CommonHealth

(H. Zell/Wikimedia Commons)

The journal “Pediatrics” reports today that nearly one third of children with food allergies are bullied for it. From the press release:

Researchers surveyed 251 parent and child pairs to see if they have experienced bullying related to their food allergies. The results show that 31.5 percent of these children report being bullied, and threats frequently involved food. Children who report being bullied, and their parents, had higher stress levels and lower quality of life. Of those surveyed, approximately half the parents reported being aware of bullying.

The study confirms earlier findings that kids — and adults — can be real jerks about allergies. We posted a similar study in 2010 reporting that “approximately 35 percent of children with food allergies over age five have experienced bullying, teasing, or harassment as a result of their allergies. Of those, the study says, 86 percent experienced repeated episodes, with classmates being the most common perpetrators. But beyond that, more than 20 percent reported harassment or teasing from teachers and other school staff, according to the findings published in the medical journal Annals of Allergy, Asthma & Immunology.”

I spoke today with Dr. Mark Schuster of Boston Children’s Hospital and Harvard Medical School, co-author of an accompanying editorial in Pediatrics whose title begins, “Did the Ugly Duckling Have PTSD?” Our conversation, lightly edited:

You discuss the important role that parents and other adults can play in helping to stop bullying. How exactly should we talk to our kids who don’t have allergies about the kids who do?

The first thing is for parents to take allergies seriously. It’s very easy for parents to just react with annoyance that they can’t send their kid to school with a peanut butter sandwich. It’s understandable why parents feel constrained by restrictions due to allergies, but if their child doesn’t have an allergy they often don’t understand just how serious it can be. Some kids really can go into anaphylactic shock from touching someone else’s peanut butter cookie and die at school.

So it’s important for parents of kids who do not have allergies to be respectful of the seriousness of a child who does have an allergy. A parent might try asking a child without an allergy: “What is your favorite food? How would it feel if you could never eat that food ever again? And if you did eat that food, it would kill you?”

Part of it is just to build empathy. And a lot of it is role modeling. If parents are dismissive and say, ‘It’s no big deal’ or ‘Why should I have to change because of some other family’s problem?’ then they’re sending a message to their child that is stigmatizing of a kid with allergies.

And should parents try to explain the biology at all?

Well, they don’t have to get into the immunology, but they can explain that there’s a biological reaction in the child’s body that makes it very dangerous for the child to eat, and sometimes even touch, the specific food.

One of the things going on is that food allergies have been on the rise, and so many parents are thinking back to when they were kids and allergies were rare and not as big a deal. And now they are more common, so it’s important to educate parents. Any parent of a kid who has a food allergy knows what it’s like to have other people minimize it. Schools can really help to educate both parents and kids on this topic.

Could you sum up what we know about the health consequences of bullying??

Bullying can have serious health consequences. Obviously it can have physical consequences if a child is beaten up; it can also have serious emotional and psychological effects: It can make a kid feel withdrawn; it can lead to depression; it can create anxiety and stress. There are kids who have committed suicide following being bullied, particularly when it’s something that reaches to their core identity, like their sexual orientation. Kids who’ve been bullied can experience psychological effects that last into adulthood.

Another article just out in “Pediatrics” concerns bullying about weight. You write: “A clinician who is trying to motivate a child to lose weight might use language, tone, and facial expressions that are undermining, scolding, and even bullying.” What does that look like? How can a parent watch out for it and what’s the correct response?

Parents may do it as well: Calling a kid fat, any suggestion from a parent that they’re embarrassed by the kid. And some of this can be well-intentioned. The parent can be feeling desperate to try to help their kid maintain a weight that isn’t at an unhealthy level or what they perceive to be an unhealthy level. So they may be trying everything they can think of, and may not realize that calling their child names and mocking their child is not the way to go about getting their child to eat healthier, put away the video games, and be more physically active. And even if it works, the price they’re paying with their child’s psychological health is probably a high one, particularly when it’s the parent more than anybody who should be serving as the child’s safe haven.

And what do pediatricians do wrong?

It’s the same approach: A pediatrician might try to motivate a child to exercise more and change her diet by using epithets that are mocking or by suggesting that she won’t have friends if she’s fat or she’ll never get a date. In reality, I think that would be the rare pediatrician who would do this, but there are examples of all sorts of adults who are demeaning of kids.

It’s such a minefield, to get across the weight message without causing damage…

It is a challenge particularly when you’re trying to partner with the parent but look out for the best interests of the child. So when a parent is insulting their child, a pediatrician who’s trying to be supportive of the parent but also of the child needs to be careful not to go too far in speaking the language of the parent. Bonding with the parent by saying, ‘Yes, I realize this might be so hard and embarrassing’ is trying to be supportive of the parent but it’s going to be very hurtful to the child. The kid will pick up the subtleties of the physician’s word choice, tone and facial expression, which is why we teach our students and residents about the importance of nonverbal communication.

Say you’re the parent of a kid who’s not overweight, and talking to them about a kid in their class who is. On the one hand, people get overweight by eating too much; on the other hand, you want to say that it isn’t so-and-so’s fault…

I think what a parent has to do is create an environment where their child learns to respect other people in general and recognize that there is a lot of diversity in the world and not everyone is like them. And yes, people can typically take steps to be less obese. They can exercise, they can eat a certain way, but it’s also the case that people do probably have sort of a range of a regular weight for them, and some people are larger than others. Being physically fit is what’s most important, regardless of one’s size. And certainly in the case of a child, a child doesn’t have complete control over what he eats or how much he exercises. There’s a lot of influence that comes from the family, school, community and media.

If the parent is someone who goes to their high school reunion and comes home laughing about how the prom queen is now super-heavy, the kid hears that and learns it’s okay to laugh about someone who is heavy, and then that gets transmitted to how he treats other kids at school. So a lot of it is how the parents view others. It’s about teaching empathy and helping one’s child think about things they might be embarrassed about, and things they’re not perfect at, and how it would feel if someone were to make fun of them.