Maternal perceptions of toddler body size often wrong

Feeding behaviors are influenced by perceptions of a child's body size and misperception of a child's size could lead to inappropriate feeding behaviors, such as encouraging a healthy-weight child to eat more, the authors write in their study background.

"Mothers of overweight toddlers were more than 88 percent less likely to accurately perceive their child's body size. … This may be because high-weight status is often regarded as a sign of successful parenting, especially during the early years when parents are responsible for their child's health, nutrition and activity opportunities," the authors comment.

Erin R. Hager, Ph.D., of the University of Maryland School of Medicine, and colleagues conducted a study that included 281 mother-toddler pairs recruited from a suburban Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinic and an urban pediatric clinic serving predominantly low-income families.

The mean (average) age of the toddlers was 20.2 months and 54.1 percent of them were male. The mothers ranged in age from 18 to 46 years and most (71.9 percent) of them were overweight/obese.

According to the results, nearly 70 percent of mothers were inaccurate in assessing their toddler's body size when selecting a silhouette that correctly reflected their child's true body size. Overall, 71.5 percent of mothers were satisfied with their toddler's body size, with a greater proportion of mothers of healthy-weight or overweight toddlers likely to be satisfied than mothers of underweight toddlers.

"In conclusion, the majority of mothers were satisfied with their toddler's body size, yet were inaccurate in their perception of their child's actual body size. … Future studies should examine how parental satisfaction and/or accuracy are related to parenting behaviors including feeding behaviors and encouragement of physical activity," the authors conclude.

In an invited commentary, Eliana M. Perrin, M.D., M.P.H., of the University of North Carolina at Chapel Hill, writes: "This research is instructive because an emerging body of literature suggests that parents with accurate perceptions of weight have greater readiness to make weight-related behavioral changes and are more effective making them."

"We likely need a public health campaign that allows us to visualize the range of healthy toddlers' and older children's weight. I am imagining posters showing photographs of children of all ages between the 5 th and 85 th percentiles saying, 'I'm at a healthy weight!' This type of campaign may help reset our nationally normed pictures of health, helping parents appreciate healthy undulations of weight," Perrin continues.

"In short, we should be able to explore parental perception and satisfaction with children's weight and preserve cultural ideals and pride in children's growth but also help parents achieve healthy weight trajectories. We can do this by counseling with sensitive and culturally competent dialogue and providing guidelines for eating and activity tailored for age, culture and socioeconomic status compatible with lifelong health," Perrin concludes.

More information: Arch Pediatr Adolesc Med. 2012;166[5]:417-422.
Arch Pediatr Adolesc Med. 2012;166[5]:422-423.

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