POLICY STATEMENT
Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children
Robert D. Sege, MD, PhD, FAAP,a Benjamin S. Siegel, MD, FAAP,b,c COUNCIL ON CHILD ABUSE AND EffectiveNEGLECT, COMMITTEE ON PSYCHOSOCIAL Discipline ASPECTS OF CHILD AND to FAMILY Raise HEALTH Healthy Children Pediatricians are a source of advice for parents and guardians concerning abstract the management of child behavior, including discipline strategies that are used to teach appropriate behavior and protect their children and others from the adverse effects of challenging behavior. Aversive disciplinary strategies, including all forms of corporal punishment and yelling at or aCenter for Community Engaged Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, shaming children, are minimally effective in the short-term and not effective Massachusetts; and Departments of bPediatrics and cPsychiatry, in the long-term. With new evidence, researchers link corporal punishment Boston Medical Center and School of Medicine, Boston University, Boston, Massachusetts to an increased risk of negative behavioral, cognitive, psychosocial, and Drs Sege and Siegel created the first draft of this statement, emotional outcomes for children. In this Policy Statement, the American responded to committee and Board comments, and edited the Academy of Pediatrics provides guidance for pediatricians and other child Policy Statement; and all authors approved the final manuscript as submitted. health care providers on educating parents about positive and effective This document is copyrighted and is property of the American parenting strategies of discipline for children at each stage of development Academy of Pediatrics and its Board of Directors. All authors have as well as references to educational materials. This statement supports the filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process need for adults to avoid physical punishment and verbal abuse of children. approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.
Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and INTRODUCTION external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.
1 The guidance in this statement does not indicate an exclusive course Pediatricians are an important source of information for parents. They of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. are often asked by parents and guardians about nutrition, development, All policy statements from the American Academy of Pediatrics safety, and overall health maintenance. Pediatricians form a relationship automatically expire 5 years after publication unless reaffirmed, with parents, within which they partner with parents to achieve revised, or retired at or before that time. optimal health, growth, and development in their2 children, including DOI: https://doi.org/10.1542/peds.2018-3112 childhood behavior management. Duncan et al reviewed periodic Address correspondence to Robert D. Sege, MD, PhD, FAAP. E-mail: surveys of members of the American Academy of Pediatrics (AAP) and [email protected] noted that between 2003 and 2012, pediatricians had increased their PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). discussions of discipline with parents. By 2012, more than half (51%) of the pediatricians surveyed responded that they discussed discipline in 75% to 100% of health supervision visits with parents of children ages To cite: Sege RD, Siegel BS, AAP COUNCIL ON CHILD ABUSE 0 through 10 years. AND NEGLECT, AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH. Effective Discipline to Raise A recent survey (2016) indicated that US pediatricians do not endorse Healthy Children. Pediatrics. 2018;142(6):e20183112 corporal punishment. Only 6% of 787 US pediatricians (92% in primary care) who responded to this survey held positive attitudes toward Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 142, number 6, December 2018:e20183112 FROM THE AMERICAN ACADEMY OF PEDIATRICS EFFECTIVE DISCIPLINE SUPPORTS NORMAL CHILD DEVELOPMENT spanking, and only 2.5% expected with the hand or with an implement positive outcomes from spanking. “ (a whip, stick, belt, shoe, wooden Respondents did not believe that spoon, or similar), but it can also ” Optimal child development requires spanking was the only way to get “ involve, for example, kicking, shaking, the active engagement of adults the child to behave (78% disagreed) ” or throwing children; scratching, who, among other functions, teach or that spanking is a normal part of “ ” 3 pinching, biting, pulling hair, or children about acceptable behavior. parenting (75% disagreed). “ ” boxing ears; forcing children to stay The word discipline is derived in uncomfortable positions; burning, This policy statement incorporates ’ from the Latin word disciplinare, new research and updates the scalding, or forced ingestion (for “ ” meaning to teach or train, as in 1998 AAP clinical report titled example, washing a child s mouth disciple (a follower or student of “ 4 Guidance for Effective Discipline, out with soap or forcing them to a