Asking older children "What happens if you do something bad" is a regular part of my visits. Why? Because 60% of 10- to 12-year-olds are struck and have increased aggression and decreased self-esteem as a result. Don’t forget that 40% of 14-year-olds and 25% of 17-year-olds are still hit even though the result is that 8- to 17-year olds who are struck have increased delinquency, controlling for family violence, alcohol, and parenting competence.
Most parents do not want to hit their child. Actually, 85% of parents who believe in spanking say that it was the wrong thing to have done the last time they used it. Yet about 90% of parents hit their 3-year-olds. Why? Parents who hit say that they don’t know what else to do when their children act out. They may try not to spank, but end up spanking out of anger and frustration. And hitting not only stops behavior, but also relieves the anger parents feel in dealing with their child. Even though they may regret it afterward, it feels good to them at the time.
How can you approach this touchy subject with your patients? The first principle is to resist your impulse to correct the parent and instead say nothing – at least right away. Carry on your visit and observe the child’s behavior. Some misbehavior is likely to appear. Then comment on what you see about child – "He sure is busy!" Then ask, "How is that for you?", or "How bad does it get?" Be nonjudgmental. Instead praise acceptable techniques they already use well, such as distracting the child or removing temptation.
Because parenting is learned from our own experiences, it is important to explore how the parents were raised. You might start by asking, "How would your parents have handled that behavior when you were growing up?" then "What have you decided about how you want to discipline your children?" Often, you will find that they do not want to repeat history, but don’t know other ways. Now you have an opening to offer other effective techniques. You might even ask permission, for example, "Would you like to hear about some other things that can work?" The main strategies you can teach quickly include first paying attention to acceptable behavior, and also proper use of Time Out. For toddlers and preschoolers, I also teach parents to use "only one request then move" the child silently to do as told.
Your advice will be more effective when you individualize the plan to make small adjustments to their current parenting with which the family can agree and be successful. For example, if one parent is willing to try these alternatives but the other is not or is unsure I suggest an agreement for use of Time Out instead of hitting for 2-3 weeks by the willing parent and noninterference plus limits on physical punishment (spank on clothed buttocks only) by the other parent. What usually happens is that the "Time Out parent" has success in this time period, and the other parent sees this and adopts the same method. It is really important to schedule one or more follow up visits soon, at least by phone, to reinforce their success and problem solve any difficulties. Changing such an ingrained habit is difficult but worthwhile and deserves your support.
Advising to avoid corporal punishment can be even more difficult for some doctors and in some settings. You may have been raised with spanking yourself and see it as not harmful or even helpful to your own development. Remember, spanking only increases the chances of a poor outcome by a factor of four, so most people grow up fine! The parents’ or your religion may even advise the use of spanking. I like to translate "spare the rod" as meaning "draw a line in the sand with the rod" to set limits. You may be of a different culture than your patient in which their belief is that corporal punishment is the key to neighborhood survival and gaining the child’s respect. But a child who is hit is actually more likely to bring him/herself trouble through aggression or delinquency.
To be effective in counseling about corporal punishment, you need to be clear about your own ideas on the acceptability of hitting. You need to be rational and avoid strong emotions during the visit. Instead, show empathy to the difficulties of parenting and work to understand and address the parents’ justifications for spanking with the facts. If you have shown knowledge of behavior and development in the regular care you provide, you will be a credible source and influence on this important area.
Dr. Howard is assistant professor of pediatrics at Johns Hopkins University, Baltimore, and creator of CHADIS. She has no other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid expert to Frontline Medical Communications. E-mail her at pdnews@frontlinemedcom.com.