Online Health Chat with Emma Raizman, MD

October 24, 2013


Did you know that one in six students in grades 3 and up is bullied on a regular basis? Nearly 30 percent of students are victims of bullying, are bullies themselves or both. Bullying can take several forms, including physical abuse, emotional bullying, cyberbullying and sexting. Bullying can occur at school, during transit with others, at activities or online via the computer. Real or perceived differences in appearance, disability, socioeconomic status and personality are often targeted by bullies

Even though many adults still see bullying as ‘just part of being a kid,’ the reality is that no child deserves to be subjected to bullying. Most states have enacted laws regarding the enactment of bullying prevention programs to boards of education statewide. In schools where there is prevalent bullying, standardized testing grades were lower. In schools where there are antibullying programs, bullying is reduced by 50 percent.

Furthermore, bullying can have a significant effect on a child’s psychological development and in some cases lead to suicidal thoughts and tendencies. In fact, studies show that bully victims are two to nine times more likely to consider suicide than their peers. Suicide is the third leading cause of death in young people. Additionally, bullying was a factor in two thirds of the 37 school shootings reviewed by the U.S. Secret Service.

Fortunately, identification and intervention of bullying is possible with effective programs to deter bullying and increase awareness. Proactive teachers and parents and empathetic students, along with proper pediatric care, can prevent bullying with effective strategies to ensure every child feels secure and valued in society.

About the Speaker

Emma Raizman, MD is a pediatrician in the Department of Community Pediatrics at Cleveland Clinic Children’s Hospital, and is board-certified in pediatrics.

Dr. Raizman completed her fellowship in child abuse at Rady Children’s Hospital, in San Diego. She also completed a fellowship in forensic pediatrics and child abuse and her pediatrics residency at Children’s Hospital Medical Center of Akron. Dr. Raizman graduated from medical school at the University of Pittsburgh School of Medicine. She currently sees patients at Cleveland Clinic Brunswick Family Health Center.

Let’s Chat About Bullying: Being the Bigger Person

Signs of the Bully-Victim Relationship

Miles: How can we recognize if our child is bullied or, worse, being the bully?

Emma_Raizman,_MD: Sometimes it can be difficult to tell the difference. In general children who are being bullied may seem distant or scared, may be avoiding school, may even avoid their friends or doing social activities. They may have physical complaints, like headaches and stomach aches, and visit the nurse’s office frequently. They may come home without some of their belongings or very hungry because they had their lunch or lunch money taken. They may have anxiety or signs of depression. Many kids that are bullied have low self-esteem.

Kids that have become bullies may also have self-esteem issues, but are taking that out on kids that they feel are weaker than them. Some bullies have no self-esteem issues, but have a disregard for rules and trouble feeling sympathy and empathy for others. You may see impulsivity, and lack of regard for authority figures and rules. They may do poorly in school. They have a history of damaging property and may eventually get in trouble with the law.

The best way to find out if your child is being bullied or could actually be a bully, is to talk to them. Keep the lines of communication open. If you see any of these warning signs don't ignore them—talk to your children and find out what's going on.

Seymor: At what age does bullying start? Can it begin prior to beginning school?

Emma_Raizman,_MD: This is an interesting question. Bullying can start at any age. Usually it begins when a child is old enough to have intent with their actions, which would typically be around school age. So while toddlers may be physically aggressive with each other, it's not until the actions are malicious in nature and involve an imbalance of power, that we would call it bullying. This can be dependent on the maturity level of the particular child, but does not typically happen before school age.

Repeat Cycles of Bullying and Friendship

mtg: My daughter is nine years old. For the past two years my daughter has had issues with another child bullying her. The school has addressed it appropriately. The problem is that my daughter is very trusting and sensitive. There continues to be a cycle where this girl makes up to my daughter and seeks my daughter out to play at recess. My daughter trusts her, but then the girl ends up manipulating and bullying my daughter. She has been downright cruel, but when the school steps in she apologizes and tries to be friends again. I continue to tell my daughter that she can be polite to this girl, but should stay away from her. My daughter continues to get convinced that this time they will really be friends. I have tried explaining what true friendships are and so on, but it doesn't work. I don't want my daughter to think this is how healthy friendships work. What can I do? School has agreed to separate them next year.

Emma_Raizman,_MD: It sounds like both you and the school have been doing all of the right things. The advice that you've been giving your daughter is excellent. This is a hard lesson for any child to learn and, unfortunately, it is likely one that she is going to have to learn on her own. You can continue to help her by giving her examples of friendships that you feel are healthy. Hopefully, you can give her some examples that are in her own life. You can also be there for her to support her with empathy and not say, ‘I told you so,’ when she is inevitably hurt emotionally by this girl yet again. You can encourage her friendships with good influences and providing reinforcement of the great advice you've been giving her with other family members or adults she looks up to.

