One of the issues that can push your button as a pediatrician is hearing from your nurse that the parent you are about to see hit the child in the waiting room. Sometimes, the parent even hits the child right in front of you during the visit!
Your first reaction may be to want to tell the parents not to spank. But how well does that advice work?
Parents tend to use the same methods of child rearing that were used for them when they were growing up. This is deeply ingrained and tends to be accepted as "natural" even when they do not rationally believe in it. This requires that any intervention about corporal punishment be a conversation, not an edict from you. They may nod their heads if you tell them not to spank, but shut out any future advice from you on this topic.
There are some real facts that can help you address the parents’ reasons for spanking. The first "fact" that pediatricians often pull out is that "hitting the child does not work." Wrong. Hitting a child works fast to stop an unwanted behavior – but it has side effects. If you deny this, you lose credibility. If you acknowledge this, you will have the ears of the parents. Then you can point out some related truths – the child will soon go back to the same behavior whether hit or not because that is what young children do. Avoiding repeat behavior requires adjusting the environment, removing the child, and often changing the mood of the interaction. It is a fact that painful punishments must be progressively increased to maintain effectiveness and make nonpainful interventions less effective. I sometimes muse, "What are the teachers going to do at school if only hitting can control his behavior?"
The next fact is that other consequences, notably time out, work just as well as spanking to reduce unwanted behaviors, but without the side effects. What are these side effects? There are immediate side effects of corporal punishment, even if no bruising or harm occurs, and also long-term side effects. The immediate side effects are to increase the child’s aggressiveness to peers, siblings, and often the parent, and to increase fear of the parent. Fear of the parent undermines the child’s wanting to do as the parent asks, makes the child avoid the parent – making him/her less available to all parenting, and interferes with the problem solving that the child needs to do when facing a stressful situation such as conflict with a sibling. Longer term fear of the parent makes a child sneaky and less likely to admit mistakes. That is certainly not what anyone wants, especially when the child becomes a teen.
It may be hard to believe, but 25% of infants 1-6 months and 50% of infants 6-12 months are spanked for discipline. The implication is that it is never too early to have a conversation about discipline – certainly by 12 months of age. This early teaching helps parents establish control and helps prevent the early use of corporal punishment. Help parents understand that infants cannot learn to avoid a behavior from being struck; they can only become confused and frightened of their parent. In fact, 0- to 23-month-old white (not black or Latino) children had worse behavior at 6 years if they were frequently spanked, even controlling for maternal warmth (Pediatrics 2004;113:1321-1330).
Hitting a child is especially dangerous for children under age 2 years due to their size and head/body proportions. At this stage, a hit by an adult is more likely to cause serious injury even when the adult thought they were under control and managing the amount of force used. It is sobering to know that one-third of child abuse occurs to children under 6 months of age. If evidence of abuse is seen, it is your obligation to report it immediately. But you have a lot more value in educating about effective and safe discipline early on to prevent this. The American Academy of Pediatrics recommends that parents be "assisted in the development of methods other than spanking for managing undesired behavior" and that means you!
But doesn’t a toddler need discipline to learn how to behave? We know that verbal correction without action actually increases noncompliance in toddlers. But in one study, two-thirds of children under age 6 years were hit in the last week, on average 3 times per week. This is because toddlers and preschoolers typically misbehave every 6-8 minutes! Some consequence is needed as a back-up to reasoning to decrease recurrence of misbehavior, but noncorporal consequences are equally effective. The more children ages 3-6 years are spanked, the greater their antisocial behavior 2 years later, controlled for baseline behavior. Even IQ is lower at age 4 years when there is more spanking.