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Parents should not spank their children, America's peak pediatrics group has said in its most strongly-worded policy statement warning against the harmful effects of corporal punishment.
The American Academy of Pediatrics, which represents about 67,000 doctors, recommends that adults use "healthy forms of discipline" such as positive reinforcement of appropriate behaviour, setting limits and setting expectations - and not use spanking, hitting, slapping, threatening, insulting, humiliating or shaming.
The policy statement significantly updates 20-year-old guidance that recommended "parents be encouraged" not to spank.
"One of the most important relationships we all have is the relationship between ourselves and our parents, and it makes sense to eliminate or limit fear and violence in that loving relationship," said Dr Robert D. Sege, a pediatrician at Tufts Medical Centre and the Floating Hospital for Children in Boston, and one of the authors of the statement.
The academy's new policy, published in the journal Pediatrics, also recommended that pediatricians advise parents against the use of spanking.
The organisation's latest statement stems from a body of research that was unavailable two decades ago.
"In the 20 years since that policy was first published, there's been a great deal of additional research, and we're now much stronger in saying that parents should never hit their child and never use verbal insults that would humiliate or shame the child," said Dr Sege.
A 2016 analysis of multiple studies, for example, found that children do not benefit from spanking.
It may get a child's attention but is not effective in teaching right from wrong, the academy said.
Recent studies have also shown that corporal punishment is associated with increased aggression and makes it more likely that children will be defiant in the future.
There are potential ramifications to the brain as well: A 2009 study of 23 young adults who had repeated exposure to harsh corporal punishment found reduced gray matter volume in an area of the prefrontal cortex that is believed to play a crucial role in social cognition. Those exposed to harsh punishment also had a lower performance IQ than that of a control group.
So what is the best way to discipline children? That largely depends on the age and temperament of the child, experts say.
Effective discipline involves practicing empathy and "understanding how to treat your child in different stages in development to teach them how to cool down when things do get explosive," said Dr Vincent J. Palusci, a child abuse pediatrician at Hassenfeld Children's Hospital at NYU Langone.
The academy's parenting website, HealthyChildren.org, offers tips for disciplining younger and older children, such as using timeouts and establishing a clear relationship between behaviour and consequences.
"So if they run out in the street, you don't want the natural consequence to be that they get run over by a car," Dr Sege told CNN. "But a natural consequence might be that they have to hold your hand when they're in the street or they can't go out on their own past a busy street until you've observed them always looking both ways. In other words, holding mum's or dad's hand becomes the consequence."
For children younger than 1 who are misbehaving, the academy suggests picking them up and moving them somewhere else, distracting them or changing the subject.
Fairfax Media, New York Times