Frequent School Nurse Visits May be Telltale Sign of Bullying

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School bullying, or what experts call “peer aggression,” harms both victims and perpetrators, sometimes even ending with tragic results that make news nationally.

In recent years, anti-bullying efforts have sprung up around the United States as policymakers try to tamp down the problem. But because bullying often occurs below the radar of parents and teachers, better ways to identify bullying must be sought.

Now, research headed by Eric Vernberg, professor of clinical child psychology and director of the Child and Family Services Clinic at the University of Kansas, has shed light on a new method for detecting school peer aggression — repeated visits to the school nurse with somatic complaints, illness or injury.

His results recently were published in the journal Pediatrics.

“In this study, there is a connection between how often kids self-report being the target or victims of aggression and how often they visit the school nurse over the course of the year,” Vernberg said.

The KU researcher found that it is not only victims of bullying who make more visits to the nurse — it is aggressors as well. In the study, Vernberg and his coauthors compared school nurses’ logs with voluntary questionnaires completed by 590 children in grades 3 through 5. Students were asked to “nominate” classmates who displayed hostile behavior toward others. (The students all were participants in a larger study of school violence.)

“We also found this to be true in terms of how often a kid was nominated as being aggressive with their peers,” said Vernberg. “The more they were nominated, the more likely they were to have higher number of visits to the school nurse.”

What prompts such visits to the school nurse? For both the aggressors and their targets, Vernberg said that stressful interactions could bring on somatic symptoms, examples of which include tension headaches, muscle and joint pain and chronic fatigue. Repeated involvement in bullying as the aggressor or target also causes stress that may weaken a child’s immune system, leaving him or her vulnerable to illness. Injuries that may or may not be related to peer aggression were a third reason for visits to the school nurse.

Vernberg characterized bullying as “actions taken by one person with the intention of causing harm to another person.”

“We also look for an imbalance of power between the two people, so that the person who is the target of bullying isn’t able to effectively stand up for themselves or fight back,” he said. “The third thing we look for is an ongoing relationship between people, so it’s something that happens over time and is repeated.”

Such interactions drive negative feelings that often linger with the aggressor and target long after an antagonistic interaction.

“It’s upsetting for the person involved in that kind of encounter,” said Vernberg. “It’s probably going to have some residual feelings such as, ‘This was unpleasant. I got in trouble for this. I have a problem with this person that may come up again in the future.’ It involves negative emotions.”

The KU study concludes that school nurses and pediatric health care providers should prioritize prevention, early identification and treatment of aggressor-victim problems and mental and physical health problems that can happen as a result. Further, educators and parents might consider bullying to be a possible reason for a child making frequent school-nurse visits.

“How might schools know that bullying is occurring, that there are chronic problems with aggression or victimization?” said Vernberg. “One way might be that people tell you about it. Another might be that you observe some of the indicators that would raise your level of concern. Frequent visits to the school nurse for any of these reasons would seem to be one of those things that would raise your suspicion.”