Attitudes of Primary Care Physicians

Toward Corporal Punishment

Kenelm F. McCormick, MD

Objective.\p=m-\Thepurpose of this study was to determine whether or not family that these requirements and others would
physicians and pediatricians support the use of corporal punishment. The be impractical within the school setting.
frequency with which these physicians offer anticipatory guidance on discipline In particular, Bongiovanni notes that the
was also studied. requirement for intense punishment puts
the punished child at considerable risk
Design.\p=m-\Self-reportsurvey, mailed to study participants. for physical injury. Few school districts
Participants.\p=m-\Thesample for this study was 800 family physicians and 400 would be willing to take such a risk. While
pediatricians, randomly selected from the Ohio State Medical Board's roster of Bongiovanni addressed the use of corpo¬
family physicians and pediatricians. Physicians with a subspecialty were ex- ral punishment in schools, there is no rea¬
cluded. Participants who did not return their surveys received a second, and if son to suppose that parents, who rarely
necessary, a third mailing of the survey. After three mailings, a total of 619 phy- receive formal training in parenting,
sicians (61%) completed a survey. should be able to apply corporal punish¬
Main Outcome Measure.\p=m-\Participantswere considered to support corporal ment more effectively or less dangerously
punishment if they would tell a parent in their medical practice that spanking would than school officials. It is ironic that the
be an appropriate response to any one of a series of childhood misbehaviors pre- risks of corporal punishment are such that
no investigator is likely to find support
sented in the survey.
for an experimental protocol in which
Results.\p=m-\Offamily physicians, 70% (95% confidence interval [Cl], 66% to some children receive effective levels of
75%) support use of corporal punishment. Of pediatricians, 59% (95% Cl, 52% to physical punishment and some do not.
66%) support corporal punishment. Of pediatricians, 90% (95% Cl, 86% to 94%) A mechanism by which intergenera-
indicated that they include discipline issues either always or most of the time when tional transmission of violence may take
providing anticipatory guidance to parents. Significantly fewer family physicians place is observational, incidental learn¬
(52%; 95% Cl, 47% to 57%) indicated that they discuss discipline either always ing. In one study, preschool children en¬
or most of the time when providing anticipatory guidance (P<.01). gaged in another task were allowed to
Conclusions.\p=m-\Mostfamily physicians and pediatricians support the use of observe adult models performing an ar¬
corporal punishment in spite of evidence that it is neither effective nor necessary, bitrary behavior.23 Control subjects did
and can be harmful. Pediatricians offer anticipatory guidance on discipline more not observe the behavior. Later, the chil¬
dren who had observed the behavior re¬
often than family physicians.
(JAMA. 1992;267:3161-3165) produced it, while control subjects did
not. In a similar study, preschool children
observed adults modeling unusual, ag¬
INTERPERSONAL violence is a ma¬ is evidence that corporal punishment is gressive behavior while control subjects
jor health problem that needs to be ad¬ ineffective and even counterproductive did not.24 Children in the experimental
dressed by physicians.1"4 The genesis of as a child-raising strategy.8"10,16"20 The
group spontaneously reproduced the
violent behavior involves many factors. use of corporal punishment decreases
novel, aggressive behavior while controls
Many social and behavioral scientists the likelihood that more effective parent- did not. Flanders25 reviewed literature
assert that childhood experiences with child interaction will take place. Corpo¬ on imitative learning and found that such
violence are part of the underpinnings ral punishment and other power-asser¬ learning could generalize across different
of violence and tolerance of violence in tive discipline practices result in infe¬ models, different physiological drives, and
adults.5·6 Corporal punishment is a com¬ rior development of moral reasoning.13 different stimulus situations. Carlson26
