Letters

Child discipline

Weak evidence for a smacking ban

Parents need techniques for behavioural control

Occasional smacking does no harm

Parents must be in charge of their children

Author's reply

Weak evidence for a smacking ban

EDITORA ban of a medical intervention would never be supported on the basis of such meagre evidence as used by Waterston to support a ban of the parental intervention of smacking.¹ "Significant adverse effects" and a failure to "learn the desired behaviour" were based on a literature review that is unpublished² and that includes studies that included severe types of corporal punishment such as "beating with a stick," "still hurt the next day," "burning," and "using a knife or gun." Most studies that were reviewed were cross sectional, which cannot disentangle the causal direction between smacking and child misbehaviour.²

In the only published review (in 1996) of child outcomes of non-abusive or customary physical punishment, only eight studies could disentangle the causal effects of smacking.³ All eight studies, including four randomised clinical trials, found that nonabusive smacking benefited children when it backed up milder disciplinary tactics with children aged 2 to 6 years.

Smacking, then, makes milder tactics more effective, not "harder to use" as concluded by Waterston.¹

Another study was cited to conclude that Swedish "public opinion on the need for physical punishment changed dramatically after a public education campaign" following the 1979 smacking ban.⁴ The so called dramatic change was artificially created because survey questions from before 1982 and from 1994 were compared. The 1994 survey question that was most similar to the previous question showed an increased endorsement of mild or moderate physical punishment as sometimes necessaryfrom 26% in both 1978 and 1981 to 34% in 1994.⁵ The 1994 Swedish survey also found that corporal punishment of teenagers was as prevalent after the 1979 ban as in previous generations and that, overall, the incidence of corporal punishment had decreased little.⁵

Consequently, the British proposal for a middle ground between the status quo and a 100% smacking ban is reassuring. As Waterston noted, parents are already motivated to find alternatives to smacking, and positive interaction between parents and children and enhancing appropriate child behaviours are good places to start. The most difficult puzzle for parents and professionals concerns effective methods for decreasing misbehaviour.

Eighteen studies in the 1996 review investigated alternative disciplinary tactics as well as smacking.³ Only grounding was more effective than smacking, in two studies of older children. In contrast, nine alternatives were associated with more detrimental outcomes in children than was smacking.

Parents need to be empowered with more effective alternatives, not disempowered by premature bans on traditional disciplinary tactics.

Robert E Larzelere, psychologist. 
Psychology Department, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68198-5450, USA rlarzelere{at}unmc.edu

Parents need techniques for behavioural control

EDITORThe art of child rearing is a complex process in which the outcome of a parent's efforts is influenced by many factors unique to the child, the parent, the environment, and the context. Waterston's editorial promoting a ban on all disciplinary physical punishment does not respect this complexity and oversimplifies the debate over a parent's use of spanking (smacking).¹

As a participant in the American Academy of Pediatrics consensus conference, I would like to clarify some of its findings. The group's goal was to develop consensus statements regarding the scientific evidence on the long term and short term effects of corporal punishment on children. Definitions were the first order of business for the group: corporal punishment was defined as "bodily punishment of any kind"; spanking was defined as "physically non-injurious, intended to modify behavior, and administered with the open hand to the buttocks or the extremities." Using strict definitions prevented the common mistake of mixing abusive physical punishment with non-injurious spanking. With these definitions, however, the committee could not reach any strong conclusions favouring or opposing a parent's use of disciplinary spanking for children aged 2-11 years.

Central to the conference was the exhaustive review of the literature on corporal punishment presented by clinical psychologist Robert Larzelere. He found stronger evidence of beneficial than detrimental effects of non-abusive spanking by parents with preschool children (aged 2 to 6 years). The conference chairpersons concluded: "Given a relatively `healthy' family life in a supportive environment, spanking in and of itself is not detrimental to a child or predictive of later problems . . . there is a lack of research related to the use of corporal punishment."²

Developmental research indicates that optimal outcomes in children result from an authoritative style of parenting that combines positive encouragement with consistent behavioural control of the young child.³ Waterston describes the process of encouragement well, but leaves parents shorthanded on techniques for behavioural control. Young children need correction and punishment, but this is often ignored by the opponents of physical punishment. Time out and disapproval are effective tools but are not sufficient to control all problem behaviour with all children. Disciplinary spanking, when properly applied, can augment nonphysical measures and optimise the process of behavioural control. To remove spanking from the repertoire of parents of young children could promote child abuse and lead to increased violence among older, unruly children. This seems, from statistics, to be an effect that the Swedish ban has had on that society.

I urge the makers of public policy in the United Kingdom to move slowly and scientifically in analysing this issue. An in depth analysis of this subject can be found at www.frc.org/fampol/fp96jpa.html.

Den A Trumbull, paediatrician. 
4700 Woodmere Blvd, Montgomery, AL 36106, USA trumbulld3{at}aol.com

Occasional smacking does no harm

EDITORIn his article saying that smacking children is wrong, Waterston shows himself to be a caring paediatrician who wishes to speak up for children in what he sees as an important ethical issue.¹ However, his article shows the pitfalls of representing a viewpoint that is based on emotion as a considered, evidence based approach.

