BULLYING

CASE 1
History
J.M. a 7 y.o. female child from Sitio VDR, Purok 1, San Miguel, Cordova Cebu. Patient is the youngest of 4 siblings: Geraldine 12/f, Gerame 10/f, Genevieve 9/f. Lives with siblings and parents, Jelyn and Randy in Cordova. Mother is a housewife while father is a construction worker/ driver. Currently a kindergarten student at a Cogon Elementary School, Cordova Cebu .
Patient came at VSMMC- WCPU with referral from Cordova Police Station and Cordova Social Welfare Office. Incident occurred 1 day prior to consult, 11:30 am, at school grounds. Around that time, the teacher let them off for lunch 30 minutes earlier because of a staff meeting. Patient spent her lunch break at their classroom. While eating, classmates J.C. 8 y.o. male and C. S., 7 y.o., unexpectedly approached her and they suddenly started poking her with a stick around her general genital area. She then cried and went home. She did not approach her teacher or classmates about the incident and opted to go home. At home she was seen with bloodied skirt, shorts and panty. When asked by mother, she reluctantly told her story and admitted that these two classmates usually acts in this manner with her and other classmates. She further claimed that whenever reported to the teacher, they would be reprimanded. However they still continue with the same behavior repeatedly. When asked how many times before she was she hit by a stick, she then admits “ Karun pa man” . Physical Examination
Patient was examined coherent, shy but cooperative and with the following pertinent findings:
HR: 101 RR 25 T 37.3 Ht: 120 cm Wt: 22.2kg
Female genitalia External Genitalia 1. Contusion, bluish-violet, labia majora, Left 2. Abrasion, linear, fresh, red, 1 cm, labia majora, right 3. Laceration, linear, fresh, red, 2cm, labor majora, right 4. Laceration, linear, fresh, red, 1 cm , labia minora, Left
Internal genitalia
Hymen- cresentic, no evident injury

Impression: The anogenital injuries caused by blunt force inflicted by the action of a third party (bullying). Please correlate with child’s disclosure, accounts from witnesses.

Case 2

A case of Diaz, Glenilyn 6 y.o. female child from 516 St. Andrew, Hipodromo, Cebu City. Patient is the youngest of 3 siblings. Lives with mother, 37 years old, housewife and father is a construction worker. Currently, child is a Grade 1 student of Hipodromo Elementary School.
Patient was brought in by mother and homeroom teacher at WCPU at 6 hours prior to consult when at lunch time was seen with a bloodied skirt. Upon interview by teacher, initially would not tell of what happened, then told that maybe she was wounded when she fell from her chair, then from a table. Teacher then repeatedly inquired of the real story and Glenilyn told her that during class while they were doing individual work and was about to let their teacher check hers, she passed Ivan’s chair and he abruptly poked her around the general genital area with a pencil. Glenilyn said “ Nagpuyo raman ko, hait man kaayo iya lapis” then upon approaching back to her chair another classmate, Angel also poked her with a pencil at the back area. Glenilyn also admitted that this was not the first time it happened and she reported that she was usually get hit by hand or any school supply. Asked whom she told the story, she told us that their teacher but would not believe her and asked why she replied “ wala man cya ka kita”. Also, when elaborated who else bullied her, she replied “ daghan man”.
PHYSICAL EXAMINATION

Pertinent Findings
Breast- Tanner Stage 1
External Genitalia- 1. Fresh abrasion with erythema, 1-2 cm, at the medial aspect, Left and superior Right labia majora 2. Erythema, lateral aspect of clitoral hood, bilaterally 3. Swollen clitoral hood 4. Erythema labia minora
Impression: 1. Anogenital findings are diagnostic of blunt force trauma. (Bullying)

Case 3

A case of Tingzon, John Veny 11 y.o. male child from 288 R15, Escario St. Kamputhaw, Cebu City. Patient is an only child. Lives with mother, 45 years old, housewife and father, 42 year old office employee. Currently, child is a Grade 5 student of Lahug Christian School. This was the 2nd visit at the WCPU, last visit was 10 months prior for psychological evaluation. During that first visit, mother was seen by WCPU for physical abuse, perpetrator was husband. Patient was brought for consult at WCPU by mother. Incident happened 2 days prior to consult and narrated that after having lunch, patient was playing with his portable game console and minding h is business when Hans Adrian Castanares , an 11 year old classmate approached him and started teasing him “baboy” . Hans did this repeatedly, chanting “baboy, baboy…” that Veny finally said “ Ayaw na Hans be” , which Veny admitted that was the first he talked back to Hans. Hans then suddenly punched him in the face, this was then made known to the school personnel and bothe parties was called. Veny recounted that this was not the first incident, that the teasing and calling him names started at Grade 3 at the same school. Further conversation with the child yielded that aside from name calling, Hans would also walk by him and hit him anywhere in the body. When asked if he confided with anybody he said, his mom and dad about a month ago but nothing was made. Also, when asked about his first visit at the WCPU, he recalled that his mom was beaten by his dad but immediately added “ wala naman karun, ok naman sila karon.”
Physical Examination
Ht 144cm Weight 60.7 k
HR:81 RR 20 T 37.1
Pertinent Findings
HEENT:
1. Contusion hematoma, violaceous 3 cm x 2 cm at the periorbital area, Left eye 2. Subconjunctival hemorrhage., Right eye

Impression: Physical injuries caused by blunt force inflicted by the action of a third party (bullying). Please correlate with child’s disclosure, accounts from witnesses. Consider child physical abuse.

Case 4

A case of Iway, Jay 12 y.o. male child from Upper Kanulasan, Cebu City. Patient is the eldest child of 4 siblings. Lives with mother, 37 years old, hospital employee and father is deceased. Currently, child is a 1st year student of Ramon Duterte High School. This was the 2nd visit at the WCPU, last visit was 10 months prior for psychological evaluation.
Patient was brought to WCPU by mother. Latest Incident occurred 2 days prior to consult when patient came home with a contused forearm., later when asked confirmed that Kim Salvador hit him in the forearm. He then relates that Kim 12 y.o. and john also an 13 y.o.had started to bully him since the start of school. Also, Jay shared that you only get beaten up if you don’t give them money. While having their afternoon break at school he was approached by Kim asking him to hand over his daily allowance. Jay however refused thus he was boxed. Jay relates that this situation is repeated more than twice a day and happen to almost everyone in class. Also, Jay said that they have informed their teacher about this and concerned parties were called to the guidance counselor of the school and everything was settled. But still Kim and John repeated their behavior over and over again.

Physical exam
Pertinent finding:
HEENT: abrasion, linear, 1 cm, at the nasolabial fold. Left
Extremities: Contusion (2.5 x 4 cm) purplish hue, distal third, anteromedially, forearm left

Impression: 1. Physical Injury (contusion, left forearm) caused by blunt force inflicted by the action of a third party. Please correlate with child’s disclosure, accounts from witnesses. Consider child physical abuse (bullying) 3. Physical injury ( abrasion, nasolabial area) accidentally inflicted.