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Re: We need the full picture on both smacking and vaccinations

Dear Editor

Dr Elliman is noted for his careful methodological analysis of vaccination studies,[1] but is not so careful in his recent analysis of physical punishment.[2]

The American Academy of Pediatric's co-sponsored scientific consensus conference on corporal punishment used a more scientific approach than the Elliman-Lynch summary. First, it carefully defined spanking as a subset of corporal punishment. Second, it incorporated a range of scientifically validated perspectives into summary statements that were more balanced than the Elliman-Lynch perspective. Third, it solicited the first systematic review of child outcomes of nonabusive or customary physical punishment by parents.[3] An update of that review is due to be published in December 2000.[4]

Both reviews concluded that non-abusive smacking had consistently beneficial child outcomes in the most causally conclusive studies (eg, randomized trials): Both non-compliance and fighting decreased in 2- to 6-year-olds after non-abusive smacking was used to back up milder disciplinary tactics, such as reasoning or time out.

Causal evidence of detrimental effects of customary physical punishment was less conclusive and limited to overly frequent smacking (eg, 3 times weekly for 6- to 9-year-olds). In head-to-head comparisons, the effects of non-abusive or customary smacking rarely compared unfavorably with any disciplinary alternative, whereas its effects were significantly better than 6 alternative disciplinary tactics, mostly in 2- to 6-year-olds.

My updated review considered all 92 studies included in the unpublished 1999 Gershoff review cited by Elliman and Lynch. Most (76) of her studies were excluded from my review for reasons that Elliman would use to discount vaccination studies (eg, inappropriate measures, cross- sectional designs).

Ellison and Lynch also presented a one-sided summary of Swedish statistics since their 1979 smacking ban. Additional information on this issue and other related issues can be found at http://people.biola.edu/faculty/paulp/. The issues are complex, requiring the same careful analysis given to concerns about vaccination.

References
(1) Bedford H, Elliman D. Concerns about immunisation. BMJ 2000;320:240-3.

(2) Elliman D, Lynch MA. The physical punishment of children. Arch Dis Child 2000;83:196-8.

(3) Larzelere RE. A review of the outcomes of parental use of nonabusive or customary physical punishment. Pediatrics 1996;98:824-8.