We know that bullying affects the mental and physical health of its victims. Emerging evidence now suggests that stigma-based bullying, including bullying that is motivated by actual or perceived sexual orientation, is associated with worse health outcomes than non-stigma–based bullying.‍

Lesbian, gay, bisexual, transgender, and queer youth, in particular, experience significant verbal bullying, physical bullying, and cyberbullying‍ leading to physical injury, psychological distress, and even suicide. The prevalence and consequences of bullying among LGBTQ youth are increasingly well understood, yet successful efforts to address LGBTQ bullying are lagging, as reported in an article in Pediatrics last month. The articles goes on to summarize findings from a national symposium in 2016 on how pediatricians can focus on LGBTQ bullying via clinical care, research, interventions, and policy.

To give us more perspective on this issue, we talked with Debra Weissbach, MD, FAAP, a pediatrician at Children's Hospital of Philadelphia Primary Care, Mount Laurel in Mount Laurel, NJ.

Do you think more pediatricians will play a more active role in trying to identify LGBTQ youth to help deal with the issue of bullying?
For many of us, our training did not include issues of gender and sexual identity, but it behooves us to educate ourselves so that we can support our patients. We need to become more adept at both identifying and supporting LGBTQ youth. For many of them, the pediatrician is the first adult with whom they will acknowledge their true identities. One of the unique things about pediatrics is that we have the opportunity to develop relationships with children over time through all stages of development.

We can often pick up on cues that might suggest that a child is struggling with his/her/their identity or that they are being stigmatized in school. The pediatrician can be a safe person in whom a child can confide. An understanding of the evidence supporting the positive outcome that pediatricians can have on the lives of these children will result in our greater involvement in addressing all of their concerns, including bullying.

We need to start by creating inclusive and welcoming environments in the health care setting so that children and parents feel comfortable addressing all aspects of their health, both physical and emotional. Providing opportunities for our patients to speak with us alone is beneficial as often times children are uncomfortable discussing issues of identity in the presence of parents.

Being aware of bullying as a possible cause for physical complaints enables us to provide appropriate guidance and support. We need to be aware of the resources in our communities, including mental health providers with appropriate expertise to treat these children.

How have you dealt with this issue?
I have had the opportunity to care for youth who identify as gay as well as those who are transgender. My experience is that transgender youth are more stigmatized and deal with a greater degree of bullying than cisgender students who identify as gay. (Cisgender refers to someone who identifies with their gender assigned at birth.) I have provided guidance for parents who need support and advice in advocating for their children. I have tried to facilitate communication with schools, often in the form of letters, to create safe learning environments. Youth are unable to learn and thrive when marginalized by their peers and it is the responsibility of the school to create a safe learning environment.

I have accessed other professionals to assist in school advocacy. Although many districts have anti-bullying policies, not all schools specifically address the stigma-based bullying experienced by their LGBTQ students and I believe that this needs to be changed. I have reinforced for families that it is not the fault of the victim of bullying nor should they feel ashamed of their stated identity. Such victimization and shame exacerbates the anxiety and depression experienced by many these children. Frequently, the most important thing that I do is listen and affirm.

What's your advice to parents who suspect their child could be LGTBQ, but hasn't opened up yet?
I think children will open up in their own way and in their own time when they know that they are loved, valued and respected regardless of their differences. Open-ended respectful conversations at home, that include discussion of individuals and identities unlike ourselves, enables children to feel secure if they too are different from their peers.

Are you concerned some parents may shun their child for coming out?
Yes, it is not uncommon for a parent to have difficulty accepting their child's sexual orientation or gender identity (or both) when it is different from their own. Providing guidance and resources for parents to process what may be difficult information is an important role for pediatricians as well.

What resources are out there to support LGTBQ youth and their families?
The Gender and Sexuality Development Clinic at CHOP provides comprehensive care and school advocacy for transgender and gender nonconforming youth.

PFLAG (formerly Parents, Families and Friends of Lesbians and Gays) is a national advocacy group with multiple local chapters.

Gay Straight Alliance (GSA) is in many high schools.