The Journal of the American Medical Association reported that one out of every three students in grades six through 10 is the victim of bullies. Joe Childs, MD, vice president of medical services and medical director of the pediatric intensive care unit at East Tennessee Children's Hospital, offers the following answers to questions about bullying and gives advice to parents about how to prevent and deal with the issue.

What is bullying exactly?
Bullying is difficult to define, because in today's society it extends much further beyond someone taking your child's lunch money or pushing him or her around on the playground, and the effects of this type of behavior go much deeper than a black eye. Teasing, taunting, ethnic slurs and sexual harassment are all forms of bullying. Bullying behavior is generally repetitive hostility and aggression directed toward a victim who is physically or mentally weaker than the bully. This can come in various forms:

• Physical bullying. This is perhaps the most obvious form of intimidation. It can be anything from intentionally bumping into another child in the hall to hitting or threatening with a weapon.
• Verbal bullying. This can include name-calling, spreading rumors and persistent teasing. Girls typically bully and are bullied this way.
• Emotional intimidation. A bully may deliberately exclude a child from a group activity like a class party. The bully may also make other kids turn against a child by not letting that child play with them. Emotional intimidation is closely connected to physical and verbal bullying.
• Racist bullying. Racial slurs, spray painting graffiti, mocking the victim's cultural traditions and making offensive gestures are all examples of racist bullying.
• Sexual bullying. This form or bullying is characterized by unwanted physical contact or abusive comments.

Why are some children bullies?
Just like their victims, bullies often have low self-esteem. They pick on kids who are weaker than they are to feel more important or powerful. This behavior is a way of dealing with their own problems, like a difficult situation at home. Some bullies have been victims of abuse themselves.

How can I tell if my child is a victim of bullying?
Ideally, a child will tell an authority figure if he or she is in danger, but some children may be embarrassed or feel weak by admitting to being the victim of a bully. Also, the effects of bullying aren't always as obvious as a black eye. Some signs to look for include:

• Avoiding school. A child may suddenly invent mysterious illnesses or stomachaches to avoid going to school.
• Changing behavior. A child may react to being bullied in a number of ways. Some children become withdrawn or moody, while others become overly aggressive or violent.
• Showing pain. Bruises and scratches may be a sign a child has been bullied, but these can be common in active youngsters. Parents and caregivers should pay close attention to a pattern of bruises that the child can't explain.
• Losing possessions. If a child starts mysteriously misplacing his or her favorite toys, he or she could be the victim of a bullying. Bullies will sometimes intimidate their victims into handing over their belongings.

My child is being bullied at school. What can I do to help?
First of all, do not overreact. It's understandable to be upset, but try not to let your child see that, because he or she might interpret it as you being upset with him or her. Listen to and assure your child that he or she did the right thing by telling you about the incident.