Pediatricians are a source of advice for parents and guardians concerning the management of child behavior, including discipline strategies that are used to teach appropriate behavior and protect their children and others from the adverse effects of challenging behavior. Aversive disciplinary strategies, including all forms of corporal punishment and yelling at or shaming children, are minimally effective in the short-term and not effective in the long-term. With new evidence, researchers link corporal punishment to an increased risk of negative behavioral, cognitive, psychosocial, and emotional outcomes for children. In this Policy Statement, the American Academy of Pediatrics provides guidance for pediatricians and other child health care providers on educating parents about positive and effective parenting strategies of discipline for children at each stage of development as well as references to educational materials. This statement supports the need for adults to avoid physical punishment and verbal abuse of children.

Pediatricians are an important source of information for parents.1 They are often asked by parents and guardians about nutrition, development, safety, and overall health maintenance. Pediatricians form a relationship with parents, within which they partner with parents to achieve optimal health, growth, and development in their children, including childhood behavior management. Duncan et al2 reviewed periodic surveys of members of the American Academy of Pediatrics (AAP) and noted that between 2003 and 2012, pediatricians had increased their discussions of discipline with parents. By 2012, more than half (51%) of the pediatricians surveyed responded that they discussed discipline in 75% to 100% of health supervision visits with parents of children ages 0 through 10 years.

A recent survey (2016) indicated that US pediatricians do not endorse corporal punishment. Only 6% of 787 US pediatricians (92% in primary care) who responded to this survey held positive attitudes toward spanking, and only 2.5% expected positive outcomes from spanking. Respondents did not believe that spanking was the “only way to get the child to behave” (78% disagreed) or that “spanking is a normal part of parenting” (75% disagreed).3 

This policy statement incorporates new research and updates the 1998 AAP clinical report titled “Guidance for Effective Discipline,”4 which suggested, “Parents should be encouraged and assisted in developing methods other than spanking in response to undesired behaviors.”

In 1989, the United Nations (UN) Convention on the Rights of the Child, through its Committee on the Rights of the Child, called on all member states to ban corporal punishment of children and institute educational programs on positive discipline.5 In the UN report, article 19 reads, “Parties shall take all appropriate legislative, administrative, social, and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of [the] parent(s) [or] legal guardian(s) or any other person who has the care of the child.”

The Global Initiative to End all Corporal Punishment of Children provided a comprehensive definition of spanking and corporal punishment: “The definition of corporal or physical punishment adopted by the Committee on the Rights of the Child in its General Comment No. 8 (2006) has the key reference point, ‘any punishment in which physical force issued and intended to cause some degree of pain or discomfort, however light.’ According to the committee, this mostly involves hitting (“smacking,” “slapping,” or “spanking”) children with the hand or with an implement (a whip, stick, belt, shoe, wooden spoon, or similar), but it can also involve, for example, kicking, shaking, or throwing children; scratching, pinching, biting, pulling hair, or boxing ears; forcing children to stay in uncomfortable positions; burning, scalding, or forced ingestion (for example, washing a child’s mouth out with soap or forcing them to swallow hot spices). Nonphysical forms of punishment that are cruel and degrading and thus incompatible with the convention include, for example, punishment which belittles, humiliates, denigrates, scapegoats, threatens, scares, or ridicules the child. In the view of the committee, corporal punishment is invariably degrading.”6 

For the purpose of this policy statement, corporal punishment is the “noninjurious, open-handed hitting with the intention of modifying child behavior.”7 Spanking can be considered a form of physical punishment. As Gershoff and Grogan-Kaylor7 noted, most people understand “corporal punishment, physical punishment, and spanking as synonymous.” The term “verbal abuse” is used to mean nonphysical forms of punishment as defined above.

This policy statement incorporates results accrued from research and new knowledge of brain development and recommend that pediatricians advise parents against the use of any form of corporal punishment. Verbal abuse (for a definition, see above: the Global Initiative to End All Corporal Punishment of Children) by parents intended to cause shame and humiliation of the child also has deleterious effects on children’s self-esteem. This policy statement complements a previous AAP policy statement that recommended the abolishment of corporal punishment in schools.8 

Optimal child development requires the active engagement of adults who, among other functions, teach children about acceptable behavior. The word “discipline” is derived from the Latin word “disciplinare,” meaning to teach or train, as in disciple (a follower or student of a teacher, leader, or philosopher). Effective disciplinary strategies, appropriate to a child’s age and development, teach the child to regulate his or her own behavior; keep him or her from harm; enhance his or her cognitive, socioemotional, and executive functioning skills; and reinforce the behavioral patterns taught by the child’s parents and caregivers.

There are a number of approaches to discipline that pediatricians may discuss with parents during well-child visits and those visits that are designed to address discipline issues. These approaches are reviewed in Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents,9 on the AAP Web site HealthyChildren.org,10 and in the AAP program Connected Kids: Safe, Strong, Secure.11Bright Futures includes sections on discipline for each age group. Each of these recommended approaches to discipline is based on the broad concepts of child development and related common behavioral concerns.

