In the research article Bullying and Peer Victimization Among Children With Special Health Care Needs, the link between children with special health needs and bullying was assessed.  This analysis found a significant association between children with special health care needs and being bullied by others or being a bully.  Children with functional limitations or behavioral, emotional or developmental problems are 1.5 to 2 times more likely to become the victim of bullying.   Being bullied may also contribute to depression, headaches and abdominal pain, which can add to the health needs of the victim.  This study reinforced the need for the primary care provider to screen children at preventive visits for bullying behavior, either as victim or perpetrator.  The primary care provider is often in the unique position of having a long history and close relationship with the child, which allows the provider to have the ability to talk to the child and family and help with access to services and communication within the school setting.

School-based bullying prevention programs have also been shown to be effective in decreasing bullying in schools.  The article Bullies and Their Victims mentions these programs and how they have helped in the school setting to change the climate and make it clear that bullying will not be tolerated.  It can be difficult to speak on such matters; however silence should be avoided when possible.  In some instances, the school has a counselor talk to both the victim and the bully and then explains both stories to a group of their peers.  This can help prevent gossip and social exclusion, both of which can be challenging to handle in a direct manner.

In summary, for children with special health care needs, addressing the issue of bullying may be necessary and important in the school setting as bullying may result in school avoidance or lead to other emotional or health issues.  Including primary care or specialty physicians, counselors or therapists, school counselors, nurses, teachers and/or other school personnel in this process is essential to improving communication and the overall situation.  Getting these individuals involved as soon as there is evidence of bullying can help minimize the amount of time this occurs and can reduce the short and long term effects.