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Elk Grove Village, IL – The American Academy of Pediatrics (AAP), the primary professional organization responsible for establishing pediatric healthcare standards, has released updated recommendations on the dosing of infantile spanking and corporal punishment in children.

“This represents a huge step forward for pediatricians and parents,” Mort Fishman MD, Head of Disciplinary Pediatrics at Children’s Hospital of Philadelphia, explained. “Until now, parents have had to call the pediatrician, make an appointment, and travel to the office sometimes hours to days after the undesired behavior has occurred. Or they bring the child to an emergency department, urgent care center, or retail-based clinic that may not have pediatric-trained staff. Sometimes the parents just wing it.”

It is this “winging it” by many parents that has concerned pediatric medical professionals for decades. Since the discovery of corporal punishment in the 1930’s, when a Harvard researcher inadvertently dropped a heavy glass beaker on the head of a stubborn lab assistant, a number of children have overdosed. Some have suffered permanent injury or even died. Researchers have long blamed the lack of pediatric guidelines and the inappropriate extrapolation of adult dosing, shouting out the oft-repeated axiom that kids are not simply smaller adults.

Recent studies have revealed an alarming upward trend in the inappropriate use of home corporal punishment based on recommendations found online and popularized by social media influencers. The usual suspects are frequently mentioned by pediatricians, researchers, and public officials. “Anybody can publish anything on the internet,” Fishman, who co-authored the AAP paper, adds. “There are literally thousands of websites offering up unproven techniques, inconsistent dosing, and pseudoscientific mechanisms of action.”

Parent groups have also become a loud voice in the discussion of pediatric corporal punishment over the past several years, calling for more research and for guidelines for home use. Members of such organizations as Mother’s Against Time Out, and the more influential National Spanking Society, have raised awareness and millions of dollars with 5K running races, bake sales, and van-based mobile spank clinics. Many pediatricians are giving credit to these groups for speaking out on behalf of those who cannot speak for themselves, and for pushing the AAP to act.

Dr. Fishman and the AAP hope that the new guidelines will not only help healthcare professionals appropriately dose corporal punishment in children, but also serve as an evidence-based source of education for parents and other caregivers such as teachers, daycare workers, babysitters, and strangers at Target. As stated in the paper’s conclusion, “Empowered and educated caregivers can now confidently dole out safe and effective corporal punishment in a timely fashion without the need to clog up an already overburdened medical system.”

Are the new infantile spanking and corporal punishment guidelines user friendly enough for caregivers without medical training to put into use? They couldn’t be simpler according to Matt Stevens, a mechanical engineer and parent of 3 young children, one of which is kind of a jerk. “When one of my kids talks back or forgets to do a chore, usually Matty Jr., we go to the handy flow chart taped to the wall by the fridge. After a few quick calculations, I know just how hard to smack him.”

The responses to the new guidelines are not all positive, however. Despite the experience of highly educated parents such as Matt Stevens, a vocal minority of pediatricians are raising concerns over the ability for most caregivers without medical experience to decipher the recommendations. Dr. Percival Bordeaux, academic pediatric hospitalist and discipline researcher near the Mayo Clinic, is one of the more prominent voices of opposition. “Is Timmy just being a bit lazy or is he exhibiting stage 3 lollygagging? Is he a smart aleck or a wisenheimer? I have trained in pediatrics for almost thirty years and sometimes I still can’t tell the difference!”

And…scene!

If you’ve made it this far, thanks for indulging me my attempts at science-based satire. In reality, the American Academy of Pediatrics did publish a new policy statement on the topic of effective discipline in December of last year. Their recommended approach, and warning of the harms of corporal punishment, is more firm than it was when I last wrote about this issue back in early 2014. In that post, I came to the following conclusion:

The limited use of mild corporal punishment, in very isolated and specific circumstances, may have some benefit but prevention/protection is almost always a better option. Its use as a strategy to improve overall behavior is fraught with risk. Although imperfect, there is good evidence that recurrent use can lead to physical abuse, interfere with learning and increase aggression. And it may worsen behavior in the long run.

There is an absence of any data showing it to be more effective than other techniques, such as negative punishment strategies like time outs. Unfortunately, the internet is full of pro-spanking propaganda that relies on anecdotes, old fashioned thinking and one study that didn’t survive peer review. The best initial resource for questions regarding discipline should always be a child’s physician. We aren’t perfect, but most pediatricians accept that corporal punishment is a poor method of discipline and should be able to provide education and help accessing local resources.

In the new statement, based on a large amount of data that has emerged since the 1998 issuance of their last official statement on effective discipline, the AAP has removed language that in any way supports hitting kids. They also discuss the risks of non-physical forms of discipline that are also risky and ineffective. Here is a nice summary of the many potential physical and psychological downsides of unhealthy discipline strategies, but the new statement essentially boils down to the following:

The AAP recommends that adults caring for children use healthy forms of discipline, such as positive reinforcement of appropriate behaviors, setting limits, redirecting, and setting future expectations. The AAP recommends that parents do not use spanking, hitting, slapping, threatening, insulting, humiliating, or shaming.

Thankfully, the current crop of new parents are less and less likely to use corporal punishment than older generations. It is still far too common. Another issue, which I discussed in more detail in my 2014 post, is the sad fact that despite calls for a ban from the AAP and other organizations, there are still several states that allow school officials to hit kids:

As of October 2, 2018, corporal punishment is still legal in private schools in every U.S. state except New Jersey and Iowa, legal in public schools in 19 U.S. states, permitted in 18, and practiced in 15 U.S. states.

More than 100 countries around the world ban hitting kids in school. The United States is, in fact, the only Western country to have not banned this practice.

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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.