mon experience that children have with
THE CASE AGAINST CORPORAL
presented school-age children with vi¬
interpersonal violence.6,7 Corporal pun¬ gnettes of peer misdeeds and asked the
ishment contributes to the problem by PUNISHMENT AND FOR ITS children what the best response of the
serving as a model of problem solving ALTERNATIVES wrongdoer's parents should be. Children
using interpersonal violence.810 For the In reviewing the literature on punish¬ were most likely to recommend physical
child, parental use of corporal punish¬ ment in humans, Johnston21 sets out some discipline when the misdeed was aggres¬
ment validates the use of violence in requirements for its effective use. A few sive, and much more likely to do so when
resolving disputes.5,9"14 Corporal punish¬ of them are (1) the intensity of the pun¬ the misdeed involved aggression against
ment can be a harmful practice that fre¬ ishment should be as great as possible a family member. According to Carlson,
quently escalates to abuse.11,16 Not only each time it is delivered; (2) the punish¬ these results suggest that the family is a
a problem in promoting violence, there ment should be delivered after each oc¬ training ground for violence, especially
currence of the undesired behavior; (3) for violence against other family mem¬
alternative, rewarded, unpunished behav¬ bers. Owens and Straus27 analyzed the
From the Barberton (Ohio) Citizen's Hospital, Family
Practice Residency, and the Society of Teachers of iors must be available; and (4) there should data from a national survey on violence
Family Medicine, Violence Education Task Force, Kan- be no avenue for unauthorized escape from done in 1968. They found a moderate cor¬
sas City, Mo.
punishment. In reviewing the literature relation between childhood experience of
Reprint requests to Barberton Citizen's Hospital, Fam-
ily Practice Residency, 155 Fifth St NE, Barberton, OH on punishment as applied to corporal pun¬ interpersonal violence and adult approval
44203 (Dr McCormick). ishment in schools, Bongiovanni22 found of interpersonal violence. Unfortunately,

Downloaded from www.jama.com by guest on January 25, 2010

this analysis did not control for the se¬
verity of the violence experienced as a
child, lumping all experience of any cor¬
poral punishment with abuse. Lefkowitz
et al28 investigated the effects of parental
punishment practice on the behavior and
attitudes of adults in a longitudinal de¬
sign. The punishment practices of par¬
ents of a group of 8-year-old children were
determined, and the children were inter¬
viewed 10 years later, as young adults.
The analysis showed that parental pun¬
ishment practice influenced the attitudes
of the young adults toward punishing chil¬
dren, and in some subgroups, aggressive
behavior in the adults. However, the au¬
thors note that several other sociocul-
tural and individual variables accounted
for most of aggressive behavior.
It is important to dig deeper than sta¬
tistics on documented physical abuse to
identify the danger in corporal punish¬
ment. Berger et al15 interviewed college
students about their childhood experi¬
ence with physical punishment. Using
what they believed to be a very strin¬
gent definition of abuse, the authors found
that 9% of the subjects had been phys¬
ically abused in the name of punishment.
A surprising number of the abused sub¬
jects did not identify themselves as
abused. Using physical marks such as
welts and bruises to define abuse, Gra¬
ziano and Ñamaste11 found a similar
(10.6%) prevalence of abuse in the name
of punishment in interviewed college stu¬
dents. Berkowitz et al29 have shown in an
experimental design that aversive con¬
ditions may stimulate the production of
aggressive behavior, even when the tar¬
get of the aggression is not the cause of
the aversive conditions. In fact, much of
what passes for ordinary corporal pun¬
ishment is not punishment at all, but aver-
sively stimulated aggression against the
child.30 The goal of aversively stimulated
aggression is to inflict pain.31 Given that
the real goal of much corporal punish¬
ment is to inflict pain, not to punish, it is
not surprising that much corporal pun¬
ishment is abusive. Societal permission
to use corporal punishment is the child's
ticket to victimization.