There is evidence that support for corporal punishment among parents is declining in the United States. According to a 2004 survey,12 approximately two-thirds of parents of young children reported using some sort of physical punishment. These parents reported that by fifth grade, 80% of children had been physically punished, and 85% of teenagers reported exposure to physical punishment, with 51% having been hit with a belt or similar object.12,15 These findings suggest that, in 2004, many parents considered spanking to be a socially acceptable form of discipline. In contrast, a more recent national survey of adults shows declining support for spanking (or hitting), particularly among young parents. A 2013 poll16 conducted by Harris Interactive found that support for the statement “good, hard spanking is sometimes necessary to discipline a child” had dropped from 84% in 1986 to 70% in 2012. Parents younger than 36 years more often believed that spanking was never appropriate, and only half reported ever spanking their own children. An analysis of a 2016 national survey conducted by yougov.com revealed that respondents with young children in the home, regardless of race and ethnicity, did not support corporal punishment, “suggesting the possibility that a generational shift in social norms [about corporal punishment] may be taking place.”17 

Although some studies of discipline practices used observations during home visits,1 a small study published in 201418 used voice recordings to explore parent-child interactions during daily activities. The recordings of 15 of the 33 families in the study (45%) included the use of corporal punishment. Most parents used a verbal disciplinary strategy before corporal punishment. Corporal punishment then occurred at a mean of 30 seconds later, suggesting that parents may have been “responding either impulsively or emotionally rather than instrumentally and intentionally.” The effects of corporal punishment were transient: within 10 minutes, most children (73%) had resumed the same behavior for which they had been punished.

A 2016 meta-analysis showed that current literature does not support the finding of benefit from physical punishment in the long-term.7 Several small, older studies (including meta-analyses),19,22 largely of parents who were referred for help with child behavior problems, demonstrated apparent short-term effectiveness of spanking. Only a single 1981 study of 24 children showed statistically significant short-term improvement in compliance compared with alternative strategies (time-out and a control group).23 

Evidence obtained from a longitudinal cohort study suggested that corporal punishment of toddlers was associated with subsequent aggressive behavior. The Fragile Families and Child Wellbeing Study was based on a population-based birth cohort of approximately 5000 children from 20 large US cities between 1998 and 200024; data were collected at birth and 1, 3, 5, and 9 years of age. Young children who were spanked more than twice per month at age 3 years were more aggressive at age 5 even when the researchers controlled for the child’s aggressive behavior at age 3, maternal parenting and risk factors, and demographic factors.25 A follow-up study26 assessed these children at 9 years of age and noted correlations between spanking at age 5 years and higher levels of externalizing behavior and lower receptive vocabulary scores at age 9. A subsequent study analyzed data from all 4 waves and concluded that an increased frequency of spanking was associated with a subsequent increased frequency of externalizing behaviors, which were then associated with more spanking in response.27 This interaction between spanking and misbehavior occurs over time; each negative interaction reinforces previous negative interactions as a complex negative spiral.

In a study that explored parental discipline approaches,28 researchers noted that both European American and African American parents used an escalation strategy in disciplining their 6- to 8-year-old children. Both groups of parents used reasoning more frequently than yelling. The next most frequent strategy was denying privileges, and spanking was the least frequent method reported by all parents. Similarly, in focus groups conducted around the country in 2002 during the development of the AAP Connected Kids materials, participating parents reported the use of corporal punishment as a last resort.11,29 

Children in foster care who have experienced abuse or neglect may exhibit challenging behaviors. Programs exist that assist foster parents in addressing discipline. A recent AAP clinical report describes the behavioral effects of maltreatment and offers suggestions for helping these children heal.30 Pediatricians may advise foster parents to consider the behavioral consequences of past abuse in understanding how these children may respond differently to their foster parents’ attempts to correct their behavior.31 

Parents of children with special health care needs may need additional assistance regarding discipline strategies. These strategies begin with an understanding of a child’s physical, emotional, and cognitive capacities. In some cases, consultation with a developmental-behavioral pediatrician may be helpful.32 

Parental Depression

A longitudinal study examined the interactions between parental corporal punishment, parental depression, negative perceptions of a child’s behavior, and the child’s externalizing behavior.33 The sample included 245 children and parents in stable relationships from mostly middle-class, married, European American parents. Depressive symptoms for both mothers and fathers were related to more negative appraisals of the child’s behavior and more frequent corporal punishment and predicted higher levels of child externalizing problems at 5.5 years of age.

Influence of Past Parental Trauma

A recent article, Kistin et al34 reported interviews with 30 low-income mothers and provided an important perspective on the complexity of disciplinary strategies used by mothers who had themselves experienced trauma. They reported that mothers related their children’s negative behaviors to their own past experiences; harsh discipline was used in an attempt to prevent future behavioral problems.

There appears to be a strong association between spanking children and subsequent adverse outcomes.35,53 Reports published since the previous 1998 AAP report have provided further evidence that has deepened the understanding of the effects of corporal punishment. The consequences associated with parental corporal punishment are summarized as follows7,19,21,27,35,54,62:

  • corporal punishment of children younger than 18 months of age increases the likelihood of physical injury;

  • repeated use of corporal punishment may lead to aggressive behavior and altercations between the parent and child and may negatively affect the parent-child relationship;

  • corporal punishment is associated with increased aggression in preschool and school-aged children;

  • experiencing corporal punishment makes it more, not less, likely that children will be defiant and aggressive in the future;

  • corporal punishment is associated with an increased risk of mental health disorders and cognition problems;

  • the risk of harsh punishment is increased when the family is experiencing stressors, such as family economic challenges, mental health problems, intimate partner violence, or substance abuse; and

  • spanking alone is associated with adverse outcomes, and these outcomes are similar to those in children who experience physical abuse.

The association between corporal punishment and adverse adult health outcomes was examined in a 2017 report that analyzed original data from the 1998 Adverse Childhood Experiences Study, which recommended that spanking be considered as an additional independent risk factor, similar in nature and effect to other adverse childhood experiences.63 In their analysis of the original 1998 Adverse Childhood Experiences study data, the investigators found that spanking was associated with increased odds of suicide attempts, moderate-to-heavy drinking, and substance use disorder in adulthood independent of the risks associated with having experienced physical and emotional abuse.

