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Traveling abroad for health care is referred to as medical tourism & globally, it’s a $120 billion business. The reason why an employer might offer medical tourism benefits is for cost savings on medical care & here are the top 5places where employees travel along with the most common procedures they have done.

Austria tops the list with it being a destination that most people want to visit. Top procedures are orthopedic such as hip, spine, & knee surgeries and cardiac care.

The next destination is a clean very modern country with phenomenal healthcare Singapore.   Singapore can handle very complex cases mostly related to organs such as liver, pancreatic, & kidney.

John Hopkins Hospital known for its orthopedic surgeries has a location in Panama.

Colombia ranks among the top three countries in healthcare delivery for orthopedic surgeries.

Mexico also makes the list with the most common procedures being preformed include hip, knee, & spinal surgeries, as well as dental work.

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ABC World News reports children with autistic brains have heavier brains and an overabundance of brain cells called neurons suggests a new study.

Autism might be the result of abnormal brain growth and development has been the suspicion among Autism researchers. It has been proven that Autistic children have larger brains along with larger heads, & that brain regions crucial for social, emotional, & communication processing are particularly larger than normal.  This particular study is the first to count the actual number of brain cells & first to provide hard evidence of higher than normal brain development.

Scientists investigated the brains of 13 deceased boys who were donated for scientific study from age 2 to 16 seven of whom had autism & six who did not. Using a precise microscopic technique, the researchers counted the neurons in the brains of these children.  The study is published in the Journal of the American Medical Association.

The study found that the brains of the autistic children had 67 % more neurons in the region called the prefrontal cortex, an area linked to social, emotional, & communication processing. These functions are typically lacking in an autistic person. The weight of the children’s’ autistic brains also weighed an average of 17.5% more than the brains of children without the disorder.

Eric Courchesne a neurobiologist at the University of California & who wrote the findings of this study found the results to be surprising & dramatic.  The study was not expecting such a dramatic find & difference. With autistic children, something goes wrong in the brain development before birth. The brain doesn’t generate new neurons in the prefrontal cortex after birth, which this happens during prenatal development. During a baby’s development pre-birth, during the 10th or 12th week of gestation, the baby’s brain typically goes through a boom of neural growth & the number of neurons nearly doubles. Then this is followed by half of the brain cells die away leading to a normal brain size. This cycle allows the brain to organize itself & for neurons to establish connections with each other, but if the brain ends up with an overabundance of neurons, those connections could be disturbed. Previous studies have proved that connectivity is the key that’s disrupted in autism.  If there is an increase in the numbers of neurons, there is going to be a disconnection how they link up with other neurons.

Crucial genetic links to how an autistic child’s brain develops have been found in previous studies.  Scientist is hoping that studies like these could lead to more effective screening & treatment for the disorder. If scientists know what has gone wrong in the development, then they have a better idea of how to screen kids for autism, & how to treat them.

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This is a great resource for all of our clients to when they need any kind of labwork done outside of preventative.

www.DirectLabs.com/texhal

Lab work for:

Allergy Testing, Anemia , Arthritis , Autism , Cancer , Cardiovascular/Heart Health , Diabetes , Gastrointestinal , General , HCP Panels , Hormones , Immunology , Men’s Health , STD’s , Thyroid  , Women’s Health , Miscellaneous , Test Packages , VitaminsFirst time users must create a MyDLS account by clicking on the link above then registering. Your secure MyDLS account is where you will print your requisition, submit HIPAA release forms, and access your results. If you need any assistance, please call 1-800-908-0000 and give the code R-THL.

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Plush, soft, fuzzy, warm, and cuddly – those seem like the perfect attributes for a newborn nursery.

Except if you’re the newborn.

A new policy from the American Academy of Pediatrics says that babies who sleep on their back on a firm, flat surface – in their own unadorned crib – are most protected from sudden infant death syndrome (SIDS) and the deadly related tragedies of suffocation, asphyxiation, and entrapment.

The AAP released its newest guidelines Oct. 18 for infant sleep safety and SIDS risk reduction (Pediatrics 2011 Oct. 17;doi:10.1542/peds.2011-2285). The take-home message for pediatricians and parents alike is a simple one, Dr. Rachel Moon said at a press briefing.