The purpose of discipline is to teach
children how to behave; the purpose of
punishment is to reduce children's mis¬
behavior. When corporal punishment is
used, the motivation for behaving well is
avoidance of pain rather than good be¬
havior for its own sake. Hoffman and
Saltzstein32 used indexes of guilt, inter¬
nalized moral judgment, acceptance of re¬
sponsibility for actions, and consideration
for others to measure the moral devel¬
opment of seventh-graders as affected
by parental disciplinary practice. The au¬
thors compared power assertion parent¬
ing techniques (including corporal pun-
Downloaded from www.jama.com by guest on January 25, 2010
ishment) with love withdrawal and in¬
duction (focusing children's attention on
the harmfulness of their behavior). They
found that frequent use of power asser¬
tion techniques resulted "considerably
consistently" in less advanced moral de¬
velopment compared with induction. In
this study, mild corporal punishment was
not considered separately from other
power assertions, but was clearly the main
thrust in classifying parental practices. It
must be noted that the association of pa¬
rental practices with moral development
was strong in middle-class children, but
not clear in the lower class. The authors
suggest that more socializing influences
come from outside the home in the lower
class. In a longitudinal, prospective study
spanning 19 years, McCord33 found that
aggressive parents raised more expres¬
sive and antisocial children. Punitive par¬
ents raised more egocentric and antiso¬
cial children. McCord postulated that ex¬
pressive action, including doing physical
violence, was normalized for the children
of aggressive parents.
Many proponents of corporal punish¬
ment argue that it is necessary and that
its abandonment will result in less disci¬
plined children. Some cite their experi¬
ence with children who are not physically
punished and are not well-behaved. Far¬
ley et al34 interviewed officials of 36 school
districts in which corporal punishment
had been eliminated. Only one school dis¬
trict reported increased problems because
corporal punishment was eliminated. Al¬
though a large majority of American
youngsters are subjected to corporal pun¬
ishment, a considerable number are
not.11·15 Studies of the consequences of
corporal punishment such as those cited
above27·28,32"34 provide no support for the
notion that children who are not physi¬
cally punished behave inferiorly to those
who are physically punished.
In spite of evidence that corporal pun¬
ishment is not a useful discipline tech¬
nique, parents and physicians will be
unwilling to give it up if there are no
alternatives. Many studies have shown
that effective alternatives to corporal
punishment exist and can be learned by
parents.3539 Published studies vary from
case reports of one subject using ex¬
tinction40 to a controlled experimental
design with 32 subjects using time-out
to modify behavior.41
In summary, evidence for the futility
and harm of corporal punishment spans
the research of a variety of disciplines
from laboratory psychology to education
to medicine. Also, the literature of these
disciplines is poor in work that supports
the use of corporal punishment. Although
the use of mild corporal punishment (such
as spanking) by parents has not been stud¬
ied often, application of principles derived
from the work of investigators in a va¬
riety of fields shows that the practice can
be damaging and unnecessary.
Since corporal punishment can be
harmful, and effective alternatives ex¬
ist, its use should be discouraged by
physicians. Several national organiza¬
tions, including the American Academy
of Pediatrics, have taken at least limited
stands against the use of corporal pun¬
ishment.8·16·42"45 These organizations are
not always supported in their objections
to corporal punishment by the people
they represent. In a study of pediatri¬
cians' attitudes toward use of corporal
punishment in schools, only 13% indi¬
cated strong disagreement with the use
of corporal punishment.46 In another
study, only 10% of pediatricians and fam¬
ily physicians agreed that light spank¬
ing was inappropriate as a disciplinary
measure.47 A survey of psychologists
found that the majority used corporal
punishment in their own homes.48
Small, mobile contemporary families
allow little opportunity for young people
to learn parenting skills by observation
and practice with younger siblings. Thus,
young parents often turn to the family
physician or pediatrician for advice on
child-raising issues. Common behavioral
concerns and questions, including disci¬
pline questions and problems, were the
most frequent behavioral issues encoun¬
tered in a study of pediatrics in family
practice.49 Many behavioral problems may
be avoided or more effectively managed
if parents have skills to deal with the
problems before they occur.17·50'61 Thus,
anticipatory guidance on discipline should
be considered an essential part of the
family physician's or pediatrician's pre¬
ventive medicine program for young
families.