A history of parental corporal punishment and parental verbal abuse has been associated with changes in brain anatomy that can be visualized by using MRI. Researchers studied a group of young adults (N = 23; ages 18–25) who had prolonged and repeated exposure to harsh corporal punishment and compared the results of brain MRIs to those from a matched control group (N = 22). They reported reduced prefrontal cortical gray matter volume and performance IQ.64 A similar study from this group noted MRI results that revealed differences in white matter tracts in young adults (N = 16) who were exposed to parental verbal abuse and had no history of trauma.65 A more recent review noted relationships between physical punishment and cortisol levels.66 Elevated cortisol levels reflect stress and have been associated with toxic stress and subsequent changes in brain architecture.

In 2009, the UN Children’s Fund defined “yelling and other harsh verbal discipline as psychologically aggressive towards children.”28 In a longitudinal study investigating the relationship between harsh verbal abuse by parents and child outcomes, researchers noted that harsh verbal abuse before age 13 years was associated with an increase in adolescent conduct problems and depressive symptoms between ages 13 and 14. Adolescent behavior affected parental behavior as well; misconduct predicted increases in parents’ use of harsh discipline between ages 13 and 14 years. Furthermore, parental warmth did not moderate the longitudinal associations between harsh discipline by parents and adolescent conduct and depressive symptoms.67 

Effective disciplinary techniques grow from an understanding of normal child development. Parents value advice from their pediatricians, as illustrated by a 2012 study1 involving 500 parents in New Orleans, Louisiana. The investigators found that parents were more likely to follow the advice of pediatricians compared with other professionals, and nearly half (48%) indicated that they were most likely to consult their pediatricians for advice on corporal punishment. In a second article,68 these investigators further noted that perceived social norms were the strongest predictor of having a positive attitude toward corporal punishment, with the second-strongest predictor being perceived approval of corporal punishment by professionals.

Pediatricians may assist parents by providing information about child development and effective parenting strategies. Although parents often seek information and hold their pediatricians in a position of trust, discussions of discipline may prove challenging. This section presents approaches to counseling.

A direct discussion advising against any form of corporal punishment may be useful. When appropriate, the pediatrician may counsel family members that spanking is not an appropriate or effective disciplinary strategy. Parents may be counseled that although spanking seems to interrupt a child’s misbehavior, it is ineffective in the longer-term. For many children, spanking increases aggression and anger instead of teaching responsibility and self-control. This advice will be most helpful if it is combined with teaching parents new strategies to replace their previous use of corporal punishment. Appropriate methods for addressing children’s behavior will change as the children grow and develop increased cognitive and executive function abilities.9 

Teaching parents effective strategies may allow them to avoid escalating to the point of using corporal punishment. In a randomized trial, Barkin et al69 demonstrated that it was possible to teach parents to use time-outs within the constraints of an office visit. Clinicians used motivational interviewing techniques to help parents learn to discipline using other techniques.

When discussing corporal punishment, pediatricians may explore and acknowledge parents’ current experiences, past social-emotional development, attitudes, and beliefs. Because parents may use spanking as a last resort, they may spank less (or not at all) if they have learned effective discipline techniques.11 Specific discussions of behavior problems and behavior management strategies allow pediatricians to provide useful advice that is based on an understanding of child behavior.

Pediatric providers may reinforce behavioral counseling through recommending or distributing parent education materials. For example, studies have shown that in-office videos may be able to deliver messages to multicultural parents.70,71 Having parents read brief research summaries of problems associated with corporal punishment decreased positive attitudes about it.72 Each of these approaches reinforced verbal advice with other means of supporting caregivers in learning new parenting techniques.

The Centers for Disease Control and Prevention has posted positive parenting tips on its Web site.73 The AAP provides content for parents through its HealthyChildren.org Web site and its Connected Kids: Safe, Strong, Secure11 and Bright Futures9 programs. Each of these resources encourages parents to use positive reinforcement as a primary means of teaching acceptable behavior. For example, parents can learn that young children crave attention, and telling a child, “I love it when you . . .” is an easy means of reinforcing desired behavior.

Although pediatricians offer anticipatory guidance, many parents will want or need more assistance in developing strong parenting skills. The medical home can link parents to community resources. Health care sites may implement the Safe Environment for Every Kid74,75 program. The program includes a brief questionnaire that examines family risk factors. Parents who identify needs, including parenting challenges, meet with a colocated social worker who can link them to parent supports in the community. This program also has online educational modules.76,77 

A variety of national and community-based organizations offer parents support through Triple P,78 which is one example of an evidence-based parent education program. In another program, HealthySteps,79 a developmental specialist is placed in the office setting to help support families of children ages 0 to 3 years. In most states, Children’s Trust Funds and child welfare agencies sponsor parent resource centers. Help Me Grow,80 a state-based information and referral network, has been implemented in the majority of the United States. The Center for the Improvement of Child Caring offers resources specifically tailored to African American families.81,83 

Many clinic- and community-based programs are specifically oriented toward helping parents effectively address their children’s behavior.84 Examples include The Incredible Years,85 a brief office-based video intervention in the office that is used to discuss discipline issues86; Safety Check, which is used to teach time-outs69; the Family Nurturing Program, which is used to improve parenting attitudes and knowledge87; and the Chicago Parent Program, a comprehensive 12-week parenting skills training program.88 The Video Intervention Project is an evidence-based parenting program that involves feedback on parent-child interactions by trained child development staff in a primary care office setting.89 

The 2012 AAP clinical report was focused on the psychological maltreatment of children and adolescents and contained a comprehensive review of preventive measures that provide alternatives to the use of corporal punishment.90 The literature describe other resources and programs, such as Internet-based training and group-based parent training programs.91,93 This list of resources is not intended to be comprehensive; many national organizations and local communities also offer effective parenting resources.