teacher, leader, or philosopher). ’ which suggested, Parents should swallow hot spices). Nonphysical Effective disciplinary strategies, be encouraged and assisted in forms of punishment that are cruel appropriate to a child s age and developing methods other than and degrading and thus incompatible development, teach the child to ” spanking in response to undesired with the convention include, for regulate his or her own behavior; behaviors. example, punishment which belittles, keep him or her from harm; enhance BACKGROUND humiliates, denigrates, scapegoats, his or her cognitive, socioemotional, threatens, scares, or ridicules the and executive functioning skills; and ’ child. In the view of the committee, ” reinforce the behavioral patterns corporal punishment is invariably In 1989, the United Nations (UN) 6 taught by the child s parents and Convention on the Rights of the Child, degrading. caregivers. through its Committee on the Rights There are a number of approaches For the purpose of this policy of the Child, called on all member “ to discipline that pediatricians may statement, corporal punishment states to ban corporal punishment discuss with parents during well- is the noninjurious, open-handed of children and institute educational5 ” child visits and those visits that are programs on positive discipline. hitting with the intention of “ 7 Brightdesigned Futures to address Guidelines discipline for Health issues . In the UN report, article 19 reads, modifying child behavior. Spanking SupervisionThese approaches of Infants, are Children,reviewed and in Parties shall take all appropriate can be considered a form of physical Adolescents legislative, administrative, social, punishment. As7 Gershoff and “ 9 and educational measures to protect Grogan-Kaylor noted, most people , on the AAP10 Web site the child from all forms of physical understand corporal punishment, ” “ HealthyChildren.org,Bright and Futures in the or mental violence, injury or abuse, physical punishment, and spanking ” AAP program Connected11 Kids: Safe, neglect or negligent treatment, as synonymous. The term verbal Strong, Secure. maltreatment or exploitation, abuse is used to mean nonphysical includes sections on discipline including sexual abuse, while in the forms of punishment as defined for each age group. Each of these care of [the] parent(s) [or] legal ” above. recommended approaches to guardian(s) or any other person who discipline is based on the broad has the care of the child. This policy statement incorporates concepts of child development and The Global Initiative to End all results accrued from research and related common behavioral concerns. Corporal Punishment of Children new knowledge of brain development CORPORAL PUNISHMENT provided a comprehensive and recommend that pediatricians “ definition of spanking and corporal advise parents against the use of Use of Corporal Punishment punishment: The definition of any form of corporal punishment. Verbal abuse (for a definition, see corporal or physical punishmentGeneral Commentadopted by No. the 8 Committee on the above: the Global Initiative to End All There is evidence that support Rights of the Child in its Corporal Punishment of Children) for corporal punishment among ‘ by parents intended to cause shame (2006) has the key ’ parents is declining in the United 12 reference point, any punishment and humiliation of the child also has States. According to a 2004 survey, in which physical force issued and deleterious effects on children s approximately two-thirds of parents ’ intended to cause some degree of self-esteem. This policy statement of young children reported using pain or discomfort, however light. complements a previous AAP policy some sort of physical punishment. “ ” According to the committee, this statement that recommended the These parents reported that by fifth “ ” “ ” mostly involves hitting ( smacking, abolishment8 of corporal punishment grade, 80% of children had been slapping, or spanking ) children in schools. physically punished, and 85% of Downloaded from www.aappublications.org/news by guest on September 27, 2021 2 FROM THE AMERICAN ACADEMY OF PEDIATRICS Ineffectiveness of Corporal Punishment teenagers reported exposure to over time; each negative interaction physical punishment,– with 51% reinforces previous negative having been hit with a belt or interactions as a complex negative 12 15 A 2016 meta-analysis showed that similar object. These findings spiral. current literature does not support suggest that, in 2004, many parents the finding of benefit from physical considered spanking to be a socially 7 punishment in the long-term. Several In a study that explored parental acceptable form of discipline. In – 28 small, older studies (including meta- discipline approaches, researchers contrast, a more recent national 19 22 analyses), largely of parents who noted that both European American survey of adults shows declining were referred for help with child and African American parents used support for spanking (or hitting), behavior problems, demonstrated an escalation strategy in disciplining particularly among young parents. 