“Put baby on the back for every sleep. Use a firm sleep surface designed for infants, with no soft objects, wedges, positioners,” or any other fashionable accoutrements such as ruffles, blankets, crib drapes, or bumper pads.

The ideal sleeping set-up? A crib, bassinet, or portable crib/play-yard in mom and dad’s room, with a firm mattress, a tight-fitting bottom sheet, and no blanket or other baby-dangerous decorative items.

Although such adornments may satisfy a parent’s fashion sense, they make no safety sense at all, said Dr. Moon, the policy’s primary author and a pediatrician at the Children’s National Medical Center, Washington.

Since 1992, when the AAP first launched its “Back to Sleep” campaign, SIDS cases in the United States have decreased by 50%. “But we’ve seen an alarming increase in other deaths,” Dr. Moon said. “There has been a quadrupling of infant deaths due to suffocation and entrapment, and a lot of this is attributable to inappropriate bedding and to cosleeping” with parents.

Those deaths – grouped together as sudden unexplained infant deaths (SUID) – can’t always be distinguished from SIDS, she noted. SIDS infants probably have some vulnerability that predisposes them to an unexplained death, whether that is an inborn error of metabolism, prematurity, or exposure to cigarette smoke. SUID may occur either among those infants or among those who have no identifiable risk factors. Other than a coroner’s exam – almost universally unhelpful – there’s no way to tell these deaths apart.

The safest course is to make sure that infants have the safest possible sleep accommodations. The bare crib eliminates a number of dangerous factors that can cause an accidental infant death.

The new policy also tackles the controversial subject of cosleeping. The family bed has been promoted among many circles as the most natural way to care for a newborn. Some groups – and even physicians – have suggested that cosleeping may help prevent SIDS.

There are no data to support those claims, Dr. Moon said. In fact, cosleeping can put the infant at risk of smothering under heavy covers, airway obstruction if an adult limb falls across its face, and even overheating – a recognized SIDS risk factor.

Bed sharing is even more dangerous with adults who are medicated or have consumed alcohol or drugs, Dr. Moon added. Those adults will be less aware of their movements and whether they might endanger the sleeping infant.

“There has been a quadrupling of infant deaths due to suffocation and entrapment, and a lot of this is attributable to inappropriate bedding and to cosleeping.”

Parents shouldn’t worry that babies might choke on their own secretions when sleeping on their backs, Dr. Moon said. Babies have built-in protective physical guards against choking. There’s also no evidence that placing newborns on their sides helps drain amniotic fluid or other secretions from their lungs. Moms who choose rooming-in after delivery should also put their baby to sleep in the supine position and request that nurses do the same.

Preterm babies and those with low birth weights are especially at risk for SIDS, Dr. Moon said. Even infants in the neonatal intensive care unit should sleep supine as soon as they are medically stable.

The AAP policy stresses the protective influence of breastfeeding, but notes that infants who come to the adults’ bed for nighttime nursing should go back to their own crib after feeding.

“Because of the extremely high risk of SIDS and suffocation on couches and armchairs, infants should never be fed on a couch or armchair when there is a high risk that the parent might fall asleep,” according to the policy’s authors.

The AAP policy gives the pacifier its proper place as well. Pacifiers seem to protect against SIDS, although the mechanism isn’t really understood, Dr. Moon said. “It seems to have something to do with stimulating arousal,” as the babies suck during sleep.

But if the plug comes unplugged during the night, don’t worry, she said. “Parents don’t need to worry about putting the pacifier back in the baby’s mouth, especially if the baby doesn’t seem to want it.”

But Dr. Moon warned parents to never, ever attach a pacifier to an infant’s clothing in any way, especially with a string or ribbon around the baby’s neck.

Immunizations also protect against SIDS, so it’s critical to keep babies up to date with vaccinations, she said. And adults should never smoke around infants. Infants exposed to cigarette smoke are at a significantly increased risk of unexplained infant death.

Despite all the talk of supine positioning, supervised “tummy time” in which infants are allowed to lie prone for some time is also important, Dr. Moon added. Tummy time is an important way for infants to develop neck, back, and arm muscles, and prevent positional plagiocephaly.

