EBM Review: Spanking and child development across the first decade of life.

MacKenzie MJ, Nicklas E, Waldfogel J, Brooks-Gunn J. Spanking and child development across the first decade of life. Pediatrics. 2013 Nov;132(5):e1118-25.

Full-text for Children’s and Emory users.

OBJECTIVE: To examine the prevalence of maternal and paternal spanking of children at 3 and 5 years of age and the associations between spanking and children’s externalizing behavior and receptive vocabulary through age 9.

METHODS: The Fragile Families and Child Well-Being Study, a longitudinal birth cohort study of children in 20 medium to large US cities, was used. Parental reports of spanking were assessed at age 3 and 5, along with child externalizing behavior and receptive vocabulary at age 9 (N = 1933). The data set also included an extensive set of child and family controls (including earlier measures of the child outcomes).

RESULTS: Overall, 57% of mothers and 40% of fathers engaged in spanking when children were age 3, and 52% of mothers and 33% of fathers engaged in spanking at age 5. Maternal spanking at age 5, even at low levels, was associated with higher levels of child externalizing behavior at age 9, even after an array of risks and earlier child behavior were controlled for. Father’s high-frequency spanking at age 5 was associated with lower child receptive vocabulary scores at age 9.

CONCLUSIONS: Spanking remains a typical rearing experience for American children. These results demonstrate negative effects of spanking on child behavioral and cognitive development in a longitudinal sample from birth through 9 years of age.

Reviewed by:

Amy Tang, MD  Amy Tang, MD 

Tracie Walker, MD  Tracie Walker, MD

Importance of study:

  • Corporal punishment remains a common parenting tool
  • Some countries have banned spanking
    • Germany, Costa Rica, Sweden, Spain, Greece, Ukraine…
  • AAP recommends other methods of discipline
  • There have been studies showing an association between spanking and higher levels of aggression in children

Strengths of study design:

  • Followed sequential families through age 9 → longitudional data
  • Followed families with and without fathers
  • Diverse population with multiple cities
  • Large subject number

Weaknesses of study design:

  • Only used families with continued data through 9 yo, could have lost many unstable and risky families
  • Reporter bias: selective reasoning or suppression of information
  • Sampling bias: more stable families responded to every call/visit

What this study adds:

  • Controlling for multiple different measures of stress and socioeconomic variables
    • Child and family characteristics (gender, age, birth order, maternal age at birth, marital status, maternal race/ethnicity, maternal education, household income to needs ratio, number of adults in household, number of other children in household, maternal prenatal drugs, alcohol, or smoking, supportive birth father, prenatal care, etc.)
    • Maternal factors: health and cognition, stress level, impulsivity, presence of depression or anxiety
    • Earlier child behavior and temperament
  • Longitudinal data – association between spanking at ages 3 and 5 with outcomes at age 9
    • Previous studies only went up to age 5
  • Cognitive developmental outcomes
    • Looks at both behavioral AND cognitive development
    • Previous studies had already established a link between spanking and later aggressive behavior
  • Effects of paternal spanking
    • High frequency (>2x/wk) paternal spanking at age 5 predicted lower receptive language scores later on
    • Effect not seen with maternal spanking or with less frequent spanking or spanking at age 3

Study limitations:

  • Measures for child externalizing behaviors rely on maternal report – room for parental bias
    • Negative perception of child → negative maternal ratings AND spanking
  • Study population as a whole – disadvantaged urban population
    • Sample for vocabulary testing analysis was a subgroup within the externalizing behavior group
    • The vocabulary testing group as a whole had more resources and more stability in general – presence of father figure?
    • Applicability to the general population?

Practical applications:

  • AAP recommends that physicians counsel parents on the use of discipline for their children
  • What to use instead:
    • Positive reinforcement strategies
    • Other types of punishment: time outs, removal of privileges
    • Need for a secure, loving relationship
  • Could use this paper part of your discussion with families about avoiding physical punishment

Future directions:

  • Other outcomes associated with spanking?
  • What kind of discipline really is most effective?
  • Role of extended family members and other care-givers (daycare, babysitters)?