Corporal punishment is used for discipline in most homes in the United States. It is also associated with a long list of adverse developmental, behavioral, and health-related consequences. Primary care providers, as trusted sources for parenting information, have an opportunity to engage parents in discussions about discipline as early as infancy. These discussions should focus on building parents’ skills in the use of other behavioral techniques, limiting (or eliminating) the use of corporal punishment and identifying additional resources as needed.
Key points
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Corporal punishment is extremely common.
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Corporal punishment is associated with physical abuse in many studies.
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Anticipatory guidance around discipline should focus on building the skills to employ a variety of healthier techniques in an effective and consistent manner.
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Parents using escalating and ineffective discipline or those with psychosocial comorbidities will require additional resources.
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Systematic approaches to addressing discipline in the pediatric office setting can increase effectiveness and consistency.
Introduction
Corporal punishment (CP) includes use of any physical punishment against a child in response to perceived misbehavior. In the United States, this most often takes the form of spanking, but many other forms of CP are widely practiced in the United States and abroad. There can be a fine line between corporal punishment and physical abuse. In the United States, spanking and hitting with an object (such as a belt or switch) in the home are legal, if no significant injury occurs. For practical purposes, some child protective services agencies and consulting physicians use a 24 -hour rule; that is, if a mark from CP lasts greater than 24 hours, injury is said to have occurred, and the fine line between CP and physical abuse has been crossed. CP should be considered in the context of discussions of child abuse for several reasons:
It is associated with numerous harms to the well-being of the child, including adverse developmental and behavioral harms.
It is closely associated with child physical abuse.
It is considered by many child rights advocates to be a form of physical abuse.
This article will consider the harms associated with CP, the clinical context for discussing CP, and the prevention of CP.
Introduction
Corporal punishment (CP) includes use of any physical punishment against a child in response to perceived misbehavior. In the United States, this most often takes the form of spanking, but many other forms of CP are widely practiced in the United States and abroad. There can be a fine line between corporal punishment and physical abuse. In the United States, spanking and hitting with an object (such as a belt or switch) in the home are legal, if no significant injury occurs. For practical purposes, some child protective services agencies and consulting physicians use a 24 -hour rule; that is, if a mark from CP lasts greater than 24 hours, injury is said to have occurred, and the fine line between CP and physical abuse has been crossed. CP should be considered in the context of discussions of child abuse for several reasons:
It is associated with numerous harms to the well-being of the child, including adverse developmental and behavioral harms.
It is closely associated with child physical abuse.
It is considered by many child rights advocates to be a form of physical abuse.
This article will consider the harms associated with CP, the clinical context for discussing CP, and the prevention of CP.
Extent of CP
CP is widespread in the US. Population-based data on spanking is often difficult to compare based on differences in methodology and sampling. The most systematically comparable data on corporal punishment over time comes from the 1975 and 1985 National Family Violence Surveys and the 1995 Gallup survey on discipline. A recent report compared the results from those studies over three decades to 2002 data from North and South Carolina to demonstrate a decline of 18% in spanking over nearly four decades. Analysis was restricted to children between ages three and 11 because spanking very young and older children is less common. Overall rates of spanking have declined 18% from 76.5% (1975—national sample) to 62% (2002–Carolinas) of children three to 11. Spanking peaks among three to 5 year olds, with a rate of 78.8% in 2002, down 4% from 82.2%in 1975. However, this still indicates that a large majority of preschool aged children are spanked. Hitting with an object is reported less often, with a rate of 33.2/% in 2002. This type of punishment peaks somewhat later, with nearly 50% of 7–9 year olds being hit in the past year. It should be noted that this data comes from parent self-report. Therefore the decline might be a real decline in the use of spanking, but it also may reflect a decline in the social acceptability of spanking; increasingly, parents may be reluctant to disclose their use of CP. A more recent study of CP of children less than two demonstrated that 30% of children were spanked in the past year. Further, when analyzed by month of age, 50% of 17 month olds and 70% of 23 month olds were spanked in the last year.