The purpose of this study was to de¬
termine what family physicians' and pe¬
diatricians' attitudes are toward corpo¬
ral punishment. The frequency with
which these physicians offer anticipatory
guidance on discipline was also studied.
METHODS
Subjects
The sample for this study was 800 fam¬
ily physicians and 400 primary care pe¬
diatricians randomly selected from the
Ohio State Medical Board's roster of li¬
censed physicians.52 The study popula¬
tion (948 pediatricians and 1902 family
physicians) was meant to include physi¬
cians who spend a significant amount of
time taking care of children, and who may
frequently receive questions from par¬
ents about discipline problems. Physicians
identified as pediatricians or family phy¬
sicians with a subspecialty (eg, pediatrie
gastroenterologist) were excluded.
Study Design
A self-report survey was used for the
study. Subjects were asked to complete
the survey and return it in a preaddressed,
stamped envelope. A cover letter accom¬
panied the survey and assured respon¬
dents of response confidentiality. To max¬
imize the response rate, the survey was
remailed to nonresponders about 4 weeks
after the first mailing. A third mailing
was done 4 weeks after the second. The
first round of surveys was mailed in Feb¬
ruary 1991; data collection was completed
in the first week of June 1991.
The date of return of each survey was
noted to identify any differences between
early and late responders. To identify po¬
tential bias due to nonresponders, the sex,
age, and practice location of the respon¬
dent family physicians was compared with
data on all Ohio family physicians pro¬
vided by the American Academy of Fam¬
ily Physicians.53,54 Similar data were not
available for pediatricians.
Study Instrument
In the survey, the term spanking was
used. Spanking was explicitly defined
as only "mild spanking" (striking of the
child's buttocks or hand with an open
hand, lightly, leaving no mark except
transient redness). The term was spe¬
cifically meant to exclude practices that
might be considered abusive. The sur¬
vey included questions about the phy¬
sicians' demographic characteristics and
practice location and questions about the
physicians' approach to the practice of
corporal punishment.
The survey presented respondents
with nine scenarios of childhood misbe¬
havior, three different behaviors for three
ages. The scenarios were meant to sam¬
ple respondents' opinion about corporal
punishment in various age groups as well
as in response to dangerous, trivial, and
aggressive misbehaviors. Subjects were
asked to state whether they would ad¬
vise a parent in their practice that spank¬
ing is an appropriate response for each
combination of misbehavior and age. The
survey also asked respondents to indi¬
cate how often they include discipline-
related issues when providing anticipa¬
tory guidance.
The survey instrument was the prod¬
uct of multiple revisions tested on small
groups of family practice residents and
faculty and pediatrie residents. The orig¬
inal survey attempted to identify atti¬
tudes toward corporal punishment more
directly. Subjects were asked to state
whether they felt spanking was "defi¬
nitely," "probably," "probably not," or
"definitely not" a useful strategy in child-
raising. The results of this survey were
difficult to interpret because many sub-
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Percent of Physicians Who Would Support Spanking
Age, y
I-1
2 5
-1
Situation Pediatricians
Family
Physicians
Child refuses to go to 4 9
bed at the usual,
established time
Child runs into the 46 44
street without looking
Child hits one of his or 9 18
her playmates
jects stated that they objected to spank¬
ing, but noted certain circumstances in
which they would approve of it. The
circumstances cited most often were "dif-
ficult-to-control" children and grave mis¬
behavior. Also, the age of the child was
a factor.
Since the stated question in this inves¬
tigation was to find out whether the study
group supports the use of corporal pun¬
ishment, the survey was constructed to
account for individuals who find any rea¬
son to use corporal punishment. To tap
attitudes, the survey asked respondents
to state what they would advise parents
under a variety of circumstances.
