Bullies and Bullied Frequently See School Nurse

Surprise Finding of Study: Kids Who Are Aggressive Also Show Up at the Nurse’s Office

Reviewed by Laura J. Martin, MD on April 25, 2011
From the WebMD Archives

April 25, 2011 -- Children who are bullies and children who are victims of bullying both tend to visit the school nurse more often, according to a new study.

"Kids who either are relatively frequent targets of other peers' victimization or who act aggressively themselves toward their peers both are at risk for having more visits to the school nurse and more health complaints," researcher Eric Vernberg, PhD, a professor of psychology and applied behavior science at the University of Kansas in Lawrence, tells WebMD.

While it is expected that the victims would visit the school nurse's office often, the surprise finding was that the aggressive kids did, too. The visits involved illness, injury, and somatic complaints -- physical complaints without objective medical findings.

Nearly one in five students may be affected by bullying, according to the Olweus Bullying Prevention Program, a preventive program. This includes bullies, the bullied, onlookers, followers, and defenders.

The study is published in Pediatrics.

Tracking Visits to the School Nurse

For a year, Vernberg and colleagues followed 590 grade school children from six elementary schools in a large Midwestern city. The children were in grades three though five.

The children reported whether they were victimized. The children also reported whether their classmates were aggressive.

Vernberg tracked the school nurses' logs for the year. He coded them for the number of times each child visited, and whether it was for a routine visit, illness, injury, or a somatic complaint.

Experts know that children who are often targets or the perpetrators of aggression towards their classmates are at increased risk for psychosocial problems. Less is known, however, about health problems and their link with childhood aggression.

In some cases, Vernberg says, a child was both victim and aggressor, on different occasions.

On average, the children visited the nurse 4.7 times during the school year, Vernberg says.

Those who were victims or aggressors had more than the average number of visits, he says, "but we didn't compute how many more."

When Vernberg's team evaluated the reports, they came up with a profile of a child most likely to be affected adversely. Most likely was a child who was bullied but not judged by peers as being aggressive himself or herself.

The take-home message for parents and other adults?

Children who are not aggressive but get bullied may become withdrawn, Vernberg says. "They may not tell their parents or others about the difficulties they are having."

Bullies Frequently Bullied Themselves

The new research will contribute to a field of research that is still developing, says Allan L. Beane, PhD, CEO and president of Bully Free Systems, a prevention program for school districts.

He cites the unique approach of evaluating nurse visits. "Even though we have always thought visits to the school nurse's office was a 'red flag,' to my knowledge, the study is unique in that it looks at nurse visits by victims of bullying and bullies."

Beane says he was initially surprised that both victims and bullies made injury complaints. However, he says, this may be explained at least partially by the dual role some bullies have. "Some bullies are also victims," he says, "perhaps mistreated at home or in their neighborhoods."

The effects of bullying on victims are well known, he says. But only more recently have experts become more aware of the impact bullying has on the bullies.

"Recent studies have found some bullies to be depressed, just like their victims," he says. That is not surprising, he tells WebMD, given that some bullies may be mistreated at home.

The unhealthy effects of anger, displayed by the bullies, are well known, too, he says.

''Bullying is robbing children of their health and their childhood," Beane says. Even those children who observe bullying can be stressed and anxious, he says. Some also feel guilty if they don't help the victim.

Parents can become more aware of any potential problems, he says, by asking the school nurse to discuss with them their child's visits. He says parents can also be alert to behavior changes that may suggest a bullying problem. A child may become anxious, not want to go to school, complain of headaches, or drop out of favorite school activities.

Parents should also be aware of potential signs their child is becoming a bully, he says. Among them may be manipulative behavior, cruelty to animals, or being a sore loser.

Show Sources


Vernberg, E. Pediatrics, May 2011; vol 127: pp 842-848.

Eric Vernberg, PhD, professor of psychology and applied behavioral science, University of Kansas, Lawrence.

Allan L. Beane, PhD, CEO and president, Bully Free Systems.

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