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NATIONAL HARBOR, Md.  – Frequent hot flashes in menopausal women were significantly associated with higher levels of low-density lipoproteins, high-density lipoproteins, and triglycerides during a 7-year follow-up study of 3,201 women enrolled in an ongoing longitudinal study.

Women who reported 1-5 days of hot flashes or 6 or more days of hot flashes during the past 2 weeks were significantly more likely to have elevated levels of LDL cholesterol.

Previous investigations using the Study of Women’s Health Across the Nation (SWAN) database have shown that women with more hot flashes have an elevated risk for subclinical cardiovascular disease, said Rebecca Thurston, Ph.D., of the University of Pittsburgh. But “there is a lot we don’t know about this association, including what could possibly explain this,” she said at the annual meeting of the North American Menopause Society.

Dr. Thurston and colleagues examined hot flashes as they related to lipid profiles in women enrolled in SWAN. The subjects’ median age was 46 years, 48% were white, 46% were in early or perimenopause, and 26% reported hot flashes within the past two weeks.

Hot flashes were analyzed in relation to six lipid profiles, after controlling for age, race, menopausal status/cycle day, alcohol use, physical activity, smoking, anxiety, body mass index, cardiovascular disease status and medications, lipid lowering medications, and estradiol.

Compared to women who reported no hot flashes, women who reported 1-5 days of hot flashes or 6 or more days of hot flashes during the past 2 weeks were significantly more likely to have elevated levels of LDL cholesterol, triglycerides, apolipoprotein B, and apolipoprotein A1. For example, LDL levels among women with 6 or more days of hot flashes peaked at approximately 125 mg/dL during a 2-week period, compared with a peak of approximately 120 mg/dL among women with 1-5 days of hot flashes and a peak of approximately 118 mg/dL among women with no reported days of hot flashes.

Levels of HDL cholesterol were significantly higher in women who reported 6 or more days of hot flashes during the past 2 weeks, compared with those who reported no hot flashes, but HDL levels were not significantly different between women who reported 1-5 days of hot flashes and those who reported no hot flashes.

By contrast, levels of lipoprotein(a) were not significantly different among women who reported no hot flashes, women who reported 1 to 5 days of hot flashes, and women who reported 6 or more days of hot flashes.

The positive relationships between hot flashes and lipoprotein(a), and between hot flashes and HDL in some women, were surprising, Dr. Thurston said. “The cardioprotective nature of HDL may depend on particle size,” she noted. HDL particles become smaller as women transition through menopause, she added, which might explain the differences.

Additional studies are needed to address the findings on HDL and lipoprotein(a) and to explore how vasomotor symptoms may provide additional information about women’s vascular health, Dr. Thurston said. Future studies should be designed with improved measures of vasomotor symptoms, she added.

The study was supported by a grant from the National Institutes of Health. Dr. Thurston had no financial conflicts to disclose.

By: HEIDI SPLETE, Family Practice News Digital Network

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The recent finding that active-duty soldiers are at a significantly elevated risk for osteoarthritis may have relevance for the civilian population.

Data from 10 years of military medical surveillance data showed that active-duty U.S. military service members who are 40 years of age or older are twice as likely to be diagnosed with osteoarthritis (OA) as their peers in the general population.

The study also found that, when researchers controlled for other factors, women had a 20% higher rate of OA compared with men; the incidence of OA in service members 40 years or older was almost 19 times higher than service members less than 20 years old; members of Army had the highest incidence rate of OA, followed by Air Force, Marine Corps, and Navy; and junior service members had the highest incidence rate of OA, followed by senior enlisted, senior officers and junior officers.

The study found 108,266 incident cases of physician-diagnosed OA in the military’s Defense Medical Surveillance System (DMSS) between 1999 and 2008. Among the study’s other findings were that the incidence of OA was most likely to be increased among soldiers who were women, black, somewhat older, in the Army rather than another branch of the military, or of enlisted rank (Arthritis Rheum. 2011;63:2974-82).

A number of factors may explain the increased incidence of OA among soldiers. Traumatic knee injuries are common among military service members, according to the study’s authors and studies by other groups (Am. J. Sports Med. 2010;38:1997-2004; Mil. Med. 2007;172:90-1; J. Bone Joint Surg. Am. 2003;85-A:1656-66; Am. J. Prev. Med. 2000;18(suppl 3):33-40).

