A roly-poly toddler strikes many mothers as the picture of health.
But the road to obesity can start early in life, so it's important to know whether the baby fat that lingers on a toddling child is a healthy cushion or a sign of too much food too soon.
How good are mothers at recognizing whether their toddlers are overweight, underweight or just right? Not very.
More than two-thirds of the mothers participating in a recent study were inaccurate in their assessments. And the biggest problem was moms who thought their overweight toddlers were just fine.
Researchers asked 281 mothers recruited from two clinics (one in Baltimore and another in a nearby suburb) that serve mainly low-income mothers to find out. Seventy-one percent of the participants were African-American.
The researchers picked those clinics because children in low-income families are at higher risk of becoming overweight or obese.
The moms were asked to find the best match for their child from silhouettes of toddlers of various weights. They also asked which picture the moms wanted their kid to resemble. Moms and kids got their weights and heights measured.
Mothers with overweight toddlers were generally satisfied with how their kids looked. Those with underweight toddlers were more likely to get the assessment right — and to be dissatisfied with the situation.
Tellingly, 4 percent of the mothers of overweight toddlers and 21 percent of those whose kids were a healthy weight wanted their kids to weigh more.
"The concern is that perceptions are likely to drive behavior," Erin Hager, the lead author of the study. And parents control what their toddler eat, says Hager, an assistant professor in the pediatrics department at the University of Maryland med school in Baltimore.
The results appear in the latest Archives of Pediatrics and Adolescent Medicine.
Hager tells Shots that the findings suggest doctors should work harder to talk with families about what a healthy weight is for young children, including specifics about their kids. "Seventy-five percent of parents of overweight kids have never been told that by a pediatrician," she says.
An accompanying editorial by pediatrician Eliana Perrin praised the study and pointed out that it's harder for people to recognize weight problems these days because "being overweight has become the norm for too many children and parents."
She calls for a public education campaign and routine screening of 2-year-olds for weight problems. The issue is fraught, she writes, but it should be possible to open the discussion while preserving "cultural ideals and pride in children's growth but also help parents achieve healthy weight trajectories."