OBJECTIVE: To provide family physicians with a guide for evaluating discipline problems, giving suggestions for parental guidance, and diagnosing problems when discipline guidance fails. QUALITY OF EVIDENCE: A MEDLINE and PsycINFO search from 1990 to the present produced articles reviewing research on aspects of discipline. Case-control studies, expert opinion, and position statements published by the American Academy of Pediatrics and the Canadian Paediatric Society were chosen as a basis for this article. In a special supplement in 1996, a pediatric journal reviewed the controversy of spanking as an effective disciplinary method, with comments by noted researchers and clinicians. Other authors reviewed research evaluating discipline techniques. MAIN MESSAGE: Discipline problems require evaluation of children, parents, and parent-child relationships, including assessment of child development and evaluation of parenting skills and parental stressors. Parents can learn techniques more effective than spanking. Physicians can review discipline strategies and guide parents through difficult situations. Monitoring progress is important, and immediate reassessment of the situation if techniques are failing or referral to a specialist will increase the chances of a successful intervention. CONCLUSION: Discipline problems are complex and require careful assessment. Guiding parents during these types of problems requires close follow up and reevaluation when methods do not have the expected effect.
OBJECTIVE: To provide family physicians with a guide for evaluating discipline problems, giving suggestions for parental guidance, and diagnosing problems when discipline guidance fails. QUALITY OF EVIDENCE: A MEDLINE and PsycINFO search from 1990 to the present produced articles reviewing research on aspects of discipline. Case-control studies, expert opinion, and position statements published by the American Academy of Pediatrics and the Canadian Paediatric Society were chosen as a basis for this article. In a special supplement in 1996, a pediatric journal reviewed the controversy of spanking as an effective disciplinary method, with comments by noted researchers and clinicians. Other authors reviewed research evaluating discipline techniques. MAIN MESSAGE: Discipline problems require evaluation of children, parents, and parent-child relationships, including assessment of child development and evaluation of parenting skills and parental stressors. Parents can learn techniques more effective than spanking. Physicians can review discipline strategies and guide parents through difficult situations. Monitoring progress is important, and immediate reassessment of the situation if techniques are failing or referral to a specialist will increase the chances of a successful intervention. CONCLUSION: Discipline problems are complex and require careful assessment. Guiding parents during these types of problems requires close follow up and reevaluation when methods do not have the expected effect.