Disciplining a child by spanking, or by other forms of physical punishment, increases child behavior problems over time, according to a narrative review published in The Lancet.

The United Nations Committee on the Rights of the Child defines physical punishment as “any punishment in which physical force is used and intended to cause some degree of pain or discomfort.” The UN committee considers physical punishment a form of violence. Spanking is the most common form of physical punishment of children in the home in the United States.

The researchers argued that the continued practice of physical punishment by parents stems from a lack of knowledge. This lack of knowledge is due to information spread across hundreds of specialist studies, which makes it hard for health care professionals to obtain the information and communicate that information to parents.


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To bring this information together, the researchers conducted a narrative review summarizing findings from 69 studies published between January 2002 and October 2020. The search included MEDLINE, PsycINFO, and Web of Science databases. Most of the studies that met the criteria were from the US (60 out of 69).

The researchers found physical punishment was associated with increases in externalizing behavior in 13 of the 19 samples that focused on this behavior. Internalizing behavior was the outcome of 15 studies. Other behavior problems such as attention-deficit hyperactivity disorder and cognitive abilities were not shown to be tied with physical punishment.

After reviewing the literature, the researchers identified 7 themes:

  • Physical punishment consistently predicts child behavior problems over time.
  • Physical punishment is not associated with positive outcomes over time.
  • Physical punishment increases the risk of child maltreatment.
  • The only evidence of children’s behavior eliciting physical punishment is for externalizing behavior.
  • Physical punishment is linked with worsening behavior over time in studies using quasi-experimental methods.
  • The associations of physical punishment with increases in detrimental child outcomes are robust across child and parent characteristics.
  • Physical punishment shows a dose–response relationship with some child outcomes.

Of the limitations, the literature review did not consider the number of participants in each study or the magnitude of effect sizes. More research is also needed in countries outside of the US as the search skewed so heavily to this country.

Nevertheless, the researchers conclude, “Given the high prevalence of physical punishment around the world, there is no time to waste — all countries should heed the UN’s call to uphold children’s human rights and promote their wellbeing by prohibiting physical punishment in all forms and all settings.”

Reference

Heilmann A, Mehay A, Watt RG, et al. Physical punishment and child outcomes: a narrative review of prospective studies. Lancet. Published online June 28, 2021. doi:10.1016/S0140-6736(21)00582-1

This article originally appeared on Psychiatry Advisor