exposure, treat the condition and coach the family.”On-demand Education — Updates in Pediatrics: Pediatric Bullying
The Centers for Disease Control and Prevention defines bullying as “unwanted aggressive behavior involving an observed or perceived power imbalance, repeated or likely to be repeated.” When federal surveys ask bullied students what made the other child powerful, the leading answer isn’t physical size, but the ability to influence what their peers think of them.Bullying is not mutual playful teasing, disliking someone, accidental harm, bossiness, classroom debate or a single exclusion. These behaviors only cross the line into bullying once it becomes deliberate, repeated and aggressive.Signs of a child being bullied: somatic complaints, social withdrawal, loss of interest in previously loved activities, declining grades, new outbursts or anger at home, sleep problems, and school avoidance.For example, consider a 13-year-old presenting for a well-child visit with a Patient Health Questionnaire (PHQ) depression score of 20 after a normal screen the year before, whose grades have slipped and who has quit the soccer team. With the parent out of the room, she describes a more talented teammate treating her aggressively, reporting a power imbalance and repeated behaviors.According to Dr. Frazier, cyberbullying deserves close attention, because it is both persistent and difficult to recognize. It can cause anxiety as children anticipate new negative comments. Among girls, cyberbullying disproportionately targets their appearance, and signs of cyberbullying may include abrupt appearance changes, self-harm and disordered eating.
Signs of a child who bullies others include: verbal or physical aggression, blaming others, unwillingness to address conflict, and coming home with items that aren’t theirs. Something usually drives it, such as social status, difficulty or bullying at home, neglect, peer pressure or low self-esteem.
Children who are at higher risk of being bullied include those with poor social skills, autism spectrum diagnoses, learning differences or attention-deficit hyperactivity disorder, LGBTQ+ youth, and being overweight or having obesity. Bullying and being bullied can increase the risk of substance use, depression and absenteeism.
Directly asking a patient, “Are you being bullied?” usually results in the child saying no. However, other questions can offer better insights. Dr. Frazier encourages providers to consider adding a prompt to their well-child visits when the parent is not in the room.Questions that can lead to information on pediatric bullying include:
When a child discloses, four validating responses usually result in positive outcomes: It’s not acceptable; it’s not your fault; you’re not alone; and people can help.An example response may be: “I’m really sorry to hear you’re being bullied. This is common — it happens to about 1 in 5 kids. That doesn’t make it OK, and there are people who can help you, both at home and at school. Schools have policies to address this. Let’s make sure your school counselor knows what’s going on so they can support you.”
Parental instincts in response to bullying often can backfire. Abrupt school changes, ignoring it, peer mediation, retaliation, suspension, confronting the other child’s parents, and confiscating the phone/device usually don’t solve the issue. With cyberbullying, implementing boundaries, such as blocking accounts, removing devices from the bedroom overnight, or only using devices in shared spaces may be helpful. “Fear of a parental overreaction is in itself a reason children stay silent, so we should coach parents to promise they won’t call the other family and won’t overreact,” Dr. Frazier said. “Before anything happens, point families to StopBullying.gov and tell them to watch for changes in friendships, grades or activities.”
When assessing concerns of pediatric bullying, providers should first triage the situation. In the most serious cases, concerns of imminent physical harm may warrant law enforcement contact, while suicidal or homicidal ideation warrants immediate mental health involvement.
For most patients, who are not in imminent danger, providers should coach the child to “take the power back.” A brief in-office role-play takes under a minute. Empower the patient to say “stop,” walk away with confidence, tell a trusted adult, defuse with humor, or build other friendships. If a child witnesses bullying, a friend willing to speak up as a defending bystander is one of the most powerful tools available.
In nearly every case, it is worth involving the school counselor, as schools have policies and are obligated to investigate reports. Students experiencing bullying-driven school refusal require a mental health professional and an explicit return-to-school plan built with the counselor. Schools often respond by moving the child to a different classroom and increasing observation. Some children may need medication for a period of time. Providers also should schedule a follow-up visit to reassess the patient’s mood and attendance and to check on resolution of the issue.