The evidence cited by Waterston has shown that smacking has adverse effects only when it is excessive. There is no evidence that occasional smacking is harmful, and indeed it would be astonishing if there were, given the trivial nature of the physical and psychological event. There are even theoretical reasons to suppose that smacking may be less harmful than some alternative strategies. It is, after all, quickly over and avoids protracted emotional withdrawal ("I won't love you if you're naughty") which, for many parents, is the alternative.

It can be inferred from Waterston's article that he acknowledges that a consistent and measured strategy of discipline that happens to include smacking is likely to benefit rather than to harm a child. So why does he oppose it so strongly? Perhaps because his experience is that for many parents smacking is not a measured or consistent strategy. Instead, it is a last resort when control is lost. It is this element of unpredictable, irrational, and potentially uncontrolled violence that is dangerous in smacking, rather than the smack itself.

By definition, this element will not be influenced by changing the law. In recommending legislation against smacking, Waterston ensures that chaotic, uncontrolled smacking will continue, and that only measured smacking, which does no harm and may even help a child understand discipline, will stop. In other words, he will have achieved the reverse of his intention.

There is an urgent need to support parents in developing parenting skills. Agitating, with little evidence and less logic, for the criminalisation of smacking does little to help in this endeavour. It does, however, do much to undermine the credibility of our profession in trying to advocate for children in this area.

Richard D W Hain, senior lecturer in paediatric palliative care. 
Llandough Hospital, Penlan Road, Penarth CF64 2XX

Parents must be in charge of their children

EDITORWaterston articulates the arguments for restraint and possible legislation on the physical punishment of children.¹ Why then, as a child psychiatrist and family therapist who espouses and promotes these ideas daily in my professional practice, and as a father with two children under 5 against whom my wife and I have never raised a hand (though sorely tempted), do I still demur? Because I do not wish the state to be able to intervene where it should not. Similar arguments apply to child sexual abuse and seatbelt legislation. Both are now "state-intervenable" matters. Why is smacking different?

The best I can come up with (and it may not be intellectually rigorous) is that I also believe, professionally and personally, that it is important for parents to be in charge of their children. In this sense the use of physical punishment is qualitatively different from sexual abuse. There is a benign aim in the use of punishment that cannot be said to exist in child sexual abuse, even though all the evidence shows that there are better ways to achieve the aim. We must let parents parent in their own individual ways, even if that may sometimes involve physical chastisement. Even if children are given the power to be able to sue their parents for such chastisement, I am not encouraged to believe that this would produce a more benign environment for that child or, more importantly for public policy, for all children. Indeed this prospect may only lead to the inversion of the perhaps politically incorrect but bald fact that parents need to be more powerful than children in the hierarchical structure that we call family. At the very least parental power represents the best we have yet come up with for successful child rearing, in the early years at least. Public education (Waterston cites the example of Sweden) may be a more effective route to change.

Let us hope that the debate and consequent changing of minds continues, but let us not try to impose values that may not lead where we want to go. Perhaps the government has got it right.

Richard Fry,  consultant child and family psychiatrist. 
Child Family and Adolescent Consultation Service, Uxbridge UB8 1BN

Author's reply

EDITORA key part of the case against a ban on corporal punishment is the desire to distinguish between injurious and non-injurious smacking. In legal terms this is not possible, as a smack on any part of the body is potentially injurious, whatever the intention.

Larzelere states that smacking has beneficial outcomes, on the evidence of his review published in 1996.¹ These outcomes were short term only and in artificial situations. Of the eight studies he mentions that showed benefit of non-abusive smacking, five were laboratory studies by the same team,² the children were in an extreme group for disordered behaviour, and only immediate outcomes were assessed. Parents were trained to give two spanks while being observed by a therapist, and it would not be wise to draw general conclusions in relation to the population of smacking parents. The authors state that spanking was not a superior method of discipline. A sixth study was on one extremely disordered child with no control subject,³ and in the remaining studies in which parents used structured diaries to observe the effects of their own management of their children within specific parameters, the authors stated that "to use this research as general evidence supporting punitive parenting or corporal punishment outside these parameters would be totally inappropriate."⁴

In relation to the survey of the effects on public opinion of the ban on smacking in Sweden, the question used was identical in a series of four surveys conducted between 1965 and 1981.⁵ The data are as follows: in 1965, 53% of respondents to the survey believed that corporal punishment is necessary in child rearing; in 1968 the percentage was 42%; in 1971 it was 35%; and in 1981 it was 26%.

In 1994, a different question was used: Are you positively inclined toward physical punishment, even in its mildest forms? Eleven per cent of Swedes answered this affirmatively.

Sweden's rate of fatal child abuse is low. Between 1976 and 1990, no child in Sweden died as a result of abuse. Between 1990 and 1996, four children died from the effects of physical abuse; only one of these children was killed by a parent.

Trumbull attempts to distinguish between abusive physical punishment and non-injurious spanking. I do not believe that this is practicable in law. The increasing trend in reports of youth assaults in Sweden is at least partly attributable to increased enforcement.⁵

I agree with Hain that there is no evidence that occasional smacking is harmful, and that it provides a model to the child. Is the practice of violence by parents against a small child a good model to learn from?

Fry believes that parents need to be "more powerful than children." Surely this should be through intellectual rather than muscular strength. The Swedish experience does not lead us to expect that children will start suing their parents.⁵ A change in the law following an educational campaign would set a marker that violence in the family is not to be condoned.

Tony Waterston,  consultant paediatrician. 
Community Paediatric Department, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE