A new policy statement issued by the American Academy of Pediatrics is fortifying its previous stance on corporal punishment — specifically, that it should not be used as a method to discipline children.

In a follow-up advisory published Monday — 20 years after its “Guidance for Effective Discipline” that said parents should “be encouraged” not to use spanking for punishments — doctors noted that “there appears to be a strong association between spanking children and subsequent adverse outcomes.”

The new guidelines strongly oppose using spanking as a method of discipline by listing the consequences of doing so, broken down by age group. For example, children younger than 18 months old have a higher risk of physical injury, while it can lead to mental-health issues down the road.

Furthermore, the act of spanking in itself can lead to an aggressive, conflict-ridden relationship between a parent and a child of any age. The AAP states that spanking can also lead to outcomes that are similar to those seen in individuals who have been physically abused as children.

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The guidelines take the lead from “the opinions of the vast majority of U.S. pediatricians, who do not recommend corporal punishment,” whereas the AAP’s 1998 policy statement cited a survey where “≤59 percent of pediatricians support the use of corporal punishment, at least in certain situations.”

“The purpose of discipline is to teach children good behavior and support normal child development,” Dr. Robert D. Sege wrote in Monday’s release about the new policy statement which Sege, a pediatrician, helped author. “Effective discipline does so without the use of corporal punishment or verbal shaming.”

Sege continued in the release, “Children who experience repeated use of corporal punishment tend to develop more aggressive behaviors, increased aggression in school, and an increased risk of mental health disorders and cognitive problems. In cases where warm parenting practices occurred alongside corporal punishment, the link between harsh discipline and adolescent conduct disorder and depression remained.”

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Aside from giving hard advice on the detrimental effects of using physical punishment, the AAP provides alternative suggestions for disciplining both younger and older children.

“The best way to improve behavior is to give children a lot of attention when they are doing something you like and remove your attention when they are doing something you do not like,” the group advises of all ages.

The AAP’s new guidelines, titled “Effective Discipline to Raise Healthy Children,” will be published in the December issue of the organization’s Pediatrics journal.