O0806 Oct.3: 1:57pm - The Problem of Bulling Among Pediatric Orthopaedic Patients

Background/Purpose: Bullying is a destructive and pervasive phenomenon, having lasting physical and emotional consequences. It affects all ages, but is particularly poignant in middle and high school youths. Although the literature suggests that children with chronic health conditions are at higher risk of being bullied, there is minimal research regarding how children with visible orthopaedic conditions are affected. Our study aimed to assess the prevalence of bullying among patients seen in pediatric orthopaedic clinics, and to evaluate how orthopaedic conditions and use of orthopaedic assistive devices/equipment are related to bullying.

Methods: Patients ages 10-17 and their parents were surveyed anonymously in pediatric orthopaedic clinics at two tertiary care children’s hospitals in neighboring cities of a major metropolitan area with an instrument (the Child-Adolescent Bullying Scale: CABS-9, Figure 1) validated in a health care setting to screen for bullying in pediatric patients. Basic demographic and school data, information related to the child’s orthopaedic condition, devices/equipment used, and parents’ perception of child being subject to bullying were also collected. Surveys were available in English and Spanish. The analysis utilized a t-test or ANOVA as appropriate to compare mean CABS-9 scores across risk factor categories.

Results: Among the 198 patients surveyed (100 girls, 96 boys, and 2 other/non-binary), 61% (N = 121) had minimal exposure to bullying, 36% (N = 72) had moderate exposure, and 3% (N = 5) had severe exposure. Although children ages 10-13 (N = 100) and children ages 14-17 (N = 98) had similar rates of bullying overall (p = 0.97), the younger age group was slightly more likely to experience severe bullying (p = 0.07). Patient attitudes regarding how their orthopaedic conditions and orthopaedic device/equipment usage contributed to the bullying experienced are shown in Table I. Patients who felt that they were made fun of due to their orthopaedic problem or felt others noticed and said things about the way they moved or walked were more likely to be bullied (p = 0.0003 and p = 0.0004 respectively). Bullying was also higher in children with individualized education plans (p = 0.02). Parental concern was highly correlated with their child’s bullying score (p = 0.0002), which indicates that parents have good awareness of the problem. Twelve percent of parents also worried their child was bullied specifically due to their orthopaedic problem.

Conclusion: Many of our pediatric orthopaedic patients (39%) experience either moderate or severe levels of bullying. We as providers must be aware that orthopaedic conditions and devices may play a role in the bullying that these children experience, and that bullying may affect compliance with orthopaedic assistive devices or equipment.