Bullying in Sibling Relationships

robbockscc: I have two sons in grades six and eight. Sometimes they are inseparable buddies. Sometimes the eldest son is a relentlessly cruel bully toward the younger son. The dynamic is such that the younger son always caves to the eldest son's will. I believe it is beyond what is normal for siblings. I have tried various fruitless approaches to both  stop the eldest from bullying, and teach the younger to resist. What advice do you have for a frustrated parent who is worried their eldest son will grow up learning it is o.k. to take advantage of others, and their younger son will grow up learning it is o.k. that others take advantage of him?

Emma_Raizman,_MD: I respect that you want to address this now and raise your sons to appreciate each other and other people. The two issues that need to be addressed here are education and discipline. Although a certain amount of sibling rivalry—and even cruelty—is a normal part of growing up, there is also a time when it is out of control and that sounds like your case. It is important to talk to each child alone about not only what they are doing to and taking from their sibling, but also why they are doing it. Is there peer pressure? Is there insecurity or self-esteem issues? Is there jealousy or looking for attention? When you find out more about the why, then I would work on addressing those specific issues (such as making sure that each one of them gets protected time with you or  their father). Then I would also continue to educate each one of them that bullying is not right and will not be tolerated. I would talk to your younger son about self-esteem. Work with him on increasing his self-esteem with positive reinforcement and get him involved in activities that he feels good at. I would also give positive reinforcement to your older son when he acts with compassion.

robbockscc: My girlfriend is a divorced mother of two sons who are 10 and 14 years old. The 14-year-old son regularly bullies the 10-year-old son, including physically hurting the 10-year-old boy. It is so much so that the boys were separated, and the 14-year-old is now in the custody of his father. The father has stated that he does not have a problem with the bullying, and states that the 14-year-old boy is unable to control his actions because of his mother. Due to legal custody arrangements, the 10-year-old son spends every other weekend at his father's home and is subject to bullying during those times. Unfortunately the father sets a questionable example for the 14-year-old boy by verbally abusing the 10-year-old son.
Obviously I cannot change the father's or the older son’s behavior, but what can the mother and I do to help the younger son cope with the bullying from his brother? I am very concerned about long-term issues for the 10-year-old boy.

Emma_Raizman,_MD: I'm very sorry for your situation. Please make sure that the legal system is aware of the current situation because the situation could have implications on visitation and the well-being of the children. If the children are not currently in therapy, I would strongly recommend counseling for each, and especially the youngest. The best thing you can do is to be supportive of the younger son, reminding him that this is not his fault or anything he deserves or did wrong. Let him know that what his brother is doing is not right, but also encourage compassion for his brother rather than aggression. Try to find things to increase your girlfriend’s 10-year-old son's self-esteem. Plan activities that you can do together, he can do with friends, or that he can do alone that will encourage his confidence and feelings of accomplishment. Good luck.

Online Bullying

mtg: There has been a lot in the media about online bullying lately. What is your advice for parents?

Emma_Raizman,_MD: Thirty three percent of teenagers report being victims of cyberbullying. It is definitely a topic that needs to be discussed with our children and that parents need to be educated on. I previously discussed this on our Health Essentials, so I would direct you to this conversation and hopefully it answers your questions and will provide more information on the subject. You can find this information at

Long-term Effects of Bullying

WG: What are the long-term effects of bullying on an adult who was bullied as a child?

Emma_Raizman,_MD: The effects can be serious or the effects can be vague. Some adults who were bullied can have problems in school and subsequently at work, such as trouble concentrating and trouble keeping a steady job. Some people end up with depression and anxiety, and can suffer with poor self-esteem and subsequent poor decision-making skills related to that. This may result in divorce, problems with drugs and alcohol, and financial instability. Some adults who were bullied as children, especially those with a good support system and counseling, can have minimal to no discernible consequences as adults. Much of the long-term effects are related to how long it went on, were there multiple episodes of bullying, was there a support system, and how the bullying was handled.

Parental Influence on Difference Awareness

Jule: Even though this web chat is focused on kids, a lot of bullying involves anyone who is ‘different’, including people with disabilities and different abilities—visible or not. There are different thought processes on a person's abilities whether based on what a person or bully is taught, generation of beliefs, etc. What's the best way to address this type of assumption from a bully?

Emma_Raizman,_MD: Sometimes educating a bully can be difficult. The place to start is with the parents because a person's belief structure starts in childhood. Parents should set a good example for their children in terms of acceptance of those who may be different from themselves—maybe that difference is a disability, a different look, a different socioeconomic class, etc. Parents should talk to their children about not only accepting children and adults who are different, but also embracing those differences and getting to know people for who they are and not how they look. In addition, teaching children to stand up for children who may be different and may be getting bullied is very important, and will keep their children from becoming bullies.