This population is “very active, constantly traveling, training, attending sporting activities, so they’re engaged in high-demand activities,” said Kenneth L. Cameron, Ph.D., the lead author of the study, and director of orthopedic research at the Keller Army Community Hospital, West Point, N.Y. Also, several studies of professional athletes, such as soccer players, have shown that knee and hip OA are common among them (Foot Ankle Spec. 2011 Sep 30. [Epub ahead of print]).

Osteoarthritis, the most common form of arthritis, is one of the leading causes of disability and medical discharge in the military, according to the authors. “The rates of OA can affect force readiness,” said Dr. Cameron.

Dr. Cameron and his team queried 10 years of data in DMSS, which captures almost all medical visits for all four branches of military, by sex, race, age, branch of military service, and rank. They used International Classification of Disease, Ninth Revision (ICD-9) code 715 (osteoarthrosis and allied disorders.)

The results showed that between 1999 and 2008, there were 108,266 incident cases of OA, and 13,768,885 person-years of follow-up were documented. The overall incidence rate was 7.86 per 1,000 person-years. That is roughly an average of 10,827 incident cases of OA each year among 1,376,889 active duty personnel.

For comparison to the general population, the authors used Canadian studies by Dr. Jacek A. Kopec and colleagues (J. Rheumatol. 2007;34:386-93; Arthritis Rheum. 2008;59:929-34). The Kopec groups’ findings, when calculated for the comparable age group, showed an OA incidence rate of 7.19 per 1,000 person-years in the general population.

Dr. Cameron said the lack of comparable studies to his study groups is “likely because the U.S. general population does not have free and open access to healthcare like they do in Canada and active duty U.S. service members do through the Military Health System.”

So using available data that were most comparable to the study’s design and criteria, the authors concluded that rates of OA were significantly higher in the military populations when compared with similar age groups in the general population.

Comparisons also showed that the incidence rate of OA in military service members in the 20-24 year age group was 26% higher than those in the general population.

Dr. Amanda Nelson noted in an interview that “[t]his study is a nice addition to the literature. … It gives us an idea that, despite all of its caveats, members of the military are at risk for osteoarthritis at a younger age compared to the general population.”

“So the question is, what do we do for younger people with osteoarthritis? Is there a way to slow progression? We don’t yet have a lot of proven treatments for osteoarthritis,” said Dr. Nelson, of the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill.

Epidemiological studies of OA in the general population have shown that old age, female gender, being overweight or obese, knee injury, repetitive use of joints, black race, muscle weakness, and genetics play a role in OA development (Clin. Geriatr. Med. 2010;26:355-69).

Meanwhile, no medications have proven effective in preventing OA, and research on cartilage repair is still developing.

Black race was also shown to be associated with higher incidence rate of OA, compared with white race and those in the “others” category.

A few studies, including several by Dr. Nelson’s group, have shown that blacks are more likely to have severe knee and hip OA. “This study confirms our findings,” she said.

The authors cited several limitations, including potential for coding errors, potential for information bias due to misclassification of the outcome of interest, lack of incidence rates for specific sites, and definitions used for incident cases of OA (physician-diagnosed vs. patient self-report, radiographic criteria or combination of both.)

Despite its limitations, some experts believe that the study’s findings support those of previous reports on OA.

Dr. Thomas M. Link, professor of radiology and clinical director of musculoskeletal and quantitative imaging research at the University of California, San Francisco, said, “The key message is that prevention is more important than anything else.”

Several programs such as RunSafe Healthy Runners Clinic at the University of California, San Francisco, try to reduce the odds of injury by making slight modifications in how the athletes run, and their work has proven effective, said Dr. Link.

“I think what we found in the study is consistent with what we expected. The next question is why that is, and what are the modifiable risk factors,” said Dr. Cameron.

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Bullying exists as more than just a buzzword these days: it’s a serious issue that’s been troubling individuals and societies worldwide for centuries and is only just now receiving the essential attention. An article such as this cannot entirely summarize the social disease’s true complexities, so it focuses mainly on the education sector. Even then, not everything comes to light. It does, however, offer up a quick overview of the various ways in which children and teens emotionally and physically suffer as a result of others’ cruelty. Looking at some numbers behind the plague’s ravages marks the first step in combating it for good. Spend this Bullying Prevention Month researching beyond the statistics listed here, and start fighting the good fight and standing up for victims in November.