Parents look to pediatric providers for guidance concerning a variety of parenting issues, including discipline. Keeping in mind that the evidence that corporal punishment is both ineffective in the long-term and associated with cognitive and mental health problems can guide these discussions. When parents want guidance about the use of spanking, pediatricians can explore parental feelings, help them better define the goals of discipline, and offer specific behavior management strategies. In addition to providing appropriate education to families, providers can refer them to community resources, including parenting groups, classes, and mental health services.94 

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.

Parents value pediatricians’ discussion of and guidance about child behavior and parenting practices.

  1. Parents, other caregivers, and adults interacting with children and adolescents should not use corporal punishment (including hitting and spanking), either in anger or as a punishment for or consequence of misbehavior, nor should they use any disciplinary strategy, including verbal abuse, that causes shame or humiliation.

  2. When pediatricians offer guidance about child behavior and parenting practices, they may choose to offer the following:

    • a. guidance on effective discipline strategies to help parents teach their children acceptable behaviors and protect them from harm;

    • b. information concerning the risks of harmful effects and the ineffectiveness of using corporal punishment; and

    • c. the insight that although many children who were spanked become happy, healthy adults, current evidence suggests that spanking is not necessary and may result in long-term harm.

  3. Agencies that offer family support, such as state- or community-supported family resource centers, schools, or other public health agencies, are strongly encouraged to provide information about effective alternatives to corporal punishment to parents and families, including links to materials offered by the AAP.

  4. In their roles as child advocates, pediatricians are encouraged to assume roles at local and state levels to advance this policy as being in the best interest of children.

     
  • AAP

    American Academy of Pediatrics

  •  
  • UN

    United Nations

Drs Sege and Siegel created the first draft of this statement, responded to committee and Board comments, and edited the Policy Statement; and all authors approved the final manuscript as submitted.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

FUNDING: No external funding.

