The WHO–UNICEF–Lancet Commission1 on children has highlighted social, economic, commercial, and environmental threats to child health and has called for urgent government action to ensure that children grow up in safe and healthy environments. Yet the home environments of most children worldwide are not safe because they include physical punishment. The UN Committee on the Rights of the Child has definitively stated that physical punishment is a form of violence that violates children's rights to protection, dignity, and physical security.2 The UN General Assembly has included the protection of children from all forms of violence as Sustainable Development Goal 16.2.3 Such human rights arguments, along with an aligned body of research indicating that physical punishment is harmful to children,4, 5, 6 have led to a growing consensus among health professionals that physical punishment of children is detrimental and ineffective,7, 8, 9 and have led 62 countries to prohibit physical punishment of children in all settings and a further 27 countries to commit to doing so.10
Most of the world's children live in countries where physical punishment is allowed by law; as a result, 63% of children aged 2–4 years—250 million children—are regularly subjected to physical punishment by their caregivers.11 The continued prevalence of physical punishment suggests that parents are not receiving, or not believing, the message that it is both ineffective and potentially harmful to their children's health and development. This lack of knowledge could be because the research to date is summarised in hundreds of specialist research studies or in detailed meta-analyses5, 12, 13, 14 that are not easily accessible to health professionals whom parents consult for advice about discipline.15 Furthermore, most countries have not prohibited physical punishment in homes or schools, or both. Policy makers might not be aware of the strength of the research evidence against physical punishment or of the likelihood that legislating against physical punishment would prevent harm to children.
The purpose of this narrative review is thus to summarise the past two decades of research on physical punishment in a format that is accessible to policy makers, community leaders, and practitioners. Although psychological punishments such as yelling, humiliating, or shaming children are also prevalent around the world11 and are harmful to children,16 we focused our review on physical punishment in response to growing interest around the world in legislating against its use.
Three strategic decisions guided our review. First, we began our review with studies published in 2002, the year that the first comprehensive meta-analysis of research into physical punishment was published.12 Second, we included only studies that examined physical punishment specifically and excluded studies of severe assaults against children. Third, we restricted our review to longitudinal studies that followed up children prospectively and took initial levels of the outcome into account, thereby meeting the minimum criterion for causality that physical punishment must precede the measured outcome in time and addressing concerns regarding the possibility of reverse causality.17
The database searches identified 3855 unduplicated records, of which 2198 were excluded after initial title screening. An additional five studies were identified through Web of Science search alerts and expert communication. After two independent reviewers assessed 1303 abstracts and 359 full texts, they identified 68 articles describing 69 studies (one article reported on two samples) that met the inclusion criteria. These were retained for review (figure).
The field is heavily dominated by
We identified seven themes from our review of the longitudinal research into physical punishment and change in children's outcomes over time.
The purpose of this narrative review was to summarise and interpret the extant research on physical punishment from prospective studies. Because it is not a meta-analysis or systematic review, this narrative review does not take into account the number of participants in a study or the magnitude of effect sizes. The vast majority of studies that met our selection criteria were undertaken in the USA; only eight studies were from other countries (one each from Canada,72 China,20 Colombia,83
The evidence is consistent and robust: physical punishment does not predict improvements in child behaviour and instead predicts deterioration in child behaviour and increased risk for maltreatment. There is thus no empirical reason for parents to continue to use physical punishment. Moreover, the UN Committee on the Rights of the Child has explicitly stated that physical punishment is a violation of a child's right to protection and should be prohibited.2
So far, 62 of the world's countries
Our review of prospective longitudinal studies has shown that physical punishment is linked with increases in negative child outcomes. Many of these studies used statistical methods to minimise potential confounding and selection bias. The review has documented compelling evidence that physical punishment is harmful to children's development and wellbeing and has shown no evidence that it is beneficial for children. Given the high prevalence of physical punishment around the world, there is no
We undertook a literature search of MEDLINE, PsycINFO, and Web of Science in June, 2020, and updated the search in October, 2020. The search terms were “physical discipline”, “physical punishment”, “corporal punishment”, “physical chastisement”, “smack”, “spank”, and “slap”. The search syntax for each database can be found in the appendix p 1. We searched for articles published from January, 2002, onwards, and did not restrict by language or country. We also identified articles from reference
We declare no competing interests.