16 apparent short-term effectiveness of their 6- to 8-year-old children. Both A 2013 poll conducted by Harris “ spanking. Only a single 1981 study groups of parents used reasoning Interactive found that support for of 24 children showed statistically more frequently than yelling. The the statement good, hard spanking ” significant short-term improvement next most frequent strategy was is sometimes necessary to discipline in compliance compared with denying privileges, and spanking was a child had dropped from 84% alternative strategies (time-out and a the least frequent method reported in 1986 to 70% in 2012. Parents 23 control group). by all parents. Similarly, in focus younger than 36 years more often Cycle of Corporal Punishment and groups conducted around the country believed that spanking was never Aggressive Child Behavior in 2002 during the development of appropriate, and only half reported the AAP Connected Kids materials, ever spanking their own children. An participating parents reported the analysis of a 2016 national survey Evidence obtained from a use of corporal punishment as a last conducted by yougov.com revealed longitudinal cohort study suggested 11,29 resort. that respondents with young that corporal punishment of toddlers children in the home, regardless of Special Populations “ was associated with subsequent race and ethnicity, did not support aggressive behavior. The Fragile corporal punishment, suggesting Families and Child Wellbeing Study the possibility that a generational was based on a population-based ” Children in foster care who have shift in social norms [about corporal birth cohort of approximately 17 experienced abuse or neglect may punishment] may be taking place. 5000 children from 20 large US Direct Observations of Corporal 24 exhibit challenging behaviors. cities between 1998 and 2000 ; Punishment Programs exist that assist foster data were collected at birth and parents in addressing discipline. 1, 3, 5, and 9 years of age. Young A recent AAP clinical report children who were spanked more describes the behavioral effects of Although some studies of discipline than twice per month at age 3 years maltreatment and offers suggestions practices used observations during were more aggressive at age 5 even 30 1 ’ for helping these children heal. home visits, a small study published when the researchers controlled for 18 Pediatricians may advise foster in 2014 used voice recordings to the child s aggressive behavior at parents to consider the behavioral explore parent-child interactions age 3, maternal parenting and risk 25 consequences of past abuse in during daily activities. The recordings factors, and demographic factors. 26 understanding how these children of 15 of the 33 families in the study A follow-up study assessed these ’ may respond differently to their (45%) included the use of corporal children at 9 years of age and noted foster parents attempts to correct punishment. Most parents used a correlations between spanking at 31 their behavior. verbal disciplinary strategy before age 5 years and higher levels of corporal punishment. Corporal externalizing behavior and lower punishment then occurred at a mean receptive vocabulary scores at age Parents of children with special “ of 30 seconds later, suggesting that 9. A subsequent study analyzed data health care needs may need parents may have been responding from all 4 waves and concluded that additional assistance regarding either impulsively or emotionally an increased frequency of spanking discipline strategies. These strategies ” ’ rather than instrumentally and was associated with a subsequent begin with an understanding of a intentionally. The effects of corporal increased frequency of externalizing child s physical, emotional, and punishment were transient: within behaviors, which were then cognitive capacities. In some cases,
10 minutes, most children (73%) had associated27 with more spanking in consultation with a developmental- resumed the same behavior for which response. This interaction between behavioral32 pediatrician may be they had been punished. spanking and misbehavior occurs helpful. Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 142, number 6, December 2018 3 Parental Factors Associated With •• Physiologic Changes Associated With Reliance on Corporal Punishment Corporal Punishment and Verbal repeated use of corporal Parental Depression Abuse punishment may lead to aggressive behavior and altercations between the parent and child and may A history of parental corporal A longitudinal study examined negatively affect the parent-child punishment and parental verbal the interactions between parental relationship; corporal punishment, parental •• abuse has been associated with ’ ’ depression, negative perceptions of corporal punishment is associated changes in brain anatomy that can be visualized by using MRI. Researchers a child s behavior, and 33the child s with increased