1
Taylor
CA
,
Moeller
W
,
Hamvas
L
,
Rice
JC
.
Parents’ professional sources of advice regarding child discipline and their use of corporal punishment.
Clin Pediatr (Phila)
.
2013
;
52
(
2
):
147
155
[PubMed]
2
Duncan
PM
,
Kemper
AR
,
Shaw
JS
, et al
.
What do pediatricians discuss during health supervision visits? National surveys comparing 2003 to 2012.
In:
Pediatric Academic Societies Annual Meeting
;
May 4–7, 2013
;
Washington, DC
3
Taylor
CA
,
Fleckman
JM
,
Scholer
SJ
,
Branco
N
.
US pediatricians’ attitudes, beliefs, and perceived injunctive norms about spanking.
J Dev Behav Pediatr
.
2018
;
39
(
7
):
564
572
4
American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health
.
Guidance for effective discipline. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health [published correction appears in Pediatrics. 1998;102(2, pt 1):433].
Pediatrics
.
1998
;
101
(
4, pt 1
):
723
728
. Reaffirmed April 2014
5
United Nations Committee on the Rights of the Child
.
General Comment No. 8: The Right of the Child to Protection From Corporal Punishment and Other Cruel or Degrading Forms of Punishment (Arts. 19; 28, Para. 2; and 37, Inter Alia)
.
Geneva, Switzerland
:
UN Committee on the Rights of the Child
;
2007
. Available at: www.refworld.org/docid/460bc7772.html. Accessed July 19, 2018
6
Global Initiative to End All Corporal Punishment of Children
.
Prohibiting and Eliminating Corporal Punishment: A Key Health Issue in Addressing Violence Against Children
.
Geneva, Switzerland
:
World Health Organization
;
2015
. Available at: www.who.int/topics/violence/Global-Initiative-End-All-Corporal-Punishment-children.pdf. Accessed July 19, 2018
7
Gershoff
ET
,
Grogan-Kaylor
A
.
Spanking and child outcomes: old controversies and new meta-analyses.
J Fam Psychol
.
2016
;
30
(
4
):
453
469
[PubMed]
8
American Academy of Pediatrics, Committee on School Health
.
American Academy of Pediatrics. Committee on School Health. Corporal punishment in schools.
Pediatrics
.
2000
;
106
(
2, pt 1
):
343
[PubMed]
9
Hagan
JF
,
Shaw
JS
,
Duncan
PM
, eds.
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents
. 4th ed.
Elk Grove Village, IL
:
American Academy of Pediatrics
;
2017
10
American Academy of Pediatrics
. HealthyChildren.org. Available at: www.healthychildren.org/English/Pages/default.aspx. Accessed July 19, 2018
11
American Academy of Pediatrics
. Connected Kids: Safe, Strong, Secure. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Connected-Kids.aspx. Accessed July 19, 2018
12
Regalado
M
,
Sareen
H
,
Inkelas
M
,
Wissow
LS
,
Halfon
N
.
Parents’ discipline of young children: results from the National Survey of Early Childhood Health.
Pediatrics
.
2004
;
113
(
suppl 6
):
1952
1958
[PubMed]
13
Socolar
RR
,
Savage
E
,
Evans
H
.
A longitudinal study of parental discipline of young children.
South Med J
.
2007
;
100
(
5
):
472
477
[PubMed]
14
Gershoff
ET
,
Bitensky
SH
.
The case against corporal punishment of children: converging evidence from social science research and international human rights law and implications for U.S. public policy.
Psychol Public Policy Law
.
2007
;
13
(
4
):
231
272
15
Bender
HL
,
Allen
JP
,
McElhaney
KB
, et al
.
Use of harsh physical discipline and developmental outcomes in adolescence.
Dev Psychopathol
.
2007
;
19
(
1
):
227
242
[PubMed]
16
The Harris Poll
.
Four in Five Americans Believe Parents Spanking Their Children is Sometimes Appropriate
.
New York, NY
:
Harris Insights and Analytics
;
2013
. Available at: https://theharrispoll.com/new-york-n-y-september-26-2013-to-spank-or-not-to-spank-its-an-age-old-question-that-every-parent-must-face-some-parents-may-start-off-with-the-notion-that-i-will-never-spank-my-child-bu/. Accessed July 19, 2018
17
Sege
R
,
Bethell
C
,
Linkenbach
J
,
Jones
J
,
Klika
B
,
Pecora
PJ
.
Balancing Adverse Childhood Experiences With HOPE: New Insights Into the Role of Positive Experience on Child and Family Development
.
Boston, MA
:
The Medical Foundation
;
2017
. Available at: www.cssp.org/publications/documents/Balancing-ACEs-with-HOPE-FINAL.pdf. Accessed July 19, 2018
18
Holden
GW
,
Williamson
PA
,
Holland
GW
.
Eavesdropping on the family: a pilot investigation of corporal punishment in the home.
J Fam Psychol
.
2014
;
28
(
3
):
401
406
[PubMed]
19
Larzelere
RE
.
A review of the outcomes of parental use of nonabusive or customary physical punishment.
Pediatrics
.
1996
;
98
(
4, pt 2
):
824
828
[PubMed]
20
Baumrind
D
.
A blanket injunction against disciplinary use of spanking is not warranted by the data.
Pediatrics
.
1996
;
98
(
4, pt 2
):
828
831
[PubMed]
21
Paolucci
EO
,
Violato
C
.
A meta-analysis of the published research on the affective, cognitive, and behavioral effects of corporal punishment.
J Psychol
.
2004
;
138
(
3
):
197
221
[PubMed]
22
Baumrind
D
,
Larzelere
RE
,
Cowan
PA
.
Ordinary physical punishment: is it harmful? Comment on Gershoff (2002).
Psychol Bull
.
2002
;
128
(
4
):
580
589; discussion 602–611
[PubMed]
23
Bean
AW
,
Roberts
MW
.
The effect of time-out release contingencies on changes in child noncompliance.
J Abnorm Child Psychol
.
1981
;
9
(
1
):
95
105
[PubMed]
24
Reichman
NE
,
Teitler
JO
,
Garfinkel
I
,
McLanahan
SS
.
Fragile families: sample and design.
Child Youth Serv Rev
.
2001
;
23
(
4–5
):
303
326
25
Taylor
CA
,
Manganello
JA
,
Lee
SJ
,
Rice
JC
.
Mothers’ spanking of 3-year-old children and subsequent risk of children’s aggressive behavior.
Pediatrics
.
2010
;
125
(
5
). Available at: www.pediatrics.org/cgi/content/full/125/5/e1057
[PubMed]
26
MacKenzie
MJ
,
Nicklas
E
,
Waldfogel
J
,
Brooks-Gunn
J
.
Spanking and child development across the first decade of life.
Pediatrics
.
2013
;
132
(
5
). Available at: www.pediatrics.org/cgi/content/full/132/5/e1118
[PubMed]
27
MacKenzie
MJ
,
Nicklas
E
,
Brooks-Gunn
J
,
Waldfogel
J
.
Spanking and children’s externalizing behavior across the first decade of life: evidence for transactional processes.
J Youth Adolesc
.
2015
;
44
(
3
):
658
669
[PubMed]
28
Lansford
JE
,
Wager
LB
,
Bates
JE
,
Dodge
KA
,
Pettit
GS
.
Parental reasoning, denying privileges, yelling, and spanking: ethnic differences and associations with child externalizing behavior.
Parent Sci Pract
.
2012
;
12
(
1
):
42
56
[PubMed]
29
Sege
RD
,
Hatmaker-Flanigan
E
,
De Vos
E
,
Levin-Goodman
R
,
Spivak
H
.
Anticipatory guidance and violence prevention: results from family and pediatrician focus groups.
Pediatrics
.
2006
;
117
(
2
):
455
463
[PubMed]
30
Sege
RD
,
Amaya-Jackson
L
;
