Legislation on smacking

In spite of intensive lobbying by professional and charitable organisations,1 members of parliament voted recently not to outlaw the physical punishment of children. Instead they voted only to outlaw abusive punishment. If as proposed the Crown Prosecution Service's charging standard is changed abusive punishment will be defined as punishment that grazes, scratches, bruises, leaves any mark, or causes mental harm. Such punishment could now result in conviction for actual bodily harm—a very serious offence. For lesser punishments parents will still be able to make the claim that they are using reasonable chastisement as enshrined in the 1933 Children and Young People Act.

In voting in this way, members of parliament have implicitly stated that the law should offer its most vulnerable citizens (children) less protection from assault than is offered to adults. Even though this does not seem to have been a problem in the 12 other European countries where a ban has been implemented, concern about the prospect of criminalising parents who smack without leaving a mark informed their decision. More general concerns about the appropriateness of nanny state interference in family life, and the potential for undermining parents' capacity to control children's antisocial behaviour are likely to have had an influence. The unverifiable argument “it never did me any harm” will have been used also.

Is this an issue about which the medical profession and others with an interest in public health should be concerned? Almost all adults in the United Kingdom were subject to physical punishment (mostly smacking) as children, and the same is true of children today.2 Because only small numbers of children have not been smacked, and because smacking is often associated with other unhelpful approaches to parenting, it is difficult to reliably estimate the health impact of smacking. However, we do know that harsh physical punishment, particularly when it is inconsistent, is a cause of criminality and violence with all its associated health problems.3 Further studies have shown a dose-response relation (more smacking, more problems) between smacking and mental health outcomes in adulthood, including depression, suicidal ideation, alcohol misuse, and externalising (antisocial) behaviour.4^–6

Some parents believe that smacking is an important component of discipline and essential for normal social development. The research evidence, however, shows that smacking is at best ineffective and at worse leads to an escalation of unwanted behaviour.7^–9 Children agree that smacking is both unacceptable and ineffective.10 A wide range of randomised controlled trials have proved beyond reasonable doubt that positive discipline is effective in curbing antisocial behaviour and that parents can learn these skills during relatively brief interventions.11 So it seems likely that smacking is an avoidable health hazard and that it is appropriate for the medical profession and others concerned with public health to work with others in continuing to press for a complete ban.1

In the meanwhile health professionals are going to have to cope with the consequences of the new legislation. It will be general practitioners, paediatricians, and primary care nurses who are required to adjudicate on whether a punishment has left a mark or caused mental harm (which may be manifest only in the future). Pronouncing that it has will be tantamount to criminalising their patients or patients' parents, and saying that it has not potentially leaves a child in danger. In the face of high profile cases of colleagues who seem to have got it wrong, and an increase in the number of complaints in child protection cases,12 paediatricians are becoming unwilling to take on child protection work, leaving vulnerable children with fewer advocates. This legislation is likely to exacerbate the situation and draw general practitioners and others into such taxing work. In addition it may make matters worse for some children, encouraging parents to hit them where marks will not show—on the head for example. It will afford more protection to children with sensitive skin.

The long term solution has to be legislation for a complete ban on physical punishment coupled with widespread parenting education and support of the sort proposed in the recently published national service framework for children, young people, and maternity services.13 This would send a clear signal to all parents that they need to move on from outdated parenting practices. Local professionals could be offered a considerable measure of discretion about which parents should be prosecuted, ensuring normal parents are not criminalised and that the law is used where it is most needed. Meanwhile, in the face of the recent poor decision by members of parliament, we need to remember that it took 10 years of public debate and intensive lobbying by those who knew it made sense before an earlier government had the courage to pass legislation requiring car drivers to wear seat belts, but such legislation was passed in the end.