aggression in N – externalizing behavior. The sample preschool and school-aged studied a group of young adults included 245 children and parents ( = 23; ages 18 25) who had •• children; in stable relationships from mostly prolonged and repeated exposure middle-class, married, European experiencing corporal punishment to harsh corporal punishment and American parents. Depressive makes it more, not less, likely comparedN the results of brain MRIs to symptoms for both mothers and those from a matched control group ’ that children will be defiant and ( = 22). They reported reduced fathers were related to more negative •• aggressive in the future; appraisals of the child s behavior and prefrontal cortical gray matter64 more frequent corporal punishment corporal punishment is associated volume and performance IQ. and predicted higher levels of child with an increased risk of mental A similar study from this group externalizing problems at 5.5 years health disorders and cognition noted MRI resultsN that revealed Influenceof age. of Past Parental Trauma •• problems; differences in white matter tracts in young adults ( = 16) who were the risk of harsh punishment exposed to parental verbal abuse and 34 65 A recent article, Kistin et al is increased when the family is had no history of trauma. A more reported interviews with 30 low- experiencing stressors, such as recent review noted relationships family economic challenges, mental income mothers and provided between physical66 punishment and an important perspective on the health problems, intimate partner cortisol levels. Elevated cortisol complexity of disciplinary strategies •• violence, or substance abuse; and levels reflect stress and have used by mothers who had themselves been associated with toxic stress ’ spanking alone is associated with experienced trauma. They reported and subsequent changes in brain adverse outcomes, and these that mothers related their children s architecture. outcomes are similar to those in Harsh Verbal Abuse Associated With negative behaviors to their own past Child and Adolescent Mental Health children who experience physical experiences; harsh discipline was Problems abuse. used in an attempt to prevent future ’ Corporalbehavioral Punishment problems. As a Risk The association between corporal Factor for Nonoptimal Child “ punishment and adverse adult In 2009, the UN Children s Fund Development health outcomes was examined defined yelling and other harsh ” in a 2017 report that analyzed verbal discipline as psychologically28 original data from the 1998 Adverse aggressive towards children. In There appears to be a strong Childhood Experiences Study, a longitudinal study investigating association between– spanking which recommended that spanking the relationship between harsh children and subsequent adverse 35 53 be considered as an additional verbal abuse by parents and child outcomes. Reports published independent risk factor, similar in outcomes, researchers noted that since the previous 1998 AAP report nature and effect to other63 adverse harsh verbal abuse before age have provided further evidence childhood experiences. In their 13 years was associated with an that has deepened the under analysis of the original 1998 Adverse increase in adolescent conduct standing of the effects of corporal Childhood Experiences study data, problems and depressive symptoms punishment. The consequences the investigators found that spanking between ages 13 and 14. Adolescent associated with parental– corporal was associated with increased odds behavior affected parental behavior ’ punishment7,19, 21, are27, 35, summarized54 62 as •• of suicide attempts, moderate-to- as well; misconduct predicted follows : heavy drinking, and substance use increases in parents use of harsh corporal punishment of children disorder in adulthood independent discipline between ages 13 and 14 younger than 18 months of age of the risks associated with having years. Furthermore, parental warmth increases the likelihood of physical experienced physical and emotional did not moderate the longitudinal injury; abuse. associations between harsh discipline Downloaded from www.aappublications.org/news by guest on September 27, 2021 4 FROM THE AMERICAN ACADEMY OF PEDIATRICS by parents and adolescent 67conduct and self-control. This advice will be The Centers for Disease Control and depressive symptoms. most helpful if it is combined with and Prevention has posted positive73 STRATEGIES FOR PROMOTING teaching parents new strategies to parenting tips on its Web site. The replace their previous use of corporal AAP provides content for parents EFFECTIVE DISCIPLINE ’ punishment. Appropriate methods through its HealthyChildren.org Web