1. Thirty-three percent of kids say they’re bullied “every once in a while, but not every week”-  By contrast, eight percent report it happening on a daily basis, seven percent say every week, and 52% say they’ve never experienced bullying at all.

2. Fifty-eight percent of kids say they’ve never bullied a peer.- Scarily enough, 15% reported that they do it every day, and 22% consider bullying a “once in a while” activity. Only five percent engage in bullying behaviors on a weekly basis

3. Victim-blamers are more likely to bully- An upcoming (at the time of this writing) study showed that elementary and middle school students are far more likely to brutalize one another if they feel a specific trait is the victim’s fault. Perspectives painting the obese as nothing but a choice, for example, even though numerous other genetic and medical factors beyond their control might be at play.

4. Around five percent of students avoid school outright- Some school avoidance might not stem directly from bullying, but it’s still a very common motivator all the same. Depression and anxiety amplify in victims, causing physiological side effects and making many feel too ill to attend class. These behaviors not only negatively impact their health, but academic performance as well.

5. Apathy and fear motivate office bullying- And these negative emotions snake their way down the hierarchy if those in power positions feel isolated from decision-making processes. Unfortunately, many “hands-off” companies ultimately facilitate office bullying with their lax policies and enforcement, which particularly screws over lower-level employees.

6. Four out of five LGBTQIA teens feel like they have no support from teachers and administrators- Both in and out of school, members of the LGBTQIA community remain some of the most vulnerable to bullying. When it comes to high schoolers, many feel as if no authority figures will guide them through regular brutality, leaving them more entrenched in depression and anxiety and at risk of self-destructive and suicidal behaviors

7. Twenty-two percent of LGBTQIA teens have skipped school for safety reasons- Within the past month, by the way. And thinking the adults in their high schools don’t care only exacerbates their desperate situations.

8. There are three “styles” of bullying- Verbal, which involves any sort of aggressive, spoken taunts, insults, threats, hate speech and other piercing, damaging words. Physical, which should be self-explanatory. And social, which manifests itself via rumors, purposeful exclusions and other words and actions meant to isolate and ostracize from further away.

9.Bullying increases the risk of suicidal thoughts and behaviors- In both victims and perpetrators, interestingly enough. However, the former are more at risk of suicidal actions, while guilty parties usually think more than behave. Females admitted to these unfortunate psychological constructs more often than males, although they plague both demographics

10. No state has passed laws regarding hazing or cyberbullying- However, every state except for South Dakota does have legislation guarding against harassment and/or bullying, so victims and, when applicable, their parents might want to be aware of what charges can and cannot be pressed. Unfortunately, though, the lack of cyberbullying and hazing laws makes it more difficult to defend the bullied brutalized from such situations.

11. More than half of minority students receive race- and ethnicity-related slurs in school- This statistics includes Latin American, Black/African-American, Asian, Pacific Islander and mixed-race students. Native Americans, however, experienced such bullying at a lessened, but still disconcerting, rate, at 43% reporting verbal harassment regarding their race and/or ethnicity. Roughly a quarter of Asian, Pacific Islander and Black/African-American kids and teens compromise their attendance in order to stay away from their bullies.

12. Native American students receive more bullying for their religious views than anything else- Although bullying targeting their race and ethnicity happens at a lower rate than their minority peers, 54% of Native American students suffer from verbal harassment regarding religion. A further 26% find themselves physically victimized for the same reasons. Over one-third end up skipping school to avoid persecution, making them and Latin Americans (whose statistics remain similar) the most likely to fall behind academically as a direct result of bullying.

13. Less than half of bullied minority students report incidents- Many feel as if teachers, administrators and even parents won’t properly address the issue, maybe even ignore it entirely. Of the individuals who do report bullying, less than half claimed the intervening adults did little to actually assuage a continuing problem

14. The staggering majority of school bullying situations receive no intervention- Eighty-three percent, in fact. Only four percent of incidents involve intervening adults, and 11% see peers coming to victims’ defenses or acting as mediators. Seeing as how school bullying happens every seven minutes, that means a stomach-churning, heart-wrenching amount of students suffering alone.

