Editor—A ban of a medical intervention would never be supported on the basis of such meagre evidence as used by Waterston to support a ban of the parental intervention of smacking.1 “Significant adverse effects” and a failure to “learn the desired behaviour” were based on a literature review that is unpublished2 and that includes studies that included severe types of corporal punishment such as “beating with a stick,” “still hurt the next day,” “burning,” and “using a knife or gun.” Most studies that were reviewed were cross sectional, which cannot disentangle the causal direction between smacking and child misbehaviour.2
In the only published review (in 1996) of child outcomes of non-abusive or customary physical punishment, only eight studies could disentangle the causal effects of smacking.3 All eight studies, including four randomised clinical trials, found that nonabusive smacking benefited children when it backed up milder disciplinary tactics with children aged 2 to 6 years.
Smacking, then, makes milder tactics more effective, not “harder to use” as concluded by Waterston.1
Another study was cited to conclude that Swedish “public opinion on the need for physical punishment changed dramatically after a public education campaign” following the 1979 smacking ban.4 The so called dramatic change was artificially created because survey questions from before 1982 and from 1994 were compared. The 1994 survey question that was most similar to the previous question showed an increased endorsement of mild or moderate physical punishment as sometimes necessary—from 26% in both 1978 and 1981 to 34% in 1994.5 The 1994 Swedish survey also found that corporal punishment of teenagers was as prevalent after the 1979 ban as in previous generations and that, overall, the incidence of corporal punishment had decreased little.5
Consequently, the British proposal for a middle ground between the status quo and a 100% smacking ban is reassuring. As Waterston noted, parents are already motivated to find alternatives to smacking, and positive interaction between parents and children and enhancing appropriate child behaviours are good places to start. The most difficult puzzle for parents and professionals concerns effective methods for decreasing misbehaviour.
Eighteen studies in the 1996 review investigated alternative disciplinary tactics as well as smacking.3 Only grounding was more effective than smacking, in two studies of older children. In contrast, nine alternatives were associated with more detrimental outcomes in children than was smacking.
Parents need to be empowered with more effective alternatives, not disempowered by premature bans on traditional disciplinary tactics.