for addressing children s behavior site and its Connected11 Kids: Safe, 9 Effective disciplinary techniques will change as the children grow Strong, Secure and Bright Futures grow from an understanding of and develop increased cognitive9 and programs. Each of these resources normal child development. Parents executive function abilities. encourages parents to use positive reinforcement as a primary means value advice from their pediatricians,1 as illustrated by a 2012 study Teaching parents effective strategies of teaching acceptable behavior. may allow them to avoid escalating For example, parents can learn that involving 500 parents in New “ ” Orleans, Louisiana. The investigators to the point of using corporal young children crave attention, and punishment. In a randomized trial, found that parents were more likely 69 telling a child, I love it when you . . . to follow the advice of pediatricians Barkin et al demonstrated that is an easy means of reinforcing it was possible to teach parents to desired behavior. compared with other professionals, Community Resources and nearly half (48%) indicated that use time-outs within the constraints they were most likely to consult their of an office visit. Clinicians used motivational interviewing techniques pediatricians for advice on corporal68 punishment. In a second article, to help parents learn to discipline Although pediatricians offer these investigators further noted using other techniques. anticipatory guidance, many parents that perceived social norms were will want or need more assistance in When discussing corporal the strongest predictor of having a ’ developing strong parenting skills. punishment, pediatricians may positive attitude toward corporal The medical home can link parents explore and acknowledge parents punishment, with the second- to community resources. Health current experiences, past social- strongest predictor being perceived care sites may implement the Safe emotional development, attitudes, 74,75 approval of corporal punishment by Environment for Every Kid and beliefs. Because parents may Clinicalprofessionals Setting. program. The program includes a use spanking as a last resort, they brief questionnaire that examines may spank less (or not at all) if they family risk factors. Parents who have learned11 effective discipline identify needs, including parenting Pediatricians may assist parents by techniques. Specific discussions challenges, meet with a colocated providing information about child of behavior problems and behavior social worker who can link them to development and effective parenting management strategies allow parent supports in the community. strategies. Although parents often pediatricians to provide useful advice This program also has online seek information and hold their 76,77 that is based on an understanding of educational modules. pediatricians in a position of trust, child behavior. Educational Resources discussions of discipline may prove A variety of national and community- challenging. This section presents based organizations offer 78parents Anticipatoryapproaches to Guidance counseling. support through Triple P, which Pediatric providers may reinforce is one example of an evidence-based
behavioral counseling through parent education program. In 79 A direct discussion advising against recommending or distributing parent another program, HealthySteps, any form of corporal punishment education materials. For example, a developmental specialist is placed may be useful. When appropriate, studies have shown that in-office in the office setting to help support ’ the pediatrician may counsel family videos may be able to deliver 70,71 families of children ages 0 to 3 years. members that spanking is not an messages to multicultural parents. In most states, Children s Trust appropriate or effective disciplinary Having parents read brief research Funds and child welfare agencies strategy. Parents may be counseled summaries of problems associated sponsor parent resource centers. ’ 80 that although spanking seems to with corporal punishment72 decreased Help Me Grow, a state-based interrupt a child s misbehavior, it positive attitudes about it. Each information and referral network, is ineffective in the longer-term. of these approaches reinforced has been implemented in the For many children, spanking verbal advice with other means of majority of the United States. The increases aggression and anger supporting caregivers in learning Center for the Improvement of Child instead of teaching responsibility new parenting techniques. Caring offers resources specifically Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 142, number 6, December 2018 5 – tailored 81to African83 American goals of discipline, and offer specific spanking is not necessary and families. behavior management strategies. In may result in long-term harm. addition to providing appropriate Many clinic- and community-based 3. Agencies that offer family support, education to families, providers can programs are specifically oriented such as state- or community- ’ refer them to community resources, toward helping parents effectively supported family resource centers, The Incredible 84 including parenting groups, classes, address their children s behavior. 