CHILD ABUSE/NEGLECT: Alternatives to spanking

Part of Contemporary Pediatrics’ coverage of the 2015 AAP Annual Conference. For more coverage, click here.

Sparing a child the rod of corporal punishment can circumvent a lifetime of adverse health consequences, said Victor Vieth, JD, in his presentation “Spanking: The Why and How of Counseling Families on Alternative Discipline Measures.”

Recommended: Cutaneous signs of abuse

Pediatricians must not only be cognizant of the medical literature and understand that corporal punishment raises risks for poor medical and mental health outcomes but they must also be able to articulate this fact and provide parents with appropriate alternatives in words they will understand.¹ The research shows that most parents would discipline their children in a way other than hitting them if they knew what those alternatives were and if there were a parenting or other program that could model those alternatives.

Research also tells us that certain cultures and religious communities exhibit higher levels of corporal punishment than the national average. A pediatrician must be sensitive to that and be able to explain these concepts in a way that is culturally sensitive. In the United States, for example, some conservative Protestant communities are more likely to use corporal punishment than many others. However it is possible to work with these communities and try to move them past this practice.

Parents in such groups often cite scripture, specifically certain sections of the Book of Proverbs, in arguing that their belief system requires corporal punishment. Pediatricians may counter, however, by pointing out that several conservative Protestant theologians disagree. Proverbs contains many more verses about corporal punishment for adults than for children, yet there are no whipping posts at churches, and corporal punishment is not advocated for adults.

Phrasing such ideas in common-sense language and pointing parents to resources within their own culture may help change their behavior, as can making better use of hospital chaplains to engage parents who use corporal punishment for religious reasons.

For more suggested strategies, pediatricians may consult a set of proposed guidelines for working with conservative religious groups.² According to pediatricians and others who deal with children’s health and abuse issues, these guidelines are proving helpful. If more pediatricians follow them, many parents will do something other than hit their children. This can be a primary means of preventing physical abuse in the United States.

References

1. Gershoff ET. Report on physical punishment in the United States: what research tells us about its effects on children. Columbus, OH: Center for Effective Discipline; 2008.  http://www.nospank.net/gershoff.pdf. Accessed October 5, 2015.

2. Vieth VI. From sticks to flowers: guidelines for child protection professionals working with parents using Scripture to justify corporal punishment. William Mitchell Law Rev. 2014;40(3):907–942. http://web.wmitchell.edu/law-review/wp-content/uploads/Volume40/documents/2.pdf. Accessed October 5, 2015.

Victor Vieth, JD, is senior director and founder, Gunderson National Child Protection Training Center, Winona, Minnesota.

NEXT: Commentary and the need for alternative approaches

Commentary

If you are going to discuss corporal punishment, it’s important to meet parents where they’re at from a cultural and religious perspective. Regarding Mr Vieth’s comments, I suspect that moving most parents completely from corporal punishment would take more than their knowing alternatives and having a parenting program to model these behaviors. In my experience, I’d say some parents are open to reducing their use of spanking.

Next: Patterned bruises on 2 infants

Many parents have a fixed, firmly held belief that corporal punishment is a necessary part of parenting. Our challenge is a little bigger than you might think. In our society, corporal punishment is not only acceptable but it is also almost universal. In a 2011 paper I published, 70% of parents in North Carolina reported spanking their infants by age 2 years.¹ In a 2002 study of corporal punishment in North Carolina and South Carolina, 90% of parents reported spanking children aged 3 to 5 years. Rates may be a little higher in the Southeast than the nation as a whole but only a little.

I’m a family physician with more than 15 years’ experience in child abuse research who sees parents and children. Although I am opposed to corporal punishment, I never say that to parents. My job is to see how much they are willing to consider alternative approaches. If I see a parent swatting a 4-year-old child throughout a patient encounter because the child is constantly fiddling with objects in the exam room, I’ll ask the parent, “How’s that working for you?” or “Would you like to try some other strategies?”

It’s a success if you can get a parent to stop spanking. It’s also a success if you can get a parent to spank 10% less often or stop using a belt or switch. My own research and several other studies show that the more often a parent spanks a child, or if a parent spanks with a belt or switch, the more likely that person is to commit child abuse.²

Moreover, due to the phenomenon of extinction, children eventually tune out any form of positive or negative reinforcement that is over-applied without variation. This leads to escalation (bigger treat or bigger stick). Spanking alternatives include positive reinforcement, negative (nonhitting) reinforcement, time-outs and time-ins (special time with a special caregiver), and token economies. Parents need more than a single tool and can parent most successfully when they have other caretakers on the same program, supportive relationships, good mental and physical health, and adequate resources.

References

1. Zolotor AJ, Robinson TW, Runyan DK, et al. The emergence of spanking among a representative sample of children under 2 years of age in North Carolina. Front Psychiatry. 2011;2:36.

2. Zolotor AJ, Theodore AD, Chang JJ, et al. Speak softly--and forget the stick. Corporal punishment and child physical abuse. Am J Prev Med. 2008;35(4):364-369.

Adam Zolotor, MD, DrPH, is an associate professor of family medicine and pediatrics, University of North Carolina at Chapel Hill.