WASHINGTON, United States (CMC — The Pan American Health Organisation (PAHO) Monday said it has launched a new initiative that brings together evidence, recommendations and practical tools to prevent and respond to a form of violence that affects millions of children and adolescents across the region of the Americas, including the Caribbean.

It said that the toolkit, “What Works to Prevent Bullying and Cyberbullying of Children and Adolescents in the Americas”, outlines the extent of bullying and cyberbullying, the toll they take on children and adolescents, and the evidence-based interventions that support prevention and response.

PAHO said drawing on evidence from the health, education and social protection sectors, the toolkit also highlights the important role of health services in early identification, comprehensive care and ongoing support for affected children and adolescents.

“Bullying during childhood and adolescence is a form of peer violence that can have significant consequences for physical, sexual, mental, and emotional health,” said Britta Baer, PAHO regional advisor on violence and injury prevention and co-author of the toolkit.

“The good news is that it can be prevented. We have evidence on what works, and this toolkit aims to make that evidence accessible to decision-makers, people who work with adolescents and those who support their development.”

According to PAHO, approximately one in four adolescents aged 13 to 17 in Latin America and the Caribbean reports having experienced bullying at school during the past month, although prevalence varies by country and subregion.

It said bullying takes many forms and often occurs simultaneously in physical, verbal, sexual, and social forms. Patterns also differ by sex: physical bullying is more common among boys, while social and sexual bullying disproportionately affects girls, with different impacts and help-seeking behaviours.

Cyberbullying takes place when someone is harassed, threatened or humiliated through digital platforms such as social media, instant messaging, online games, forums, or other online platforms. In recent years, the rapid growth of digital technologies has transformed the way peer violence occurs.

In some countries in the region, between seven and 27 per cent of children and adolescents report having experienced cyberbullying during the previous 12 months, with higher prevalence among girls.

Unlike face-to-face bullying, cyberbullying can occur at any time, spread rapidly and reach large audiences. The anonymity of perpetrators and the permanence of online content can further amplify its impact and make it more difficult to control.

PAHO said cyberbullying does not occur in isolation and that it often reflects, amplifies or extends patterns of violence that also occur offline, particularly in schools. It may also overlap with other forms of digital violence, including the non-consensual sharing of personal information, identity theft, image-based abuse, and other forms of online control.

According to PAHO, violence and bullying in particular are major determinants of the health and well-being of children and adolescents.

It said bullying and cyberbullying can seriously affect health and development and are associated with increased risks of depression, anxiety, traumatic stress, social isolation, sleep disorders, self-harm, suicidal thoughts, and suicide attempts, as well as negative impacts on educational achievement and social development.

Studies cited in the toolkit show that students who experience bullying are more likely to report feelings of loneliness, sleep difficulties and suicidal ideation than those who do not.

Bullying can also have consequences for physical, sexual and reproductive health, including injuries, psychosomatic symptoms, chronic pain, sleep disorders, and experiences of sexual coercion or pressure. These impacts demonstrate why the response cannot be limited to schools alone and requires the involvement of health systems.

The document also warns that different forms of violence can overlap and reinforce one another. Violence may begin online and continue in person or start in person and be amplified through digital platforms. Early intervention is therefore essential to break cycles of violence and reduce lifelong risks.

PAHO said that sudden behavioural changes, anxiety, irritability, social withdrawal, unexplained injuries, or reluctance to attend school may all be signs that a child or adolescent is experiencing bullying.

It said that in cases of cyberbullying, warning signs may also include sudden changes in behaviour while using or immediately after using digital devices, quickly closing screens when an adult approaches, or reluctance to discuss online activities.

PAHO said that health services can serve as a key point of contact for recognising these signs, providing initial support and referring children and adolescents to specialised services when needed.

The toolkit recommends that health workers incorporate questions about school and digital environments into routine consultations, identify warning signs, assess possible mental health impacts, and provide initial support to affected children and adolescents.

It also underscores the importance of helping families promote safe technology use and coordinating with schools and other sectors to ensure a comprehensive response.

“The most important thing is for children and adolescents to know that bullying and cyberbullying are never acceptable and that they do not have to face them alone,” Baer said, adding, “Seeking help from a trusted adult and using available reporting mechanisms can make a real difference.”