Association of physical punishment and health outcomes in early childhood: a population representative prospective study

Physical punishment without maltreatment is still a common practice worldwide. However, there is a dearth of prospective evidence on the effects of physical punishment on children's physical outcomes.

Data were derived from a 3-year cohort study of a representative sample of 3-6 years old Chinese children (n = 16715). Caregivers reported the usage of physical punishment, history of maltreatment, children's physical health status (including recurrent sickness, general physical health status, and global sleep disturbance) and two measures of medical service utilization. A propensity score weighted model was used to evaluate the effects of physical punishment on physical health outcomes.

Physical punishment without maltreatment was associated with higher risk of recurrent sickness (OR = 1·15, 95% CI: 1·03,1·28), poorer general health (OR = 1·30, 95% CI: 1·16, 1·47), global sleep disturbances (OR = 1·42, 95% CI: 1·29, 1·55), and increased number of clinic visits (B = 0·18, 95% CI: 0·10, 0·26), but not the number of hospitalizations (B = 0·03, 95% CI: -0·01, 0·06).

Even without a history of maltreatment, physical punishment adversely affects children's physical health and increases medical service utilization. Any form of physical discipline should be avoided.

The first population-representative cohort study to prospectively investigate the effects of physical punishment on physical health outcomes during early childhood. Innovatively focus on physical punishment without maltreatment, revealing that even in the absence of maltreatment, physical punishment was associated with adverse physical well-being. These effects were maintained after the propensity score weighting for sociodemographic characteristics, socioeconomic status, nurturing environment factors, BMI, physical health during the neonatal period, and baseline physical health indicators. Provides the first evidence that non-maltreating physical punishment independently predicts increased medical service utilization in early childhood. It highlights the hidden public health costs of physical punishment practices.