Sequelae of spanking and hitting
Many experts and advocates recommend corporal punishment as an option for discipline or even a necessary part of good parenting. It is clear that corporal punishment can be effectively used to alter immediate compliance, but this effect is short-lived. However, it is also clear that corporal punishment has many unintended consequences. A systematic review of over 300 original articles on corporal punishment demonstrated that corporal punishment has adverse associations in childhood including: moral internalization (i.e. a belief by the child that she/he is bad), aggression, delinquent and antisocial behavior, decreased quality of parent-child relationship, and behavioral problems. In addition, corporal punishment during childhood is associated with long-term consequences later in adulthood: aggression, criminal and antisocial behavior, worse mental health, and abuse of one’s own child and spouse.
Spanking is associated with an increased risk of physical abuse. Previous research has shown that protective services substantiated abuse often results from escalated spanking and is usually in response to perceived misbehavior. Other studies have shown that abusive parents are 3–5 times more likely to spank than non-abusive parents. If a child is spanked often, spanking will become less effective at modifying behavior. If spanking is ineffective, a parent may spank more, harder, or use an object. A recent study reported that spanking frequency and intensity (use of an object) are associated with increasing probability of parents’ reporting that they abused the child.
Spanking very young children may have particularly important consequences. One longitudinal study of CP at age three found that, among girls, CP was associated with a lower IQ. A subsequent study with a much larger sample and more effective control of confounding variables reported that spanking at 1 year of age was associated with aggressive behavior at 2 years of age and lower developmental scores at three compared to children who were not spanked. A recent prospective cohort study reported that spanking at three was associated with increased aggressive behavior at five, further reinforcing that the groundwork for adverse developmental and behavioral consequences of spanking may be laid at a young age. Social learning theory supports these findings. Children that are spanked learn that hitting is the way to deal with anger or frustration leading to aggressive behavior in childhood and adulthood.
Corporal punishment is also a human rights issue. Briefly stated, in most civil societies, it is illegal to strike an adult. Such use of force is considered a violation of human rights. The state of childhood should confer, if anything, special rights, not an abdication of those rights.
Clinical assessment
There are predominantly two reasons parents spank. Either they are angry/frustrated and/or they are trying to change behavior—usually by eliminating an undesirable behavior. The American Academy of Pediatrics recommends that pediatricians begin to assess discipline by 9 months of age. By 8 months of infant age, 8% of parents report spanking, and 5% report spanking as early as at 3 months of age. Primary care providers should consider beginning such discussions by three to 4 months of age.
Case 1: A mother brought her 4 year old to the doctor because he is having school problems. She states in the child’s presence, “he is just bad, he won’t listen, he is just like his dad.” During the course of a 20 minute initial interview, she spanks or swats the child 15 times for touching things in the exam room and speaking out of turn. He barely notices.
Comments on case 1: It is clear that this mother is at her wits end. Spanking is ineffective and used so often that it is clearly extinct and she needs another option. The risk here is that she will spank harder to achieve a desired result. Much of the misbehavior could be eliminated and thus this need for negative reinforcement by engaging the child in a constructive activity (looking at a book). The pediatrician might model soothing and praising, re-directing the child, while asking the mom how she thinks the spanking is working and offering some other options. Motivational interviewing is a useful tool in helping families develop new discipline techniques. Motivational interviewing includes identifying a patient’s self-interest in change, using their own words to express desire for change, planning for change, enhancing confidence by affirming small changes, and strengthening commitment to change. This mother needs a lot more parenting help then you can provide in a typical office visit. She should be referred to a behavioral health professional or care manager if one works in your setting or a local parenting program. The pediatrician should also assess the mother for other psychosocial stressors, such as. depression, substance abuse, stressors, support, coping mechanism, and intimate partner violence.
It is valuable to assess the reason parents spank. See Box 1 for suggested questions in assessing discipline.
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What do you do for discipline?
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What have you found to work? For how long?
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What does John do that makes it necessary to discipline him?
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How often do you spank Jane ?
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Does spanking work? If “yes”, “for how long?”
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What are you feeling when you spank John ?
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How do you feel after you’ve hit or spanked John?
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Does Jane understand what you are trying to teach her?
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Do you sometimes spank with a belt, switch, or another object?
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Do you sometimes find it necessary to spank John harder or more often to teach him a lesson?
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What else have you tried to teach Jane ? (see Box 2 )
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