Prevention and Intervention

Aussie: What can we teach our children to avoid being a target of a bully? Do we teach them to ignore, fight back or simply tell an adult (who may or may not intercede)?

Emma_Raizman,_MD: The best way to avoid being bullied is for your children to know that they should tell an adult. If they are in a situation where they are being bullied, being assertive (i.e., standing up tall and telling the bully to stop what they're doing) will stop many cases of bullying. Assertive is not the same as aggressive. It is not o.k. to fight back. Your child should find the nearest adult and tell him or her what is going on. Teach your child to ‘move in groups’ and to not go places (especially private places like dark hallways and bathrooms) alone. If the appropriate adults are aware of the situation (including teachers, principals and parents) then supervision and patrols can make those ‘private places’ much safer. Probably the most important thing you can teach your child is good self-esteem. Let them know that they are strong, capable children and that it is never o.k. for them to be bullied. Find things they can do to make them feel confident and good about themselves. Encourage friendships with a supportive group of friends. And, always keep the lines of communication open with you.

KadLac: What can we do to get our kids to promote that it is 'not cool to bully someone' message?

Emma_Raizman,_MD: Lead by example. Show your children by your actions and kindness to people that compassion is the appropriate way to treat others. Get a group of other parents together and make a pledge for everyone to talk to their children about acting with kindness and empathy. Kids are very responsive to peer influences, so if their friends are acting appropriately then they are more likely to as well. Also, talk to your children about standing up for others who may be picked on or bullied. Finally, teach your children to embrace differences instead of ridiculing them.

Anti-bullying Campaigns

memchugh: You say that in schools where there are anti-bullying programs, bullying is reduced by 50 percent. But all anti-bullying programs can't be created equal. What are the recommended programs?

Emma_Raizman,_MD: There are many different anti-bullying programs and you are correct that they are not all created equal, but then again there are also many different types of bullying. The web site  is a wonderful resource. Also, different states have different laws regarding bullying.


Moderator: I am sorry to say that we are at the end of our chat. We appreciate your participation and hope you will join us for other chat topics in the future.
Thank you, Emma Raizman, MD, for sharing your expertise and answering questions today about bullying—how to recognize, prevent and respond to the problem.

Emma_Raizman,_MD: Thank you for your wonderful questions. I appreciate the opportunity to provide you with some information on what is a growing and serious problem in our culture. This question was not asked, but we have seen in the media numerous cases of children hurting or killing themselves or others due at least in part to them being bullied. I cannot stress enough how important it is to talk to your children about tolerance, acceptance and making sure that they feel safe and supported by their school, their friends and their families.

If you suspect that your child may be bullied or have any questions about their actual safety or feelings of safety, do not ignore these signs and signals. Engage the appropriate authorities, whether it be school officials, other parents, police, coaches, your child's pediatrician, or if suicidal thoughts are suspected, possibly the emergency room. No child should have to go through this alone. Your school counselor, teachers, principals, healthcare professionals and mental health professionals are all good resources. There are several online resources that can provide good information as well, such as and together and with education we can reverse this trend and keep our kids safe, happy and healthy!

For Appointments

To make an appointment with Emma Raizman, MD or another primary care pediatrician, please call 216.444.KIDS (5437) or toll-free at 800.223.2273, ext. 45437. You can also visit us online to learn more.

For More Information

On Cleveland Clinic

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On Cleveland Clinic

As a member of the Cleveland Clinic Children's Hospital staff, Emma Raizman, MD is one of more than 50 pediatric primary care physicians who serve the well-being of newborns, infants, children and adolescents at convenient Cleveland Clinic locations throughout northern Ohio. Our pediatric physicians offer comprehensive general and preventive care, as well as care for children with complex or chronic health issues. With access to leading-edge diagnostic and treatment resources, as well as a total commitment to family-centered care, our pediatric professionals are well-equipped to diagnose and treat common, everyday illnesses, as well as serious childhood diseases and conditions like cancer, diabetes and attention deficit/hyperactivity disorder.

Cleveland Clinic Children's Hospital and Pediatric Institute provides primary pediatric care at Family Health Centers throughout the community as well as specialized and subspecialty pediatric care for the most complex cases at Cleveland Clinic Main Campus, Hillcrest and Fairview Hospitals. Our team includes board-certified pediatricians, nurses, nurse practitioners, therapists, social workers and other specialists who provide comprehensive, family-centered care for a wide variety of acute, chronic and complex children's illnesses.

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