Line of yellow school buses

Eight-year-old Abigail arrives at school every morning with her green and pink polka-dot medical bag on her shoulder. Inside, she carries her asthma inhaler and an epinephrine auto-injector in case she experiences an allergic reaction to one of her food allergens: eggs, peanuts and tree nuts.

Abigail’s fourth-grade classmates are well aware of her asthma and food allergies.

“The kids know it’s normal for her to carry her medicine,” her mom Jennifer, of Blue Ridge, Ga., says.

Four years earlier, when Abigail was in kindergarten, a classmate teased her about her peanut allergy. She came home crying.

Seeking to raise her community’s awareness of food allergies, Jennifer partnered with another mom of a food-allergic child and co-founded the Northeast Georgia Food Allergy Support Group. The school district invited them to speak to students at the school.

“We explained what food allergies are, how serious they can be, and why epinephrine auto-injectors are needed,” Jennifer says.

Now Abigail’s classmates look out for her at lunch and snack time, helping teachers make sure she is safe from her food allergens. Some even remind Abigail to take her medical bag when she goes home.

“What a difference it’s made,” Jennifer says.

Bullying Is Widespread

Not all students have such a happy story. About 10-15 percent of the 6.8 million children with asthma report being bullied, according to multiple studies. Among kids with food allergies, 30 percent report being bullied; it rises to 50 percent in grades 6-10, according to the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York City.

Bullying takes many forms.

In Maryland, an 8-year-old boy with milk allergy was taunted by a classmate who waved a milk chocolate candy bar wrapper and chanted, “You can’t eat this!”

In Florida, a 14-year-old boy with asthma had to go to the school nurse because he couldn’t find his inhaler. Turns out a classmate hid it from him.

In Michigan, a 10-year-old boy with peanut and tree nut allergies was singled out by classmates and even some teachers as the reason their school banned treats that contain nuts.

Bullying has also moved online, where kids with asthma, food allergies and other medical conditions are taunted and teased on social media.

“Children who are perceived as different are more likely to be bullied in school, and it’s both psychological and physical,” says Ralph E. “Gene” Cash, Ph.D, a nationally certified school psychologist, professor of psychology at Nova Southeastern University in Fort Lauderdale, Fla., and Anaphylaxis Community Expert (ACE) volunteer for Allergy & Asthma Network.

“Victims are shunned by social groups, talked about in whispers in the hallway, and made the subject of rumors. And while verbal abuse is the most common form of bullying, there are bullies who deliberately try to expose victims to their food allergen,” Cash says.

Bullying negatively impacts a child’s social development and self-esteem and is linked to underachievement in school, depression and chronic stress.

See the Signs

Many children don’t report bullying because they feel embarrassed or worry about retaliation. Or they think they can handle it themselves.

How do parents recognize when their child is bullied? The American College of Allergy, Asthma & Immunology (ACAAI) says signs to watch for include a sudden reluctance or fear of going to school, unexplained depression or anxiety, weight loss, and changes in sleep patterns.

Children with asthma may avoid participating in sports or gym class, while kids with food allergies may bring home a full lunchbox or not eat lunch at school.

“I recommend parents and children discuss bullying with their physician every year when prescriptions for asthma medications or epinephrine auto-injectors are written,” says Dana Wallace, MD, board-certified allergist at the Florida Center for Allergy and Asthma Care in Miami and ACE volunteer. “Ask in a casual way, ‘Do kids give you a problem because you’re not allowed to eat certain foods or you can’t participate in a certain activity?’ Or, ‘Do kids give you a hard time because you carry medication?’ It’s a way to spark a dialogue that should be ongoing.”

Instilling a sense of confidence in children can make a difference, Cash says. If a student projects confidence in self-managing their asthma or allergies, it helps ward off bullying before it starts.

Cash cautions against peanut-free lunch tables because they may create a “sense of separateness” and even put a target on students with food allergies.

“The key is not segregating kids,” he says, “but teaching them to be careful about what they eat and how to keep themselves safe. Kids who know how to prevent exposure to an allergen, how to use their medication, how to ask for help – they are better prepared.”

Culture of Support, Respect

Many schools focus on developing a positive school environment and put in place strong bullying prevention programs – a first step in establishing a school culture of support, respect and achievement where kids can thrive, says Carolyn Duff, MS, RN, a nationally certified school nurse practicing in Columbia, S.C., and president of the National Association of School Nurses.

In schools across the country, many school nurses go into classrooms to teach students about medical conditions including asthma and food allergies, Duff says. This not only increases social awareness but also instills compassion and care for peers.

“When students are presented with scientific information about asthma and food allergies, why some people have it and some people don’t, why a student carries an inhaler or epinephrine auto-injector – they understand,” Duff says. “Students become more knowledgeable and more accepting. They even want to help.”

If problems arise, it’s important that students feel they have a friend on the school staff – a school nurse, teacher, coach or guidance counselor, for example – to whom they can turn for help. Duff recommends parents and students establish those bonds early in the school year.

Every child and every school is different, but a commitment from parents, schools and students to develop a learning environment that is safe, respectful and encouraging helps stop the cycle of bullying.

Prevent Bullying At School: It’s Good 2 Talk

For more conversation starters on how parents and kids can address bullying at school, Allergy & Asthma Today talked with Jennifer LeBovidge, Ph.D, a pediatric psychologist and specialist in allergy and immunology at Boston Children’s Hospital. 

AAT: What are ways parents can ask their child about bullying at school?

Jennifer LeBovidge: A good way for parents to start the conversation is to ask whether bullying is something that happens in class or school and what kids do when it happens. Check in on things such as what lunchtime is like at school and which classmates the child sits with at the lunch table. Or ask about good or bad things that happened at school each day.

AAT: What are some proactive steps parents and schools can take to prevent bullying?

Jennifer LeBovidge: Teaching all children about food allergies can go a long way. Many children report that when peers know about a classmate’s food allergy, they take an active role in “looking out” for and including their friend in social activities.

Parents and children can practice language for handling common questions, such as “Why is your snack different?” It’s important to remember that most kids are just curious.

Teaching young children about food allergies early on has a big payoff during teenage years. Many teens say that when their friends know about their food allergy, they feel more comfortable taking steps to stay safe, such as carrying epinephrine auto-injectors.

The important thing for bullied kids to know is that parents want to help if there’s a problem. I tell kids that telling an adult is important. It’s not tattling – it’s being responsible for your health.

Parents can role-play to practice assertive – but not aggressive – language children can use to stand up for themselves. In my work with kids, we practice language for handling common teasing scenarios. For example, a response to “This ice cream is so good, I bet you wish you could have some” could be, “Why would I want to eat something that is going to make me sick? I’ll stick with my food.”

Reviewed by Martha Hogan, MD and Andrea Holka