15.Most kids are cyberbullies…and most kids are cyberbullied- Abusing one another online is apparently the hot new trend. Although 58% of children say they’ve received threatening or insulting comments online, with 40% saying it’s happened on multiple occasions. However, many of these victims turn right back around and lay the pain on others, as catharsis one would imagine. Fifty-three percent admitted they themselves perpetuated cyberbullying, and one in every three bullies said they did it more than once.

16. Eighty percent of arguments end in physical altercations- Arguments with bullies, of course. In fact, around 282,000 secondary school students end up attacked on campus every month, and one out of three report overhearing death threats.

17. Most education professionals consider bullying a “minor problem:” - Only eight percent think it serious or critical, as opposed to 35% for moderate, 47% for minor and, scarily enough, 10% for “not a problem.” However, the numbers do go up a bit when it comes to urban (15% consider bullying a major issue) and middle (15%) school professionals.

18.Most education professionals witness bullying approximately once a month- Approximately 25%, with 13% claiming they never saw any at all, 25% reporting two to three times a month, 16% saying once a week, 15% witnessing bullying several times a week and nine percent, sadly, watching it happen daily. All of this going down within the span of a month. Once again, rates increased in urban and middle school settings.

19. Eighty-nine percent of education professionals think it their job to intervene- On a less somber note, the majority of teachers and education support professionals do consider bullying intervention part of the job description. Now it’s just a matter of reaching out to and changing the hearts of the two percent who don’t.

20. The majority of schools have “formal bullying prevention efforts,” but not as many as one would think- Only 58% of American schools hold explicit anti-bullying policies and programs, although 62% of both the elementary and high school levels provide such services. Unfortunately, only 39% of educational professionals admit they take part in any available bullying prevention efforts. And schools without more formalized policies still have some sort of rules against it: 93% of all institutions, in fact.

21. But what’s the point, if only 54% of educational professionals receive anti-bullying training? - Which means 46% of teachers and education support professionals have no idea how to handle a bullying situation when it crops up. That certainly bodes well for their victimized students!

22. Twenty-one percent of middle and high schoolers report gang presence on campus- Within the previous six months, however. Students in urban areas with high gang activity are also twice as likely to fear commutes to and from school, as gang activity does increase one’s risk of becoming a bullying victim.

23. No gender delineation exists in bullying- Both males and females (if one must go with a bipolar gender model, anyways) are just as likely to be victims and perpetrators in a bullying situation. However, the ladies utilize social methods more than physical, while the menfolk prefer fists for fighting. In addition, public and private school dwellers hover at roughly the same bullying rates.

24. Six percent of students carry weapons to school- Although the rate dropped by half between 1993 and 2003, that number should still warrant concern. These findings, however, did not indicate motivations behind the presence of weapons, but many can presume self-defense ranks pretty high up there. In fact, four percent of students explicitly avoid certain corners of campus to protect themselves.

25. Teachers get bullied, too- Nineteen percent of principals reported that their teachers received taunts, threats and other disrespectful comments and actions on a daily or weekly basis. Student bullying most frequently receives media attention and scientific studies, but it happens to adults as well, both inside and outside the classroom.

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Thank you to Carol Brown onlinecollege.org  Sites like stompoutbullying.com, healthychildren.org, & kidshealth.org for all the information!

ON 10/21/2011another Texas Health insurance carrier left the market.  World Insurance/American Republic Insurance owned by American Enterprise has decided that because of the changes in the major medical marketplace and resulting uncertainties brought on by the regulatory enviroment has made the decision to exit individually written comprehensive major medical insurance business.  They will be cancelling all policies that are individual health.

They will give options to customers to make a clean switch to Celtic Insurance with no underwrting required but it must be done within a certain time period.

If you are customer of individual health insurance affected by this change in Texas please contact one of the agents at Texas Health and Life to find out the best options for you or your family moving forward.

Live Well!

Texas Health and Life

It is no joke that Laughter is truly the best medicine!

A recent US study monitored 20 people with diabetes who were at high risk for heart disease.  The researchers directed one group to watch funny videos for 30 minutes a day.  The other group did nothing different.

After 12 month the blood pressure and cholesterol of both groups measured-and there was a big difference! The people who laughed regularly experienced:

Lower stress

Reduced Inflammation

Higher good cholesterol levels

One simple thing we can all do to help improve our health!