American Academy of Pediatrics Committee on Child Abuse and Neglect, Council on Foster Care, Adoption, and Kinship Care
;
American Academy of Child and Adolescent Psychiatry Committee on Child Maltreatment and Violence
;
National Center for Child Traumatic Stress
.
Clinical considerations related to the behavioral manifestations of child maltreatment.
Pediatrics
.
2017
;
139
(
4
):
e20170100
[PubMed]
31
Council on Foster Care
;
Adoption, and Kinship Care
;
Committee on Adolescence, and Council on Early Childhood
.
Health care issues for children and adolescents in foster care and kinship care.
Pediatrics
.
2015
;
136
(
4
). Available at: www.pediatrics.org/cgi/content/full/136/4/e1131
[PubMed]
32
Kistin
CJ
,
Tompson
MC
,
Cabral
HJ
,
Sege
RD
,
Winter
MR
,
Silverstein
M
.
Subsequent maltreatment in children with disabilities after an unsubstantiated report for neglect.
JAMA
.
2016
;
315
(
1
):
85
87
[PubMed]
33
Callender
KA
,
Olson
SL
,
Choe
DE
,
Sameroff
AJ
.
The effects of parental depressive symptoms, appraisals, and physical punishment on later child externalizing behavior.
J Abnorm Child Psychol
.
2012
;
40
(
3
):
471
483
[PubMed]
34
Kistin
CJ
,
Radesky
J
,
Diaz-Linhart
Y
,
Tompson
MC
,
OʼConnor
E
,
Silverstein
M
.
A qualitative study of parenting stress, coping, and discipline approaches among low-income traumatized mothers.
J Dev Behav Pediatr
.
2014
;
35
(
3
):
189
196
[PubMed]
35
Durrant
JE
.
Physical punishment, culture, and rights: current issues for professionals.
J Dev Behav Pediatr
.
2008
;
29
(
1
):
55
66
[PubMed]
36
Mackenzie
MJ
,
Nicklas
E
,
Brooks-Gunn
J
,
Waldfogel
J
.
Who spanks infants and toddlers? Evidence from the fragile families and child well-being study.
Child Youth Serv Rev
.
2011
;
33
(
8
):
1364
1373
[PubMed]
37
Evans
SZ
,
Simons
LG
,
Simons
RL
.
The effect of corporal punishment and verbal abuse on delinquency: mediating mechanisms.
J Youth Adolesc
.
2012
;
41
(
8
):
1095
1110
[PubMed]
38
Donovan
KL
,
Brassard
MR
.
Trajectories of maternal verbal aggression across the middle school years: associations with negative view of self and social problems.
Child Abuse Negl
.
2011
;
35
(
10
):
814
830
[PubMed]
39
Surjadi
FF
,
Lorenz
FO
,
Conger
RD
,
Wickrama
KA
.
Harsh, inconsistent parental discipline and romantic relationships: mediating processes of behavioral problems and ambivalence.
J Fam Psychol
.
2013
;
27
(
5
):
762
772
[PubMed]
40
Maguire-Jack
K
,
Gromoske
AN
,
Berger
LM
.
Spanking and child development during the first 5 years of life.
Child Dev
.
2012
;
83
(
6
):
1960
1977
[PubMed]
41
Lansford
JE
,
Criss
MM
,
Laird
RD
, et al
.
Reciprocal relations between parents’ physical discipline and children’s externalizing behavior during middle childhood and adolescence.
Dev Psychopathol
.
2011
;
23
(
1
):
225
238
[PubMed]
42
Olson
SL
,
Lopez-Duran
N
,
Lunkenheimer
ES
,
Chang
H
,
Sameroff
AJ
.
Individual differences in the development of early peer aggression: integrating contributions of self-regulation, theory of mind, and parenting.
Dev Psychopathol
.
2011
;
23
(
1
):
253
266
[PubMed]
43
Lee
SJ
,
Altschul
I
,
Gershoff
ET
.
Does warmth moderate longitudinal associations between maternal spanking and child aggression in early childhood?
Dev Psychol
.
2013
;
49
(
11
):
2017
2028
[PubMed]
44
McCoy
KP
,
George
MR
,
Cummings
EM
,
Davies
PT
.
Constructive and destructive marital conflict, parenting, and children’s school and social adjustment.
Soc Dev
.
2013
;
22
(
4
):
641
662
[PubMed]
45
Gunnoe
ML
.
Associations between parenting style, physical discipline, and adjustment in adolescents’ reports.
Psychol Rep
.
2013
;
112
(
3
):
933
975
[PubMed]
46
Lee
SJ
,
Grogan-Kaylor
A
,
Berger
LM
.
Parental spanking of 1-year-old children and subsequent child protective services involvement.
Child Abuse Negl
.
2014
;
38
(
5
):
875
883
[PubMed]
47
McCurdy
K
.
The influence of support and stress on maternal attitudes.
Child Abuse Negl
.
2005
;
29
(
3
):
251
268
[PubMed]
48
MacKenzie
MJ
,
Nicklas
E
,
Brooks-Gunn
J
,
Waldfogel
J
.
Repeated exposure to high-frequency spanking and child externalizing behavior across the first decade: a moderating role for cumulative risk.
Child Abuse Negl
.
2014
;
38
(
12
):
1895
1901
[PubMed]
49
Lee
SJ
,
Perron
BE
,
Taylor
CA
,
Guterman
NB
.
Paternal psychosocial characteristics and corporal punishment of their 3-year-old children.
J Interpers Violence
.
2011
;
26
(
1
):
71
87
[PubMed]
50
Turner
HA
,
Muller
PA
.
Long-term effects of child corporal punishment on depressive symptoms in young adults: potential moderators and mediators.
J Fam Issues
.
2004
;
25
(
6
):
761
782
51
Berzenski
SR
,
Yates
TM
.
Preschoolers’ emotion knowledge and the differential effects of harsh punishment.
J Fam Psychol
.
2013
;
27
(
3
):
463
472
[PubMed]
52
Owen
DJ
,
Slep
AM
,
Heyman
RE
.
The effect of praise, positive nonverbal response, reprimand, and negative nonverbal response on child compliance: a systematic review.
Clin Child Fam Psychol Rev
.
2012
;
15
(
4
):
364
385
[PubMed]
53
Kochanska
G
,
Kim
S
.
Toward a new understanding of legacy of early attachments for future antisocial trajectories: evidence from two longitudinal studies.
Dev Psychopathol
.
2012
;
24
(
3
):
783
806
[PubMed]
54
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
55
Gershoff
ET
.
Spanking and child development: we know enough now to stop hitting our children.
Child Dev Perspect
.
2013
;
7
(
3
):
133
137
[PubMed]
56
Zolotor
AJ
.
Corporal punishment.
Pediatr Clin North Am
.
2014
;
61
(
5
):
971
978
[PubMed]
57
Durrant
J
,
Ensom
R
.
Physical punishment of children: lessons from 20 years of research.
CMAJ
.
2012
;
184
(
12
):
1373
1377
[PubMed]
58
Ferguson
CJ
.
Spanking, corporal punishment and negative long-term outcomes: a meta-analytic review of longitudinal studies.
Clin Psychol Rev
.
2013
;
33
(
1
):
196
208
[PubMed]
59
Straus
MA
,
Paschall
MJ
.
Corporal punishment by mothers and development of children’s cognitive ability: a longitudinal study of two nationally representative age cohorts.
J Aggress Maltreat Trauma
.
2009
;
18
(
5
):
459
483
60
Flaherty
EG
,
Stirling
J
 Jr
;
American Academy of Pediatrics
;
Committee on Child Abuse and Neglect
.
Clinical report—the pediatrician’s role in child maltreatment prevention.
Pediatrics
.
2010
;
126
(
4
):
833
841
[PubMed]
61
Taylor
CA
,
Lee
SJ
,
Guterman
NB
,
Rice
JC
.
Use of spanking for 3-year-old children and associated intimate partner aggression or violence.
Pediatrics
.
2010
;
126
(
3
):
415
424
[PubMed]
62
Brooks-Gunn
J
,
Schneider
W
,
Waldfogel
J