94 schools, or other public health Years and mental health services. Examples85 include agencies, are strongly encouraged , a brief office-based video The AAP recommends that adults to provide information about intervention in the office that is 86 caring for children use healthy effective alternatives to corporal used to discuss discipline issues ; forms of discipline, such as positive punishment to parents and Safety Check,69 which is used to teach reinforcement of appropriate families, including links to time-outs ; the Family Nurturing behaviors, setting limits, redirecting, materials offered by the AAP. Program, which is used to improve 87 and setting future expectations. The 4. In their roles as child advocates, parenting attitudes and knowledge ; AAP recommends that parents do pediatricians are encouraged to and the Chicago Parent Program, a not use spanking, hitting, slapping, assume roles at local and state comprehensive 12-week parenting 88 threatening, insulting, humiliating, or levels to advance this policy skills training program. The shaming. as being in the best interest of Video Intervention Project is an POLICY RECOMMENDATIONS children. evidence-based parenting program LEAD AUTHORS that involves feedback on parent- ’ Robert D. Sege, MD, PhD, FAAP child interactions by trained child Benjamin S. Siegel, MD, FAAP Parents value pediatricians development 89staff in a primary care office setting. discussion of and guidance about COUNCIL ON CHILD ABUSE AND NEGLECT child behavior and parenting EXECUTIVE COMMITTEE, 2015–2017 The 2012 AAP clinical report practices. was focused on the psychological Emalee G. Flaherty, MD, FAAP maltreatment of children and 1. Parents, other caregivers, and CAPT Amy R. Gavril, MD, FAAP adolescents and contained a adults interacting with children Sheila M. Idzerda, MD, FAAP Antoinette Laskey, MD, MPH, MBA, FAAP comprehensive review of preventive and adolescents should not use Lori Anne Legano, MD, FAAP measures that provide alternatives corporal punishment (including 90 John M. Leventhal, MD, FAAP to the use of corporal punishment. hitting and spanking), either in James Louis Lukefahr, MD, FAAP anger or as a punishment for or The literature describe other Robert D. Sege, MD, PhD, FAAP resources and programs, such as – consequence of misbehavior, nor should they use any disciplinary Internet-based training and group-91 93 LIAISONS based parent training programs. strategy, including verbal abuse, Beverly Fortson, PhD Centers for Disease that causes shame or humiliation. – This list of resources is not intended Control and Prevention to be comprehensive; many national 2. When pediatricians offer Harriet MacMillan, MD, FRCPC – American organizations and local communities guidance about child behavior Academy of Child and Adolescent Psychiatry also offer effective parenting Elaine Stedt, MSW Office on Child Abuse and and parenting practices, they may – resources. Neglect, Administration for Children, Youth and choose to offer the following: CONCLUSIONS Families a. guidance on effective discipline STAFF strategies to help parents Tammy Piazza Hurley Parents look to pediatric providers teach their children acceptable behaviors and protect them from for guidance concerning a variety of COMMITTEE ON PSYCHOSOCIAL ASPECTS harm; parenting issues, including discipline. OF CHILD AND FAMILY HEALTH, 2016–2017 Keeping in mind that the evidence b. information concerning the Michael W. Yogman, MD, FAAP, Chairperson that corporal punishment is both risks of harmful effects and the Rebecca Baum, MD, FAAP ineffective in the long-term and ineffectiveness of using corporal Thresia B. Gambon, MD, FAAP associated with cognitive and mental punishment; and Arthur Lavin, MD, FAAP health problems can guide these Gerri Mattson, MD, FAAP discussions. When parents want c. the insight that although many Raul Montiel-Esparza, MD guidance about the use of spanking, children who were spanked Lawrence Sagin Wissow, MD, MPH, FAAP pediatricians can explore parental become happy, healthy adults, feelings, help them better define the current evidence suggests that Downloaded from www.aappublications.org/news by guest on September 27, 2021 6 FROM THE AMERICAN ACADEMY OF PEDIATRICS LIAISONS Norah Johnson, PhD, RN, NP-BC – National Association of Pediatric Nurse Practitioners ABBREVIATIONS Terry Carmichael, MSW National Association of – Leonard Read Sulik, MD – American Academy of Social Workers Child and Adolescent Psychiatry Edward Christophersen, PhD, FAAP (hon) – Society of Pediatric STAFF AAP: American Academy of Psychology Stephanie Domain, MS Pediatrics UN: United Nations
Copyright © 2018 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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Downloaded from www.aappublications.org/news by guest on September 27, 2021 Effective Discipline to Raise Healthy Children Robert D. Sege, Benjamin S. Siegel, COUNCIL ON CHILD ABUSE AND NEGLECT and COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH Pediatrics 2018;142; DOI: 10.1542/peds.2018-3112 originally published online November 5, 2018;
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