There is little information on evidence-based bullying-prevention interventions in the clinical setting. One primary-care-based violence-prevention intervention in the Minneapolis-St. Paul area demonstrated reductions in parent-reported bullying and youth-reported victimization from bullying in the intervention group, compared with the control group (Borowsky et al. 2004). It consisted of mental health screening, referral, and follow-up, and referral to a telephone-based parenting program. The parenting program was adapted from a research-based, parent-training curriculum focused on authoritative parenting and promoting healthy parent–child relationships. The intervention showed larger effects for boys compared with girls.

The AAP Bright Futures guidelines recommend that pediatricians inquire about bullying, beginning with the 5-year-old well-child visit, and continuing through adolescence (Hagan et al. 2008). The recommendations include asking about bullying on the pre-visit questionnaire, discussing bullying if the provider suspects a child is involved in bullying, and providing guidance to children and parents about bullying. Prior studies show that anticipatory guidance about violence prevention is well-received by parents, who believe that pediatricians can help their child avoid violence and can provide education and counseling about community violence (Busey et al. 2006; Barkin et al. 1999). In 2005, the AAP published “Connected Kids: Safe, Strong, and Secure,” a primary-care-based youth violence-prevention program (Sege et al. 2005). This program recommends counseling about bullying at the 6- and 8-year-old visits, and provision of a brochure (“Bullying: It’s Not OK”) (American Academy of Pediatrics 2006). Program development included focus groups with parents, adolescents, and physicians to elicit opinions on violence prevention topics and to pilot program materials. Parent groups elicited opinions on car safety seats, corporal punishment, and firearm safety, and did not focus on bullying (Sege et al. 2006). Another study using parent focus groups to evaluate the implementation of Connected Kids in a community-based setting examined parental opinions on infancy and early childhood topics (Cowden et al. 2009).

Clinicians should ask about bullying at each well-child visit and more frequently for children at high risk for bullying. This could be facilitated by incorporating screening questions into electronic health records or printed pre-visit questionnaires. Bullying should also be in the differential for children who present with psychosomatic complaints, such as headaches, abdominal pain, or enuresis, behavioral problems, mental health problems, and smoking, drug, or alcohol use (Lyznicki et al. 2004). Clinicians can begin simply by asking the child about school and his/her experiences at school. If bullying is suspected, clinicians can probe further to determine the type and extent of bullying, and the child’s role in the situation.

Clinicians can educate parents on the negative consequences of bullying for all of the participants, including children who are victimized, children who bully, and those who witness bullying. Parents are often unaware that their children are involved in bullying (Shemesh et al. 2013). Clinicians can teach parents how to recognize signs of victimization such as physical bruises, torn clothes, cuts or scratches, refusal to go to school, worsening academic performance, and nonspecific or psychosomatic complaints such as headaches, abdominal pain, enuresis, sleep difficulties, sadness, or depression (Smokowski and Kopasz 2005; Williams et al. 1996; Schuster and Bogart 2013).

Victims of bullying should be evaluated for mental health disorders, such as depression, anxiety, separation disorder, and panic disorder (Lyznicki et al. 2004). Children who bully should be evaluated for conduct disorder and involvement in other high-risk behaviors such as fighting, weapon-carrying, smoking, and drug use (Lyznicki et al. 2004; Shetgiri et al. 2012a). Providers can refer children and parents for further mental health evaluation and intervention (Lyznicki et al. 2004; Shetgiri et al. 2012b). Clinicians can provide parents with information on effective interventions and coping strategies for bullying (Lyznicki et al. 2004). It may be helpful to maintain a list of local community-based programs and treatment resources, accessible to providers and patients thorough electronic health systems or on clinic websites.

