Bullied children are picked on for their vulnerability

EDITOR--All school doctors and nurses in the South Downs Health Trust were asked to record, over two months in 1997, details of health contacts with children aged 8-14 in which bullying was assessed as an important factor affecting the health consultation. Staff (eight doctors, 14 nurses) logged 97 contacts. As in Salmon et al's study,[1] half the children were aged 11-12 and attending secondary schools. Nearly two thirds of the children in the trust's study were girls; a "drop in" service at a school nurse clinic was a common mode of contact, and evidently this service was used more readily by the girls.

The vulnerability of this bullied group was particularly striking. Fifteen had recognised learning difficulties, 30 had physical disability (including cleft palate, hemiplegia, a hearing aid, spinal deformity), and 31 were experiencing a family crisis or family distress or were actually neglected. For many, the bullying was of recent onset, but one in seven complained of long term bullying. The children were followed up after six months; other support services (including social services, counselling, special school) had been arranged for 25, but most were supported by school health staff. Indeed, one in seven had longstanding difficulties and already had a programme of continuing support from school health staff.

School health staff are more likely to see bullied children with pre-existing problems, as these children would already be familiar with their school nurses and doctors and therefore able to turn to them in their distress. But it is a sad comment on group behaviours that it is anxious, depressed pupils with poor self esteem, who already have much to cope with in terms of physical, personal, or social disadvantage, who become the victims of bullies. We all need to take responsibility and protect where we can.

[1] Salmon G, James A, Smith DM. Bullying in schools: self reported anxiety, depression, and self-esteem in secondary school children. BMJ 1998;317:924-5. (3 October.)

Sonya Leff Consultant community paediatrician

South Downs Health NHS Trust, Brighton BN2 3EW jkbaksi@zauber.u-net.com

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