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Children frequently bullied due to food allergies

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‘Cultural evolution’ is needed to reject bullying

Bullies are familiar as the characters we have always loved to hate in television, films, and books, but bullies have recently become something more, said Dr. Mark Schuster and Dr. Laura Bogart. "The bully is no longer simply a representation of a moral lesson or a source of humor."

The bully is now also recognized as a source of long-term health issues, including depression, anxiety, posttraumatic stress, and suicidal ideation. But bullies can be motivated by others’ health conditions, too. Dr. Shemesh’s article about high rates of bullying related to children’s food allergies "underscores the importance of addressing food allergies in a way that protects but does not stigmatize children who have them."

Clinicians should watch for signs a child is being bullied – including emotional symptoms and chronic physical symptoms, as well as physical bruises and scratches – paying particular attention to children with "stigmatizing characteristics that could lead to bullying," such as obesity, disabilities, or gender nonconformity. Providers must also involve parents in recognizing bullying and its harmful long-term effects and making sure they are neither ignoring nor engaging in bullying themselves. "We need a cultural evolution in awareness and repudiation of bullying."

Dr. Schuster is at Boston Children’s Hospital and Dr. Bogart is at Harvard Medical School, Boston. Their comments were taken from an editorial accompanying Dr. Shemesh’s study (Pediatrics 2012 Dec. 24 [doi:10.1542/peds.2012-3253]).


 

FROM PEDIATRICS

One in three children treated at a food allergy clinic reported being bullied specifically because of food allergies, suggesting higher rates of bullying than the approximately 17% previously reported in the U.S. general population.

Although bullying was significantly associated with a lower quality of life and higher distress levels in the children and in the parents of bullied children, parental knowledge of the bullying mediated these measures in both parents and children, according to a study published Dec. 24 in Pediatrics.

Parents were aware of only 52% of their children’s reports of bullying in this sample, but "when parents knew that their children [were] being bullied for any reason, the parents’ quality of life was significantly lower, and the child’s quality of life was significantly better," reported Dr. Eyal Shemesh at New York’s Mount Sinai Medical Center and his associates (Pediatrics 2012 Dec. 24 [doi:10.1542/peds.2012-1180]).

The data come from 251 predominantly white, affluent families who visited Mount Sinai’s Elliot and Roslyn Jaffe Food Allergy Institute between April 2011 and November 2011. All the children participating, aged 8-17 years, had at least one diagnosed food allergy and completed modified versions of the Revised Olweus Bully/Victim Questionnaire. Their parents filled out separate surveys about their children’s experiences of being bullied.

Quality of life and distress were assessed using the Multidimensional Anxiety Scale for Children10 items and the Pediatric Quality of Life Inventory 4.0 in children and the Impact of Events Scale and 17-item Food Allergy Quality of Life Parental Burden in the parents.

The researchers attempted to control for the burden of the food allergy’s severity as a possible confounder in the relationship among bullying, quality of life, and distress by including in the analysis the number of allergies each child had and whether the parents had ever had to use epinephrine.

Nearly half of the children (45%) reported being bullied for any reason (compared with 36% of parents who reported knowing their child had been bullied), and 32% reported being bullied specifically because of their food allergy (compared with 25% of parents reporting knowledge of food allergy–specific bullying).

Although being teased was the most common form of bullying (42% of children), 30% reported having food waved at them, 12% had been forced to touch food, and 10% had had food thrown at them.

Most of the bullying (60%) occurred at school, and classmates were the most common perpetrators, reported by 80% of the bullied children. The children also reported being bullied about food allergies by other students at the school (34%), teachers or staff (11%), and siblings (13%).

Meanwhile, 87% of the children said they told someone about the bullying, usually their parents (71%), a teacher (35%), or a friend (32%). Since children’s quality of life was better and anxiety was lower when their parents knew about the bullying, the researchers suggested that helping children identify and report bullying appears to lessen its impact.

Children reporting frequent bullying had significantly worse quality of life scores compared with children bullied less, but there were no significant differences in anxiety levels between children bullied more or less often.

Limitations of the study included self-reporting and the possibility that children’s reports of bullying due to food allergy and bullying for any reason were conflated. The primarily white, affluent children are also not representative of the general population, and the study lacked a control group of children without food allergies.

Funding for the study came from the Jaffe Family Foundation, the National Institute of Allergy and Infectious Diseases, the Food Allergy Initiative, and and the National Institute of Diabetes and Digestive and Kidney Diseases. One of Dr. Shemesh’s associates in the study, Dr. Scott H. Sicherer, consults for the Food Allergy Initiative and is an adviser for the Food Allergy and Anaphylaxis Network.

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