Analysis
Respondents who indicated that they
would advise parents that spanking was
appropriate in any one or more of the
survey scenarios were classified as sup¬
porting corporal punishment. Several
physicians indicated in written comments
that they were not opposed to corporal
punishment, although they would not ad¬
vise it in any of the scenarios presented.
These individuals were classified
not as
opposed to corporal punishment.
Prac¬
tice location was considered urban if the
practice was located in an Ohio county
that is part of a metropolitan statistical
area.55
To detect any effect related to physi¬
cians' age, respondents were assigned to
two age groups, less than 40 years and 40
years or older. Logistic regression anal¬
ysis was used to detect age-related dif¬
ferences that might be confounded by par¬
enthood status. Survey data were tabu¬
lated and statistics calculated using stan¬
dard statistical software packages.56·57
RESULTS
A total of 183 surveys were undeliv-
erable or excluded from analysis because
the respondent was not a family physi¬
cian or primary care pediatrician. Six hun¬
dred nineteen surveys were returned for
a response rate of 61%. One hundred
ninety-seven (59%) pediatricians and 422
(61%) family physicians returned surveys.
Surveys returned from the first mailing
numbered 431; 128 surveys were returned
in a Given Situation
8
-1 I I
Pediatricians
Family
Physicians Pediatricians
Family
_
Physicians
6 20 5 16
33 46 16 29
10 31 8 25
in the second mailing and 60 surveys were
returned in the third mailing. No differ¬
ences were detected in attitudes and char¬
acteristics of physicians who responded
in the second and third mailing.
The number of physicians who support
the use of corporal punishment was 413
(67%; 95% confidence interval [CI], 63%
to 70%). Of pediatricians, 116 (59%; 95%
CI, 52% to 66%) support the use of cor¬
poral punishment. Of family physicians,
297 (70%; 95% CI, 66% to 75%) indicated
that they support the use of corporal pun¬
ishment. The difference in attitude be¬
tween pediatricians and family physicians
was significant (P<.01).
The Table shows the percentage offam¬
ily physicians and pediatricians who would
support the use of corporal punishment
in each situation presented in the survey.
Although a minority of respondents sup¬
ported corporal punishment in any single
situation, a majority indicated support
for corporal punishment in at least one
scenario. Only 128 (21%) respondents in¬
dicated support for corporal punishment
in more than three of the situations pre¬
sented in the survey.
Inspection of the Table shows that, for
all children's ages, support for corporal
punishment is greatest when the misbe¬
havior is one that is dangerous to the
child (running into the street). Of physi¬
cians who would support corporal pun¬
ishment, 172 (42%) would support it for
the dangerous misbehavior only. Pedia¬
tricians and female physicians are more
likely than family physicians and male
physicians to support corporal punishment
only for dangerous misbehavior (P<.01).
Support for corporal punishment was
least when the misbehavior is relatively
minor (not going to bed on time). There
was considerable support for use of cor¬
poral punishment in response to an ag¬
gressive misbehavior in all children's age
groups. For instance, 31% of family phy¬
sicians would support corporal punish¬
ment for a 5-year-old child who hits one
ofhis or her playmates. Pediatricians were
significantly less likely than family phy¬
sicians to support corporal punishment
for aggressive misbehavior (P<.01).
Of physicians supporting corporal pun-
ishment, 90% have one or more children
of their own, 23% are female, and 25%
practice in a rural setting. Of physicians
who do not support corporal punishment,
93% have children, 25% are female, and
22% practice in a rural setting. There
was no significant difference between
physicians supporting or not supporting
corporal punishment for these charac¬
teristics. Physicians less than 40 years of
age are less likely to have children of
their own (85%) than older physicians
(96%). For family physicians, there was
no difference between the average age,
sex, and practice location of the Ohio fam¬
ily physician population compared with
respondents.
