Scott Webb (Host): Bullying, and especially cyberbullying, can have severe and lasting effects on our kids. And my guest today has some suggestions for how we can love and support our kiddos if they're being bullied. And joining me today is Dr. Nadereh Varamini. She's a pediatrician with Stanford Medicine Children's Health.

 This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, it's so nice to have you on the podcast again. Last time, we talked about swimming. Today, we're talking about bullying. And I have a little bit of experience with this in that my son was extra small when he went into high school and you know how high school kids can be. So, I'm glad to have you here. Glad to have your expertise. Let's just talk through here at the beginning, what are the most common types of bullying?

Dr. Nadereh Varamini: Most common types of bullying are kind of four categories. Verbal bullying is like name-calling, the way they did to your son; insults, threats or inappropriate comments. Social bullying is spreading rumors, excluding others on purpose, and embarrassing someone in public. Another one, physical bullying is like hitting, kicking, tripping, or any form of physical aggression. And unfortunately, last but not the least, which is on the rise is cyberbullying. And it's using digital platforms to harass, threaten, or humiliate someone.

Host: Yeah, I'm glad you brought up cyberbullying. This, of course, is something in my generation we didn't have to deal with. All of our stuff was in the hallways and, you know, kids knocking books out of your hand, you know, old school type stuff. But cyberbullying is on the rise, and it's important that we talk about it. So, I want to get from you any advice you have for parents and children, just broadly, in dealing with bullying, but particularly about cyberbullying.

Dr. Nadereh Varamini: Yes, cyberbullying is very harmful, and unfortunately is on the rise and especially in teenage years. And even in college, you can see cyberbullying. And unfortunately, the kids are having phones, smartphones earlier and earlier and that exposes them to more risk of cyberbullying. Risks of cyberbullying or emotional distress. And the victim may experience anxiety, depression, feeling of isolation or helplessness, and it'll affect their self-esteem.

Another one is academic impacts that makes them not study as before, being preoccupied with that cyberbullying, and they often have lower academic performance due to stress and distraction.

One of the biggest is mental health issues. It increases a risk of developing mental health problems like depression and anxiety disorders, and even behavioral problems. Sometimes victims become bullies themselves. And the self-esteem that I mentioned earlier can happen with repeated bullying. It can erode self-esteem and self-worth. And social withdrawal is very common. Victims may withdraw from friends and family. They feel ashamed. They feel embarrassed. This an aggressive behavior. As I mentioned, some victims might become aggressive, or use bullying as a defensive response to the fact that they were bullied themselves. Suicidal thoughts can happen. In some cases, it can be severe, and cyberbullying can contribute to suicidal ideation and behavior.

Host: Yeah. As you're saying here, it could lead to serious mental, physical effects on our kids and then they take it out on other kids or siblings perhaps. What are some of the signs we should be on the lookout for, whether our kids are younger or older, that they may be being bullied? And are there different signs for younger versus older children, or maybe different signs for the different types of bullying?

Dr. Nadereh Varamini: Yes. Signs of bullying can be different in younger children, like you would notice sudden changes in their behavior or mood, unexplained injuries or lost personal items. They can be reluctant to go to school. They will have like stomachache, headaches, any excuses not to go to school. And when they're older, in older children, you will see changes in their sleep patterns or appetite. They avoid social situations. They close themselves in their rooms, and they don't want to get out. A decline in academic performance is very common in older children.

Host: Yeah. Just thinking about, Doctor, you know, as I said, I have two kids, my youngest is 17, and lots of people listening obviously have children, and we were all kids once ourselves, of course. And I know that those years, those adolescent years, those teen years can be so tough for kids, right? Between acne and braces and just awkwardness and just, you know, everything that we know about being a kid, being an adolescent, being a teen. But when we think about just in general, who's at the highest risk for bullying?

Dr. Nadereh Varamini: In general, children who appears different from their peers due to their appearance, the way they're dressing, their behavior, their socioeconomic status, and those who are perceived as weak or shy or unable to defend themselves; and kids who are less popular, who don't have that many friends, who are lonely. And, unfortunately, they use them as victims, the bullies use them as victims, kind of aim at them.

Host: Yeah, kids who are shy, kids who are introverts. You see how easy it is for a child, an adolescent, a teen to be at risk simply because of who they are and we know that those years are so important in figuring out who we are, right, and who we're going to be. Yeah.

Dr. Nadereh Varamini: Exactly. Those are such fragile years for children. And bullying will affect them further more.

Host: Yeah. As you say, many of those who have been bullied become bullies themselves simply because it's what they know and maybe they feel the need to take it out on someone else. And yeah, there's just a lot to process here today for me, for parents. I'm wondering what your role is as a pediatrician in addressing bullying with parents or just assessing the symptoms that either you are seeing or parents are reporting?

Dr. Nadereh Varamini: I think, as a pediatrician, we have a big role. At every checkup, I ask about bullying. And if the answer is yes, I try to go over several case scenarios how they can defend themselves and how they can talk to the bully or not talk to them if it's not safe. And definitely, I ask them to notify a trusted adult, the teacher, school counselor, and definitely their parents.