.
The Great Recession and the risk for child maltreatment.
Child Abuse Negl
.
2013
;
37
(
10
):
721
729
[PubMed]
63
Afifi
TO
,
Ford
D
,
Gershoff
ET
, et al
.
Spanking and adult mental health impairment: the case for the designation of spanking as an adverse childhood experience.
Child Abuse Negl
.
2017
;
71
:
24
31
[PubMed]
64
Tomoda
A
,
Suzuki
H
,
Rabi
K
,
Sheu
YS
,
Polcari
A
,
Teicher
MH
.
Reduced prefrontal cortical gray matter volume in young adults exposed to harsh corporal punishment.
Neuroimage
.
2009
;
47
(
suppl 2
):
T66
T71
[PubMed]
65
Choi
J
,
Jeong
B
,
Rohan
ML
,
Polcari
AM
,
Teicher
MH
.
Preliminary evidence for white matter tract abnormalities in young adults exposed to parental verbal abuse.
Biol Psychiatry
.
2009
;
65
(
3
):
227
234
[PubMed]
66
Gershoff
ET
.
Should parents’ physical punishment of children be considered a source of toxic stress that affects brain development?
Fam Relat
.
2016
;
65
(
1
):
151
162
67
Wang
MT
,
Kenny
S
.
Longitudinal links between fathers’ and mothers’ harsh verbal discipline and adolescents’ conduct problems and depressive symptoms.
Child Dev
.
2014
;
85
(
3
):
908
923
[PubMed]
68
Taylor
CA
,
Hamvas
L
,
Rice
J
,
Newman
DL
,
DeJong
W
.
Perceived social norms, expectations, and attitudes toward corporal punishment among an urban community sample of parents.
J Urban Health
.
2011
;
88
(
2
):
254
269
[PubMed]
69
Barkin
SL
,
Finch
SA
,
Ip
EH
, et al
.
Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial.
Pediatrics
.
2008
;
122
(
1
). Available at: www.pediatrics.org/cgi/content/full/122/1/e15
[PubMed]
70
Scholer
SJ
,
Hudnut-Beumler
J
,
Dietrich
MS
.
A brief primary care intervention helps parents develop plans to discipline.
Pediatrics
.
2010
;
125
(
2
). Available at: www.pediatrics.org/cgi/content/full/125/2/e242
[PubMed]
71
Smith
AE
,
Hudnut-Beumler
J
,
Scholer
SJ
.
Can discipline education be culturally sensitive?
Matern Child Health J
.
2017
;
21
(
1
):
177
186
[PubMed]
72
Holden
GW
,
Brown
AS
,
Baldwin
AS
,
Croft Caderao
K
.
Research findings can change attitudes about corporal punishment.
Child Abuse Negl
.
2014
;
38
(
5
):
902
908
[PubMed]
73
Centers for Disease Control and Prevention
. Positive parenting tips. Available at: www.cdc.gov/ncbddd/childdevelopment/positiveparenting/index.html. Accessed July 19, 2018
74
Dubowitz
H
,
Lane
WG
,
Semiatin
JN
,
Magder
LS
,
Venepally
M
,
Jans
M
.
The safe environment for every kid model: impact on pediatric primary care professionals.
Pediatrics
.
2011
;
127
(
4
). Available at: www.pediatrics.org/cgi/content/full/127/4/e962
[PubMed]
75
Dubowitz
H
,
Lane
WG
,
Semiatin
JN
,
Magder
LS
.
The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population?
Acad Pediatr
.
2012
;
12
(
4
):
259
268
[PubMed]
76
Safe Environment for Every Kid
. SEEK online training activity description. Available at: https://www.seekwellbeing.org/the-seek-online-training-description. Accessed July 19, 2018
77
Maryland Department of Health
. Clinical innovations. Title: SEEK (Safe Environment for Every Kid) Program. Available at: https://health.maryland.gov/innovations/Pages/seekprogram.aspx. Accessed July 19, 2018
78
Sanders
MR
,
Kirby
JN
,
Tellegen
CL
,
Day
JJ
.
The Triple P-Positive Parenting Program: a systematic review and meta-analysis of a multi-level system of parenting support.
Clin Psychol Rev
.
2014
;
34
(
4
):
337
357
[PubMed]
79
HealthySteps
. HealthySteps for young children. Available at: http://healthysteps.org/. Accessed July 19, 2018
80
Help Me Grow National Center
. Help Me Grow. Available at: www.helpmegrownational.org/index.php. Accessed July 19, 2018
81
Center for the Improvement of Child Caring
. CICC’s Confident Parenting Program. Available at: www.ciccparenting.org/ConfidentParentingDesc.aspx. Accessed July 19, 2018
82
Center for the Improvement of Child Caring
. CICC’s Effective Black Parenting Program. Available at: www.ciccparenting.org/EffBlackParentingDesc.aspx. Accessed July 19, 2018
83
New York Charter Parent Action Network
. Resources for parents raising a black male child. Available at: http://nycpan.org/sites/default/files/resources/resources_for_raising_a_black_male_child.pdf. Accessed July 19, 2018
84
Oberklaid
F
,
Baird
G
,
Blair
M
,
Melhuish
E
,
Hall
D
.
Children’s health and development: approaches to early identification and intervention.
Arch Dis Child
.
2013
;
98
(
12
):
1008
1011
[PubMed]
85
Perrin
EC
,
Sheldrick
RC
,
McMenamy
JM
,
Henson
BS
,
Carter
AS
.
Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial.
JAMA Pediatr
.
2014
;
168
(
1
):
16
24
[PubMed]
86
Scholer
SJ
,
Hudnut-Beumler
J
,
Mukherjee
A
,
Dietrich
MS
.
A brief intervention facilitates discussions about discipline in pediatric primary care.
Clin Pediatr (Phila)
.
2015
;
54
(
8
):
732
737
[PubMed]
87
Palusci
VJ
,
Crum
P
,
Bliss
R
,
Bavolek
SJ
.
Changes in parenting attitudes and knowledge among inmates and other at-risk populations after a family nurturing program.
Child Youth Serv Rev
.
2008
;
30
(
1
):
79
89
88
Breitenstein
SM
,
Gross
D
,
Fogg
L
, et al
.
The Chicago Parent Program: comparing 1-year outcomes for African American and Latino parents of young children.
Res Nurs Health
.
2012
;
35
(
5
):
475
489
[PubMed]
89
Video Interaction Project
. Available at: www.videointeractionproject.org/. Accessed July 19, 2018
90
Hibbard
R
,
Barlow
J
,
Macmillan
H
;
Child Abuse and Neglect
;
American Academy of Child and Adolescent Psychiatry
;
Child Maltreatment and Violence
.
Psychological maltreatment.
Pediatrics
.
2012
;
130
(
2
):
372
378
[PubMed]
91
Enebrink
P
,
Högström
J
,
Forster
M
,
Ghaderi
A
.
Internet-based parent management training: a randomized controlled study.
Behav Res Ther
.
2012
;
50
(
4
):
240
249
[PubMed]
92
Reed
A
,
Snyder
J
,
Staats
S
, et al
.
Duration and mutual entrainment of changes in parenting practices engendered by behavioral parent training targeting recently separated mothers.
J Fam Psychol
.
2013
;
27
(
3
):
343
354
[PubMed]
93
Barlow
J
,
Smailagic
N
,
Ferriter
M
,
Bennett
C
,
Jones
H
.
Group-based parent-training programmes for improving emotional and behavioural adjustment in children from birth to three years old.
Cochrane Database Syst Rev
.
2010
;(
3
):
CD003680
[PubMed]
94
American Academy of Pediatrics
.
Strategies for System Change in Children’s Mental Health: A Chapter Action Kit
.
Elk Grove Village, IL
:
American Academy of Pediatrics
;
2007
. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/mh2ch.pdf#search=Mental%20Health%20task%20force. Accessed July 19, 2018