Significantly more support for corpo¬
ral punishment was found among physi¬
cians younger than 40 years (72%) com¬
pared with physicians 40 years or older
(63%, P<.05). Subsequently, respondents
were assigned to age groups in decades:
less than 40 years, 40 to 49 years, 50 to 59
years, 60 to 69 years, and more than 69
years old. 2 analysis for trend with
advancing age was calculated for these
age groups. This analysis did not show a
linear age effect. Logistic regression anal¬
ysis did not find parenthood status to be
a confounding variable in analyzing the
effect of physician age on attitude toward
corporal punishment.
Of pediatricians, 90% (95% CI, 86% to
94%) indicated that they discuss disci¬
pline-related issues either always or most
of the time when providing anticipatory
guidance to parents. Only 52% (95% CI,
47% to 57%) of family physicians offer
such guidance always or most of the time.
This difference between pediatricians and
family physicians was statistically signif¬
icant (P<.01). Female physicians offer
anticipatory guidance always or most of
the time (81%) more often than male phy¬
sicians (59%, P<M).
There was a significant difference in
anticipatory guidance practice between
physicians who would support the use of
corporal punishment and those who would
not. Physicians opposed to corporal pun¬
ishment stated that they offer anticipa¬
tory guidance more frequently than those
who support corporal punishment
CP<.01).
COMMENT
An important recommendation of the
Surgeon General's Workshop on Violence
and Public Health14 was: "... the cultural
acceptance of violence be decreased by
discouraging corporal punishment at
home, forbidding corporal punishment at
school... (because these) are models and
sanctions of violence." The purpose of this
study was to find out whether physicians
who are responsible for the primary health
care of children support the use of cor-
Downloaded from www.jama.com by guest on January 25, 2010
poral punishment by parents. The study
suggests that the majority of these phy¬
sicians support the use of corporal pun¬
ishment in the home.
Pediatricians are less likely to support
the use of corporal punishment than fam¬
ily physicians. Pediatricians are also less
likely to support corporal punishment for
misbehavior that is not dangerous to the
child or for aggressive misbehavior. This
may reflect the amount of training these
physicians receive in residency regard¬
ing childhood development and child-rais¬
ing issues. It also may reflect the amount
of involvement of the groups' professional
academies in promoting the abandonment
of the practice of corporal punishment.
An age-related difference in attitude
toward corporal punishment was noted.
Physicians in the youngest age group are
more likely than older physicians to sup¬
port the use of corporal punishment. They
are also less likely than older physicians
to have children; but parenthood status,
itself, is not related to attitude toward
corporal punishment. The increased sup¬
port for corporal punishment in the
younger age group is not easily accounted
for. Perhaps this finding really does, in¬
directly, reflect parenthood status. Phy¬
sicians in the younger age group who
have children are more likely to have
young children. Because misbehavior in
young children is not as readily dealt
with by cognitive methods, these physi¬
cians may be more supportive of the use
of corporal punishment.
Also, younger physicians who do not
have children may have spent less time
thinking critically about discipline meth¬
ods than older physicians who have had
to confront childhood misbehavior in their
own children. In this survey, several phy¬
sicians commented that they had used
corporal punishment on their own chil¬
dren, had found the method lacking, and
did not recommend it to parents in their
medical practice.
A large block of physicians would only
support the use of corporal punishment
in response to a misbehavior that is dan¬
gerous to the child. Although it may seem
encouraging that many physicians are un¬
comfortable enough with corporal pun¬
ishment to limit its use to extreme cir¬
cumstances, this finding reflects a stub¬
born persistence of the myth that corpo¬
ral punishment is appropriate, effective,
and the best alternative for dealing with
childhood misbehavior. Female physicians
are more likely to limit support for cor¬
poral punishment to dangerous situations.