For parents, I usually educate them about the signs of a child who's a victim of bullying and encourage them to start an open dialogue with their children, and make sure they know the parents have unconditional love. It doesn't matter what other people thinks of them, that the parents think the world of their own children. It's important for a child, especially a child who is bullied, to know they're loved, and they should not believe in what the bully is telling them. We have to offer support and referral to counseling in the cases that we see those signs of mental health is appearing and definitely make sure we give them resources.

Host: I'm sure there's a variety of strategies and maybe beyond, you know, the scope of what we can cover today. But I did want to touch on at least a little bit, we think about the long-term effects of bullying on children, because they're going to become adults, right? And how do we prevent that? How do we prevent sort of bullies bullying our kids and then they become bullies? And, you know, how do we prepare them for the future?

Dr. Nadereh Varamini: Right. Effects of bullying can be short term like depression, anxiety, health complaints, abdominal pains, right and left headaches, and decreased academic achievement. But we can see long-term effects that will lead to chronic depression, social anxiety, involvement in risky behaviors for them. And what we can do to prevent them, we need to address bullying by raising the awareness about bullying. We need to teach our children empathy, and we need to work with proactive measures from both caregivers and professionals to encourage a supportive community and having open channels of communication that can help mitigate the effects of bullying on our children.

Host: Right. Yeah. As you say, support, unconditional love, open lines of communication, all of that, all good stuff. It's not easy to be a kid. It's not easy to be a parent or a pediatrician, of course. I want to touch on here at the end, Doctor, maybe some misconceptions about bullying that you would like to address to just better inform parents and, hopefully, patients.

Dr. Nadereh Varamini: Right. Some of the misconceptions is that they say, "Ah, bullying is just a part of growing up." No, that's not true. Pediatricians should emphasize that bullying is harmful and not a rite of passage. And that the other thing, they say, "Oh, it's only harmful if it's physical." Absolutely not. Emotional and social bullying can be just as damaging to a child

Host: Yeah, I agree with you. I thought I was sort of reading your mind. I was like, "She's going to say right of passage." Just because you're a kid, bullying is not a rite of passage. It doesn't have to happen. It shouldn't happen. And to the best we can, if we can't put a stop to it, at the very least, we can help our kids and their friends and just everybody to raise awareness, right?

Dr. Nadereh Varamini: Exactly. Yes. Actually, when my daughter was in middle of school with 20 other parents, we were going once a month all day in different classes to raise awareness, to help kids to detect bullying so they can defend themselves. And it was very helpful in raising awareness and talking to the school about having policies, even to support the bully. I believe the bullies are being bullied. They're living in different situations at home that is not good for them. And then, they come to school and hurt other people.

Host: Right. Yeah. I've always believed that-- not being an expert, of course, just as a lay person-- but I've just always believed that, you know, whatever's going on at home for those kids, you know, it's manifesting itself in bullying and they're coming to school and they're taking out their anger, aggression, whatever it might be on other kids, perhaps our own kids, and it's just this vicious cycle, right?

Dr. Nadereh Varamini: Exactly. Exactly. And we talk about what is the role of a bystander. If we teach empathy to our kids, teach kindness. And teach that if you see somebody is being bullied, go toward that kid, talk to that kid, make sure they know they're not alone. If it's safe, stand up and help them stand up to the bully and help them. And definitely, the school needs to intervene and make sure they have clear policies and support systems, especially for victims of cyberbullying.

Host: When we think about cyberbullying, it makes me think, how do we stop this? How do we prevent this? Is it as simple as just taking phones away at night? But of course, they're going to have them during the day. You know, I want to get your expertise on this. How do we help our kiddos with cyberbullying?

Dr. Nadereh Varamini: Scott, that was a great question, because that's the main type of bullying that's on the rise. I think it's the most harmful one because just 24/7 and it is constant. Whenever something is published or something is on that platform, it's just forever.

So, one is open communication. We need to encourage kids to talk about their online experiences with a trusted adult. It could be parents, it could be the teacher, a counselor. The other one is privacy setting. We need to help adolescents understand and use privacy settings to control who sees their posts and profiles. The other thing is reporting and blocking. We need to educate them on how to report abusive behavior on social media platforms and block offenders.

Something you mentioned to take away their phones, actually, teenagers, think their phone is life. So, it's not a good idea to take it away. It's a good idea to block those platforms we don't want them to be involved with. And the other one is supervision and monitoring. Parents and guardians should monitor online activity while respecting their children's privacy. That's very important. They feel you are respecting their privacy. But at the same time, you are trying to protect them. And empower and support, empower kids to act if they witness cyberbullying and provide support to those who are affected.

Host: Yeah, that's perfect. Well, it's always lovely to have you on. You always have all the answers and I appreciate that. So, thank you so much.

Dr. Nadereh Varamini: Thank you so much, Scott. Have a great day. Bye-bye.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.