Maternal perceptions of toddler body size: accuracy and satisfaction differ by toddler weight status.

Objectives: To examine (1) accuracy of maternal perceptions of toddler body size; (2) factors associated with accuracy of toddler body size; and (3) how maternal satisfaction relates to accuracy/toddler body size.

Design: Cross-sectional.

Setting: Low-income community sample from suburban Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)/urban pediatric clinics.

Participants: Two hundred eighty-one mother-toddler dyads (toddlers: 54.1% male; mean age, 20.2 months; 70.8% African American; 8.5% underweight [<15th weight-for-length percentile]; and 29.2% overweight [≥85th weight-for-length percentile]).

Main Exposure: Measured anthropometry (mother/toddler) and demographics.

Outcome Measure: Validated toddler silhouette scale (accuracy and satisfaction).

Results: Nearly 70% of mothers were inaccurate in assessing their toddler's body size. Compared with mothers of healthy-weight toddlers, mothers of underweight toddlers were 9.13 times more likely to be accurate (95% CI, 2.94-28.36) and mothers of overweight toddlers were 87% less likely to be accurate (95% CI, 0.05-0.33); accuracy did not differ by toddler age, sex, or race or mother's education or weight status. More than 70% of all mothers and 81.7% of mothers of overweight toddlers were satisfied with their toddler's body size. Accurate mothers of underweight toddlers were less likely to be satisfied than accurate mothers of healthy-weight toddlers (30.0% vs 76.8%; P < .001).

Conclusions: Mothers of overweight toddlers had inaccurate perceptions of their toddler's body size and were highly satisfied, suggesting a view of heavy toddlers as normative. Mothers of underweight toddlers had accurate perceptions yet were dissatisfied, suggesting recognition of their child as outside the norm. Because inaccurate perceptions begin early in toddlerhood, pediatric providers should help improve families' understanding of healthy body size. Future studies should examine how satisfaction and accuracy relate to parenting behaviors.