This finding may reflect society as a whole
in demonstrating a greater readiness in
men to solve problems with violence.58,59
Pediatricians are more likely to pro¬
vide anticipatory guidance on discipline
to parents in their practices. A difference
was also noted in anticipatory guidance
between male and female physicians. That
pediatricians offer anticipatory guidance
more often than family physicians may
reflect the greater amount of trainingthey
receive on developmental and child-rais¬
ing issues. With less training, many fam¬
ily physicians may be reluctant to offer
advice on behavioral issues spontaneously.
Behavioral science training in family prac¬
tice residencies has been found lacking
by at least one study.49 However, this
lack has also been noted in pediatrie train¬
ing programs.50 It is unclear why female
physicians offer anticipatory guidance
more often than male physicians.
Certain cautions are warranted in in¬
terpreting the results of this study. Non-
responders (39%) represent a significant
proportion of this study's sample. No at¬
tempt was made to survey nonresponders
to see if their attitudes toward corporal
punishment differ systematically from re-
sponders. Comparing the first with later
waves of responders may be a way of
estimating bias due to nonresponse.60 In
this study, no significant difference in at¬
titude toward corporal punishment or an¬
ticipatory guidance practice was found in
comparing the responses of subjects in
the first, second, and third mailings. Also,
for family physicians, certain demographic
characteristics of the population were
available. No difference in these charac¬
teristics was found when comparing the
family physician respondents with the
Ohio family physician population. Thus,
at least with regard to these character¬
istics, the respondents are representa¬
tive of the population.
The definition of corporal punishment
used in this survey was meant to exclude
any practice that most people would con¬
sider abusive. In addition, the definition
was limited to the common practice of
spanking. It is possible that some physi¬
cians would consider even this mild prac¬
tice too severe. Some physicians may not
have indicated their support for corporal
punishment, even though they would sup¬
port a milder or different form of the
practice.
The survey was constructed to present
a representative sample of childhood mis¬
behaviors, but the situations presented
do not exhaust the possible misbehaviors
for which corporal punishment may be
administered. Indeed, a few physicians
included written comments indicating that
they could support corporal punishment
for some behaviors, but not for the ones
described in the survey. As a result, it is
possible that the number of physicians
who support corporal punishment is un¬
derestimated by this survey.
The subjects in this study are Ohio fam¬
ily physicians and pediatricians. Attitudes
toward corporal punishment and antici-
patory guidance practices of these phy¬
sicians may differ from those of physi¬
cians in other regions ofthe United States.
CONCLUSIONS
According Wessel,10 "A physician,
to
educator, or other professional child care
worker who inflicts or sanctions corporal
punishment, even with parental permis¬
sion, misjudges his or her professional role
and responsibility." In this study, most
primary care pediatricians and familyphy¬
sicians were found to support the use of
corporal punishment in childhood disci¬
pline. This opinion is held in spite of con¬
siderable evidence that corporal punish¬
ment is neither necessary nor beneficial
in child-raising. The opinion is also held
contrary to the official position of scien¬
tific and professional groups. Also, only
about half of family physicians include dis¬
cussion of discipline issues when provid¬
ing anticipatory guidance to parents.
Interpersonal violence is a source of
great suffering in terms of emotional and
physical health in this country. The cycle
of violence begins in early childhood with
the use of corporal punishment. Corporal
punishment teaches the use of violence
as a problem-solving method. A contri¬
bution to ending the cycle of violence
would be made if parents abandoned cor¬
poral punishment in favor of effective,
nonviolent disciplinary techniques. Fam¬
ily physicians and pediatricians can con¬
tribute by teaching and encouraging par¬
ents to use such techniques. Unfortu¬
nately, most physicians still believe that
corporal punishment is appropriate. Fam¬
ily medicine and pediatrics educators can
help end the cycle of violence by teaching
residents about appropriate discipline
techniques and by encouraging the inclu¬
sion of such issues when providing antic¬
ipatory guidance to parents.
This study was supported by a grant from the
Ohio Academy of Family Physicians Foundation,
Columbus.
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