When a child reports to an adult that he/she is being bullied, it is important for that adult to reassure the child that the bullying is not their fault and that they are correct in reporting it to an adult (Lyznicki et al. 2004). If bullying at school is reported to a parent, parents should then discuss the problem with the child’s school (Lyznicki et al. 2004). Parents can begin by speaking with the teacher, and if there are no results, the situation can be escalated to the principal or the school board (Shetgiri 2013). Many school districts have procedures for reporting and investigating incidents of bullying. Parents should be encouraged to become familiar with such procedures at their child’s school. Parents also can request a change of classroom or seating arrangement for the child, or increased supervision during or between classes. Clinicians can consider obtaining permission from the parents and contacting the school directly about the bullying. Privacy laws may restrict the information that the school can provide about students to those outside their families. As it may be difficult to obtain information on what actions are being taken with the child who is bullying, it is important for parents of children who are victimized to continue to ascertain from the victimized child whether his experience at school is improving.

Adults are the role models for children around them. It is important for adults to be aware of their own behaviors, language, and reactions to bullying (Blood et al. 2010). It is important that bullying not be viewed as condoned or acceptable by adults, as this may provide permission for children to bully others. For example, it is important that adults who work with CSHCN treat these children in a way that models respectful treatment by their peers (Blood et al. 2010), and are aware of the indirect messages they may be sending about the acceptability of bullying. Adults need to consistently intervene when children are being bullied. Parents, coaches, teachers, and child-serving organizations who care for overweight and obese children need to be aware of the language used with children, even when encouraging them to lose weight, so that children do not feel blamed or stigmatized for their weight (Schuster and Bogart 2013). Clinicians also should be aware of their language and behaviors when caring for children with stigmatizing characteristics such as obesity, autism, and sexual orientation (Schuster and Bogart 2013). Providers also can pay attention to aggressive behaviors in parents, and help parents modify these behaviors and interactions with their child that may be stigmatizing or bullying (Schuster and Bogart 2013).

The majority of adolescents access social media sites daily, with more than one out of five adolescents accessing these sites more than ten times a day (O’Keeffe et al. 2011). Cell phones are used by 75 % of adolescents, with more than half using them for texting, and almost ¼ using them for social media and instant messaging (O’Keeffe et al. 2011). Electronic media use is integral to the lives of many adolescents and is the means for communicating with and maintaining their social network. This increase in electronic media use has, however, also contributed to increasing rates of cyber bullying.

Cyber bullying is aggressive behavior using electronic media, with the intent to harm (Kiriakidis and Kavoura 2010). Commonly-used electronic media for cyber bullying include via text messaging or cell phones, Internet websites or chat rooms, email, and computer instant messaging (Kiriakidis et al. 2010). It is more difficult to verify cyber bullying and those who are perpetrating the bullying than in traditional forms of bullying (Kiriakidis et al. 2010; Hinduja and Patchin 2010; David-Ferdon and Hertz 2007). Unlike traditional bullying, which occurs outside the home, cyber bullying follows children into their homes through their computers and cell phones (Agatston et al. 2007). Damaging information posted by bullies on the Internet or communicated via cell phones can reach a wide audience and be disseminated quickly (Kiriakidis et al. 2010; Hinduja and Patchin 2010; David-Ferdon and Hertz 2007). Children who cyber bully do so using various methods. These methods include harassment via threatening messages, spreading rumors, and posting pictures about the victim (Kiriakidis et al. 2010). Sometimes bullies may pretend to be someone else, such as someone the victim knows or admires, to trick the victim to reveal personal information about themselves through email or instant messaging, and then send this information to others (Kiriakidis et al. 2010) or use it against the victim. Bullies also may pretend to be the victim while communicating online and send vicious emails to others or post messages on other children’s websites, giving the appearance that they have come from the victim (Kiriakidis et al. 2010). Females are more likely than males to identify cyber bullying as a problem (Agatston et al. 2007). Students are less likely to report victimization from cyber bullying to adults due to fear of losing access to electronic media use (Agatston et al. 2007) and lack of confidence that adults can effectively intervene in cyber bullying (Agatston et al. 2007). Student-used strategies to manage cyber bullying include blocking the sender or the message or ignoring it (Agatston et al. 2007). Requesting removal of websites and posts and helping others who are being cyber bullied were less commonly-used strategies to address online bullying (Agatston et al. 2007).