AAP policy opposes corporal punishment, draws on recent evidence

Parents and other adult caregivers should use effective discipline strategies for children that do not involve spanking, other forms of corporal punishment or verbal shaming.

The guidance is part of an updated policy statement in which the Academy strengthens its opposition to corporal punishment. The policy Effective Discipline to Raise Healthy Children, from the Council on Child Abuse and Neglect and the Committee on Psychosocial Aspects of Child and Family Health, is available at https://doi.org/10.1542/peds.2018-3112 and will be published in the December issue of Pediatrics.

The policy summarizes new evidence published in the 20 years since the release of the 1998 clinical report on effective discipline, which discouraged the use of corporal punishment. Other AAP policies already call for the abolition of corporal punishment in schools and suggest the use of alternatives to corporal punishment to prevent child abuse.

Parents rely on pediatricians for advice on a variety of parenting matters, and most routine health care visits involve a discussion of child behavior and discipline. This policy follows the opinions of the vast majority of U.S. pediatricians, who do not recommend corporal punishment.

The purpose of discipline is to teach children good behavior and support normal child development. Effective discipline does so without the use of corporal punishment or verbal shaming.

In fact, the use of corporal punishment among U.S. parents has been declining during the 21st century. Young adults, regardless of race and ethnicity, are far less likely to endorse the use of corporal punishment than were parents in past generations.

In the updated policy, the AAP defines corporal punishment as the “non-injurious, open handed hitting with the intention of modifying child behavior.” Defined this way, corporal punishment is distinct from child abuse.

Harmful effects, vicious cycle

The change in guidance is brought about by an increasing awareness of the risks of corporal punishment for normal child development. Corporal punishment can bring on a vicious cycle of escalating poor behavior and more severe punishment.

A large national cohort study conducted in the 20 largest U.S. cities noted that children who were spanked more than twice a month were more aggressive at subsequent surveys. Thus, each negative interaction reinforced previous negative interactions as part of a complex negative spiral.

Children who experience repeated use of corporal punishment tend to develop more aggressive behaviors, increased aggression in school, and an increased risk of mental health disorders and cognitive problems. In cases where warm parenting practices occurred alongside corporal punishment, the link between harsh discipline and adolescent conduct disorder and depression remained.

It is of concern that parental reliance on corporal punishment has been associated with physiological changes in children. A small MRI study (n=23) reported reduced prefrontal cortical gray matter volume and performance IQ associated with corporal punishment — even in the absence of other identified trauma. Other studies have noted relationships between physical punishment and chronically high cortisol levels. These physiologic changes have been associated with other adverse childhood experiences and reflect the presence of toxic stress, with lifelong negative health effects.

Parental factors, counseling 

While many parents spank their children occasionally, a few parental factors increase the use of corporal punishment. For example, parents who suffer from depression tended to use corporal punishment more frequently. In addition, family economic challenges, mental health problems, intimate partner violence and substance abuse all are associated with increased reliance on corporal punishment. One small report suggested that parents who themselves have a history of trauma are more likely to use corporal punishment than other parents.

Pediatricians can help parents develop effective discipline strategies appropriate to the child’s age, developmental status and other individual factors. When counseling parents, it may be helpful to remind them that even though spanking may transiently interrupt a child’s misbehavior, it is ineffective in the long term and has substantial risk of future problems for the child.

For many parents, general comments about the problems associated with corporal punishment are best embedded as part of in-depth problem-solving of difficult child behavior. Because many parents use corporal punishment as a last resort, adoption of effective discipline strategies is likely to be extremely helpful in reducing corporal punishment. Simply put, parents who manage their children’s behavior well may no longer feel the need to use more violent approaches.

The Academy has a variety of resources concerning discipline issues (see resources).  Other sources of information for parents about effective discipline range from local efforts (e.g., family resource centers) to national programs. Formal parenting programs, many of which are evidence-based, are available throughout the country. These may be useful for parents who are struggling with behavior management for their children.

The AAP and individual pediatricians may join with others to reduce and ultimately end the use of corporal punishment in the U.S.

Dr. Sege is a lead author of the policy statement. He was a member of the former AAP Committee on Child Abuse and Neglect.