Conference Coverage

AAP strengthens stance against corporal punishment



– The American Academy of Pediatrics has issued a new policy statement taking a stronger stance against corporal punishment, including spanking, 20 years after releasing its last position statement on effective discipline.

The 1998 policy statement discouraged the use of corporal punishment and encouraged parents to seek other ways to discipline their children, while the latest statement goes further, citing the latest research showing corporal punishment’s harmful effects on children and encouraging pediatricians to counsel parents about the harms of corporal punishment and offer alternative forms of discipline. The 2018 policy statement will be published in the December issue of Pediatrics.

Support for corporal punishment, such as spanking, is declining. According to the Child Trends data bank, 76% of men and 66% of women supported spanking in some cases, compared with 84% of men and 82% of women in 1986. In its latest statement, the AAP noted that 6% of pediatricians (92% in primary care) supported spanking in a 2016 survey of 787 pediatricians.

In a presentation at the annual meeting of the American Academy of Pediatrics, Ryan D. Brown, MD, of the University of Oklahoma, Oklahoma City, noted that studies have shown children who are spanked are more likely to exhibit mental health problems, antisocial behavior, aggression, negative relationships with a parent, low self-esteem, externalizing behavior such as acting out, substance abuse, low moral internalization, and are more likely to be victims of physical abuse. He cited a study showing that children who were spanked one time per month had a 14%-19% reduction in the decision making area of their brains (Neuroimage. 2009 Aug;47 Suppl 2:T66-T71) and another study showing that children spanked aged between 2 and 9 years had 2.8-5.0 fewer IQ points than children who were not spanked (J Aggress Maltreat Trauma. 2009 Jul 22;18[5]:459-83).

Science has shown that there are more effective ways of disciplining children, and pediatricians are the experts who can explain the difference between discipline and punishment. Parents can use discipline as a teaching opportunity while corporal punishment inflicts physical pain on children with the intent to modify behavior. However, this does not train children to learn. “We want to teach our children to grow,” Dr. Brown said.

He pointed out the AAP’s policy on ipecac syrup and erythromycin/sulfafurazole for otitis media as examples of recommendations changing when more scientific data becomes available.

“[W]hen we get parents that say, ‘You know what? I was spanked as a kid and I turned out okay,’ I said, ‘You know, I rode in a car without a seat belt, but science has shown seat belts are effective,’ ” Dr. Brown said.

Instead of spanking and other forms of corporal punishment, parents should practice positive parenting, such as telling a child when they are being “good,” so children understand what good behavior looks like to build up self-esteem. Parents also should play with their children daily and provide simple, easy-to-understand commands. “Interact with the kids so they can see what is good behavior,” he said.

Disciplining children should be swift, age appropriate relative to mental rather than chronological age, and the discipline should “fit the crime,” Dr. Brown said. Parents also should not discipline a child in accidental situations, such as dropping a glass when helping clean up the dinner table, he added.

“The only time I kind of say that [discipline] should be delayed is in kids [who] understand the delay,” such as teenagers, Dr. Brown added. Rather than embarrassing or shaming a teenager in public for their behavior, parents should address the issue in private.

Pediatricians can implement the new guidelines in their practices by providing resources to parents about alternative forms of discipline, such as the AAP sites and Connected Kids, training office staff in diffusing stressful situations between a caregiver and a child, and making their office a “no hit zone” for caregivers and children.

Dr. Brown reported no relevant conflicts of interest.

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