Editorials

Giving guidance on child discipline

Physical punishment works no better than other methods and has adverse effects

The consultation document issued this month by the Department of Health on the physical punishment of children states clearly that "many parents would welcome support in learning effective measures of disciplining their child which do not involve physical punishment" while adding that "there may still be occasions when parents ... may consider it appropriate to discipline a child through physical punishment."¹ Most British parents do use physical punishment² and this fact is used by the government to justify continuing to allow some form of smacking in their proposals for new legislation. At a time when parenting has become a political issue and when child behaviour is causing difficulties both at home and in school, is there a consistent line which health professionals can follow in giving advice on discipline?

Most research on child discipline has been done in the United States. The American Academy of Pediatrics consensus conference on corporal punishment³ and guidelines on effective discipline⁴ identified three essential elements: a learning environment characterised by positive supportive parent-child relationships; a strategy for systematic teaching and strengthening of desired behaviours; and a strategy of decreasing or eliminating undesired or ineffective behaviours. Each component needs to function adequately for discipline to result in improved child behaviour. Most of these principles have been developed over many years and are based on expert opinion, observation, transcultural studies, and some controlled studies. However, it is possible to apply good judgment to many of the practices, especially in relation to physical punishment.

The need for a positive learning environment is based on social learning theory.⁵ Children thrive better when adults take an interest in what they do, praise good and pro-social behaviour and praise it, encourage the child to take part in the life of the household, allow choices, and are aware of children's developmental needs and emotional reactions to stress. Children respond well to a routine, to consistency of parental reaction, and to involvement in decision making as well as to explanations of the reasons for discipline. The converse of these featuresfrequent reprimands, inconsistent responses to undesired behaviour, a lack of recognition of the child's developmental and emotional needs, and absence of routineswill lead to antisocial behaviour. Most of these characteristics are learnt in childhood from parents, so negative parenting styles are likely to be passed from generation to generation.

It is essential to teach and model desired behaviours, and the benefits of positive reinforcement are well established.⁶ Parents need first to notice the desired behaviour ("catch the child being good") and then praise the child. Children learn best from what they see and they model their behaviour on that of their parents. Rewards may be used systematicallyfor example, in the form of star charts. Again the converse is true: if good behaviour is ignored or criticised it will not continue.

Reducing undesirable behaviour is what plagues parents most and where advice is most often sought. The commonest strategies are ignoring the behaviour, using "time out," removing privileges, and verbal or physical punishment.

Ignoring is the converse of using praise to reinforce good behaviour and is effective in reducing behaviour such as tantrums and swearing.⁷ Time out means withdrawing attention from the child for a specific period (commonly one minute per year of age) and is effective in increasing compliance.⁸ However, it must be used correctly, and when first used it can increase negative behaviour, so it requires careful instruction and supervision. Removing privileges is effective with older children,⁷ but its use must be explained to the child and it must be used consistently.

Physical punishment is the most questionable technique for reducing undesirable behaviour. In both the United Kingdom² and the US⁹ most parents use it, yet it has significant adverse effects. Although a child is more likely to comply with parental demands immediately after being hit, he or she will not learn the desired behaviour,¹⁰ and physical punishment is no more effective than other methods.¹¹ Moreover, learning theory suggests that its use teaches that violence is a solution to interpersonal conflict, makes other methods harder to use,¹² and can increase aggression.¹³ And should we recommend a behaviour that would be unacceptable in any other age group?

General practitioners, paediatricians, and other health workers have a responsibility to support parents in effective discipline, teach methods other than physical punishment, and argue against the use of physical punishment in the home. In Sweden public opinion on the need for physical punishment changed dramatically after a public education campaign, showing that opinion on this subject is open to change.¹⁴

A public health approach to good child discipline would include: widespread dissemination of information on techniques of positive parenting; teaching of parenting in school; support groups and phone lines for parents; a change in the law to outlaw physical punishment; and recognition that corporal punishment is a human rights issue

The Institute for Public Policy Research has recommended the repeal of the provisions of the Children and Young Persons Act 1933 that allow "reasonable chastisement" and an additional provision to prohibit corporal punishment.¹⁵ An alliance of over 220 organisations, including five royal colleges ("Children are unbeatable"), also believes that the defence of "reasonable chastisement" should be removed, thus giving children the same protection as adults under the law on assault. But the Department of Health does not include this measure in its consultation paper, claiming that "it would be quite unacceptable to outlaw all physical punishment of a child by a parent." The government has agreed to amend the law but recommends that legislation should outline the factors that courts should take into account in considering whether physical punishment has been moderate and reasonable following a ruling by the European Court of Human Rights that British law inadequately protects children. It is disappointing that the British government has chosen not to follow the Swedish example of enlightened thinking.

There can be no more important activity within society than bringing up our children, and discipline is crucial to this. Parents need detailed and consistent information and support. Barnardo's, EPOCH (End Physical Punishment of Children), Save the Children, and the National Society for the Prevention of Cruelty to Children already provide guidance on positive discipline without smacking. The Health Education Authority advises on positive parenting and against smacking in its book Birth to Five, given to every new parent. These and other initiatives need to be built into a public education campaign of the kind that has accompanied legal reform in other European countries.

Tony Waterston, consultant paediatrician. 

Community Paediatric Department, General Hospital, Newcastle upon Tyne NE4 6BE