Live Well!

Texas Health and Life

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Not long ago, the idea that a preschooler could be a bully seemed crazy to me. But my outlook changed when my son Nicky was 4. A bruiser of a boy in his class would chase girls around the classroom and pinch them for fun. He frequently punched and smacked kids, and I once saw him kick a child who was playing with a wagon he wanted. The teachers spent a lot of time reprimanding this boy and explaining what “okay” behavior was, but his menacing acts continued and Nicky learned to steer clear of him.

That was just the beginning. In kindergarten, Nicky encountered a handful of kids who bothered everyone during recess. Last winter, a classmate told a girl he wanted to cut off her hair with a knife. The vice principal set up meetings with each class during which the teachers explained that every child has the right to feel safe at school.

These examples may sound extreme, but they aren’t. Bullying, the act of willfully causing harm to others through verbal harassment (teasing and name-calling), physical assault (hitting, kicking, and biting), or social exclusion (intentionally rejecting a child from a group), used to be something parents didn’t need to worry about until their child was a tween. Now it has trickled down to the youngest students. In fact, some research shows that tormenting has become even more common among 2- to 6-year-olds than among tweens and teens. “Young kids are mimicking the aggressive behavior they see on TV shows, in video games, and from older siblings,” explains Susan Swearer, Ph.D., coauthor of Bullying Prevention & Intervention.

A National Epidemic

Overall, bullying in schools has become a national epidemic. A study published in the Journal of School Health found that 19 percent of U.S. elementary students are bullied. And each day, more than 160,000 kids stay home from school because they fear being bullied, according to a survey by the National Education Association, a public-education advocacy group.

“Being bullied can have traumatic consequences for a child, leading to poor school performance, low self-esteem, anxiety, and even depression,” says Parents advisor David Fassler, M.D., clinical professor of psychiatry at the University of Vermont, in Burlington. Research published in Archives of General Psychiatry revealed that kids who were bullied at age 8 were more prone to psychological problems as teens and early adults. Further, a University of Washington School of Medicine study found that elementary-school kids who are victims of bullying are 80 percent more likely to feel “sad” most days.

Harassment has become such a serious threat to kids’ health that the American Academy of Pediatrics issued its first official policy statement on the subject last year. It encourages physicians to raise awareness in their local schools and to provide screening and counseling for child victims and their families.

How A Bully Is Born

There’s a fine line between thoughtless or selfish actions and true bullying among young children. Most experts agree that a child crosses the threshold if his actions are intentional and if they occur habitually. Why do some kids choose to inflict physical or emotional pain on others? “Bullies tend to have low self-esteem,” says W. Michael Nelson, Ph.D., coauthor of Keeping Your Cool: The Anger Management Workbook, which is designed to help counselors who work with aggressive kids. “They lack empathy and have a need to dominate others.”

Preschoolers are still mastering basic social skills and figuring out how to manage their own emotions, so their overly assertive actions may simply be a way of testing the boundaries of what?s acceptable. “Teasing and grabbing are part of every little kid’s development,” says Dr. Swearer. At this age, a kid acts less deliberately and is more likely to torment whichever child is around her at the moment.

By kindergarten, children begin to grasp the concept of social power among their peers, notes Elizabeth K. Englander, Ph.D., director of The Massachusetts Aggression Reduction Center at Bridgewater State University. That’s when aggressive kids start to actively target others whom they see as vulnerable — whether it’s because they’re shy, sensitive, small, or simply different.

Teachers tend to respond differently to a bully depending on his age. In preschool, they make an effort to instill kinder, gentler behavior. But by elementary school, their emphasis shifts toward protecting the victims. However, this overlooks the fact that it’s not too late to reform a budding bully, says Dr. Swearer. “Some kids need guidance with conflict resolution well into middle and high school.”

While teachers do their best to control bullying, they can’t always be there to witness or prevent it. School administrators may not even be aware that bullying is occurring. Victims tend to keep quiet because they fear they might be treated even worse if they tattle. And in some cases, principals simply don’t know how to deal with the problem. A recent national poll from the University of Michigan C. S. Mott Children’s Hospital found that only 38 percent of parents would award their child’s elementary school with an “A” grade when it comes to preventing bullying and violence; 16 percent rated their school a “C”; 6 percent a “D”; and 5 percent gave it a failing mark.”