Robert D. Sege, MD, PhD, FAAP

Benjamin S. Siegel, MD, FAAP

Emalee G. Flaherty, MD, FAAP

CAPT Amy R. Gavril, MD, FAAP

Sheila M. Idzerda, MD, FAAP

Antoinette Laskey, MD, MPH, MBA, FAAP

Lori Anne Legano, MD, FAAP

John M. Leventhal, MD, FAAP

James Louis Lukefahr, MD, FAAP

Robert D. Sege, MD, PhD, FAAP

Beverly Fortson, PhD – Centers for Disease Control and Prevention

Harriet MacMillan, MD, FRCPC – American Academy of Child and Adolescent Psychiatry

Elaine Stedt, MSW – Office on Child Abuse and Neglect, Administration for Children, Youth and Families

Tammy Piazza Hurley

Michael W. Yogman, MD, FAAP, Chairperson

Rebecca Baum, MD, FAAP

Thresia B. Gambon, MD, FAAP

Arthur Lavin, MD, FAAP

Gerri Mattson, MD, FAAP

Raul Montiel-Esparza, MD

Lawrence Sagin Wissow, MD, MPH, FAAP

Terry Carmichael, MSW – National Association of Social Workers

Edward Christophersen, PhD, FAAP (hon) – Society of Pediatric Psychology

Norah Johnson, PhD, RN, NP-BC – National Association of Pediatric Nurse Practitioners

Leonard Read Sulik, MD – American Academy of Child and Adolescent Psychiatry

Stephanie Domain, MS

Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.