A quick public service announcement from Science-Based Medicine, or at least from me: hitting children is fundamentally wrong. It’s also not effective when done in an attempt to improve their behavior. Back in 2014, I wrote about the use of corporal punishment to discipline children, mostly focusing on its use by caregivers in the home. Sadly, not much has changed since I wrote this opening paragraph:

One of the most commonly practiced strategies used by parents to alter the long term behavior of their children is corporal punishment, commonly referred to as spanking. But use of the term spanking is problematic in that how caregivers interpret it varies widely, and there is frequent overlap with what pediatricians consider to be abuse. Despite a great deal of evidence showing that spanking is ineffective, is a risk factor for greater forms of physical abuse, and can negatively impact the behavioral and cognitive development of children in a variety of ways, it remains a controversial issue in the United States. The American Academy of Pediatrics and numerous other professional organizations have come down firmly against the use of physical punishment by parents, but unlike 34 other developed nations there are no federal laws banning spanking.

There are still no federal laws banning spanking, either in the home or in schools, which is what today’s post will focus on. Pediatricians, though not all of us unfortunately, are generally united in their stance that this is a problem. The American Academy of Pediatrics is naturally opposed to the practice of physical violence against children in all forms and recently issued a policy statement to specifically address when it is used as a form of discipline in schools.

Children in many states are still at risk of being hit as a form of punishment while at school, and this isn’t just in private schools. In my 2014 post, I wrote how laws regarding corporal punishment vary from state to state:

19 states currently allow the striking of a child in any school setting. Of the 31 states and the District of Columbia that ban the practice in public schools, only New Jersey and Iowa also include private schools. Many schools give the misbehaving child a choice between suspension and being beaten with a paddle. It is also common for schools to require a parent to opt out of their child receiving corporal punishment rather than having to sign a consent form before such physical correction is applied. Corporal punishment in schools is more prevalent in the South and in lower socioeconomic school districts, leading to poor black children being by far the most likely to face it.

I’ve realized that I used to write much longer paragraphs than I do now. Otherwise not much has changed in the past 9 years. As of 2023, hitting kids at school is still perfectly legal in private schools in every state except for New Jersey, Iowa, and (yay!) now Maryland. School beatings have also been banned in public schools in Colorado and Idaho since then, bringing the number of states where hitting a child at school instead of educating them down to 17. Kentucky, Louisiana, Mississippi, have also banned physical punishment of students with disabilities since 2014, as have Oklahoma and Tennessee unless parents sign a consent to allow it.

Why is beating children in schools allowed? Great question. In 1977, the Supreme Court had an opportunity to protect children but failed. A 5-4 decision in Ingraham v Wright provided constitutional cover for school-based physical punishment, saying that 8th amendment protections against cruel and unusual punishment don’t apply to students. They left it up to the states, many of which are seemingly incapable of thinking about the (born) children in any meaningful capacity.

The majority of children being hit at school in the United States live in the South, with the majority (nearly 3 out of every 4) living in Alabama, Arkansas, Georgia, Mississippi, and Texas. Mississippi and Texas are the worst offenders, with a third of all kids being attacked by teachers or other school administrators living in those two states. It gets worse.

When a school allows faculty to hit students, which students tend to get hit? Another great question, and one which requires a thoughtful and nuance re..black kids. It’s black kids. Children with disabilities have it the worst, however, with national data showing that 16.5% of kids who are hit at school being served under the Individuals with Disabilities Education Act. The tragic reality is that the more marginalized a child is, for example a black child with autism, the more likely they are to be physically attacked at school by someone charged with their education and safety.

The AAP is calling for corporal punishment in all school settings to be banned in every state, and one would think that all organizations comprised of pediatricians would be on board with this. But one would be wrong. The American College of Pediatricians, an anti-vaccine, homophobic, and transphobic hate group made up of old white Christian male pediatricians that sometimes fools journalists into thinking that they deserve to have their opinion heard, came out in support of hitting kids in a 2018 statement:

Despite the recent avalanche of biased research against all physical punishment, evidence indicates ordinary spanking to be a valid and needed disciplinary option when 2- to 6-year-olds refuse to cooperate with milder measures.

To support this claim, they cite a couple studies from 20 years ago and one from 2016, the latter of which found a link between spanking and increased risk for detrimental child outcomes:

Thirteen of the 17 child outcomes examined were found to be significantly associated with parents’ use of spanking. Among the outcomes in childhood, spanking was associated with more aggression, more antisocial behavior, more externalizing problems, more internalizing problems, more mental health problems, and more negative relationships with parents. Spanking was also significantly associated with lower moral internalization, lower cognitive ability, and lower self-esteem. The largest effect size was for physical abuse; the more children are spanked, the greater the risk that they will be physically abused by their parents.

The authors conclude that the numerous meta-analyses they evaluated showed, in addition to the potential harms mentioned above, that there is was no evidence of improved child behavior related to spanking. And this was seen in the highest quality studies, not just in small and methodologically weak studies. In their new policy statement, the AAP discusses multiple studies since my last post that further support calls to ban corporal punishment because of a lack of effectiveness as well as short and long term adverse effects. These include “increased incidence of behavioral and mental health problems, impaired cognitive development, poor educational outcomes, impaired social-emotional development, problems with the ongoing relationship between parents and children, a higher risk for physical abuse, increased aggression and perpetration of violence, antisocial behavior, and decreased moral internalization of appropriate behavior.”

Although there is less available data when it comes to school-based corporal punishment, there is no reason to expect it to be any different. A 2019 survey of 18 to 23 year old adults who went to school in the United States found that, among the 16% who had been hit by school personnel, there was an association with lower grades. There is better data from other countries, but this is definitely an area where more research would be helpful, not because there is much doubt regarding the negative consequences but because it might help convince people in states where hitting kids at school is allowed to change their policies.

The ACPeds statement calls studies on hitting kids into question, latching on to one sentence from the 2016 meta-analysis and ignoring the entirety of the rest of the analysis:

“As most of the included studies were correlational or retrospective (72%), causal links between spanking and child outcomes cannot be established by these meta-analyses.”

This is, of course, quite true. And the authors of the 2016 study, in addition to those of the new AAP policy statement, address the argument that you can just ignore all the available data because it doesn’t involve…(checks notes)…prospectively assigning half of a study population to being beaten by their caregivers or teachers. Obviously observational data is all that is available, but the consistency and the strength of the signals being picked up are such that a causal relationship is the most rational conclusion.

In 2019, I posted a delightful (according to my mom) and satirical take on the absurdity of corporal punishment for behavior management involving imaginary AAP guidelines on appropriate dosing.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.