The Right Steps to Deal with Bullying

Ultimately, it’s up to you to help your young child deal with a bully. Be on the lookout for signs that something is bothering her, and gently encourage her to tell you about problems she’s had with other kids. Then be ready to take the appropriate action.

• Talk to your child’s teacher. If the harassment is happening at preschool or kindergarten, make administrators aware of the problem right away. Many schools have a specific protocol for intervening. When you report an incident, be specific about what happened and who was involved.
• Contact the offender’s parents. This is the right approach only for persistent acts of intimidation, and when you feel these parents will be receptive to working in a cooperative manner with you. Call or e-mail them in a non-confrontational way, making it clear that your goal is to resolve the matter together. You might say something like, “I’m phoning because my daughter has come home from school feeling upset every day this week. She tells me that Suzy has called her names and excluded her from games at the playground. I don’t know whether Suzy has mentioned any of this, but I’d like us to help them get along better. Do you have any suggestions?”
• Coach him to get help. No matter how your child is being targeted, fighting back usually isn’t the best solution. Rather, teach him to walk away and seek help from a teacher or a supervising adult. To avoid being harassed on the school bus, suggest that he sit next to friends, since a bully is less likely to pick on a kid in a group. But you may need to get involved. When Karin Telegadis’s daughter Grace started kindergarten, she had problems with a third-grader on her bus. “He gave Grace an ‘Indian sunburn’ and tried to make her kiss another boy,” says Telegadis, of Princeton, New Jersey. When she learned that the boy had also bothered other kids, she complained to the school and asked the bus driver to keep an eye on him. He stopped misbehaving within two weeks.

Encourage Positive Behavior

• Promote positive body language. By age 3, your child is ready to learn tricks that will make her a less inviting target. “Tell your child to practice looking at the color of her friends’ eyes and to do the same thing when she’s talking to a child who’s bothering her,” says Michele Borba, Ed.D., a Parents advisor and author of The Big Book of Parenting Solutions. This will force her to hold her head up so she’ll appear more confident. Also practice making sad, brave, and happy faces and tell her to switch to “brave” if she’s being bothered. “How you look when you encounter a bully is more important than what you say,” says Dr. Borba.
• Practice a script. Rehearse the right way to respond to a tough kid (you might even use a stuffed animal as a stand-in) so your child will feel better prepared. Teach him to speak in a strong, firm voice — whining or crying will only encourage a bully. Suggest that he say something like, “Stop bothering me!” or “I’m not going to play with you if you act mean.” He could also try, “Yeah, whatever,” and then walk away. “The key is that a comeback shouldn’t be a put-down, because that aggravates a bully,” says Dr. Borba.
• Erin Farrell Talbot, of New York City, prepped her 3-year-old son, Liam, on how to cope with two aggressive boys at day care. “We talked about how if one of them grabs his toy, he should say, ‘No, stop! I’m playing with that!’ in a loud voice,” she says. “They stopped right away. I’m proud because he learned how to stick up for himself.”
• Praise progress. When your child tells you how she defused a harasser, let her know you’re proud. If you witness another child standing up to a bully in the park, point it out to your child so she can copy that approach. Above all, emphasize the idea that your own mom may have told you when you were a kid: If your child shows that she can’t be bothered, a bully will usually move on.

Is Your Kid the Problem?

When your child is the one teasing and threatening, you need to take action right away — not just for the sake of the victims but to nip this behavior in the bud. If you’re unsure, watch for these warning signs:

• She’s impulsive and gets very angry quickly.
• He takes out his frustration by hitting or pushing other kids.
• She hangs out with other kids who behave aggressively.
• He fights bitterly or physically with his siblings.
• She has difficulty understanding how her actions affect others.
• He gets into trouble at school frequently.

If one or more of the above fits your child, have him practice techniques, such as taking deep breaths or counting to ten, to help control his negative emotions. When you see your child acting in a hurtful way, tell him to stop, remove him from the situation, and then talk about what he can do instead next time. However, if your efforts don’t make a dent in his behavior, ask your doctor to recommend an appropriate mental-health professional.

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