Public Release: 

Maternal perceptions of toddler body size often wrong

The JAMA Network Journals

A study of mothers and their toddlers suggests that mothers of overweight toddlers often had inaccurate perceptions of their child's body size, according to a report published in the May issue of Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication. The study is part of the Nutrition and the Health of Children and Adolescents theme issue.

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.

(Arch Pediatr Adolesc Med. 2012;166[5]:417-422. Available pre-embargo to the media at

Editor's Note: Data collection during the baseline evaluation of the Toddler Overweight Prevention Study (TOPS) was supported by a National Research Initiative grant from the U.S. Department of Agriculture National Institute of Food and Agriculture Human Nutrition and Obesity Program and a Eunice Kennedy Shriver National Institute of Child Health and Human Development grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Invited Commentary: Toddler Weight Perception

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.

(Arch Pediatr Adolesc Med. 2012;166[5]:422-423. Available pre-embargo to the media at

Editor's Note: Dr. Perrin's work was supported by a career development award and a grant from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


To contact corresponding author Erin R. Hager, Ph.D., call Karen Lancaster at 410-328-8919 or email To contact commentary author Eliana M. Perrin, M.D., M.P.H., call Tom Hughes at 919-966-6047 or email

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