The major findings of two research teams from the School of Medicine were featured in a special nutrition issue of the Archives of Pediatric and Adolescent Medicine in May.
Mothers of overweight toddlers do not perceive their toddlers as overweight and are highly satisfied with their body size, suggesting that they view heavy as normal, found one study. Mothers of underweight toddlers had accurate perceptions of their toddlers' body size, but were dissatisfied, according to the study by Erin R. Hager, PhD, assistant professor, Department of Pediatrics and Department of Epidemiology & Public Health.
"These findings are very concerning," said Hager. "Both parental perceptions of a child's body size and how satisfied a parent is with their child's size are likely to influence how parents feed their children. Parents who desire for their child to be larger, even if the child is a healthy weight (or overweight), may overfeed their child, increasing the toddler's risk for obesity later in life. Parents of overweight children who perceive their children as being a healthy size may be unlikely to follow guidelines to prevent overweight. The next step in our research is to determine how to help parents adopt behaviors that promote healthy growth."
Specifically, the study found that most low-income mothers of overweight toddlers (94 percent) perceived their children to be smaller than they really were. The majority of these mothers (82 percent) were satisfied with their toddler's body size, with some even wanting their overweight toddler to be bigger.
This trend also was seen in healthy weight toddlers. Nearly two-thirds (63 percent) of mothers of healthy weight toddlers perceived that their child had a smaller body size than they really did. Most (72 percent) were satisfied with their child's body size, and 21 percent of mothers of healthy weight children wanted their child to be bigger.
"The clinical implications of this research suggest that pediatric providers promote guidelines for healthy growth with all families," said Hager. "The results suggest that pediatric providers should plot and discuss toddler weight status with families of all toddlers, emphasizing parents' roles in building healthy dietary and lifestyle habits for the family. The toddler silhouette scale is a helpful tool that could be used in a clinical setting to gauge parents' accuracy and satisfaction with their child's body size, thus guiding counseling strategies."
The other University of Maryland study in that edition of the journal, this one by Maureen Black, PhD, MA, (pictured), the John A. Scholl, MD, and Mary Louise Scholl, MD, Distinguished Professor, Department of Pediatrics, found that as family stresses such as food insecurity and maternal depression increase, children's health risks increase. Participation in federal Women, Infants, and Children (WIC) program reduces, but does not eliminate, the negative health consequences associated with stressed families.
"The building blocks that support children throughout life are formed during their early years.," said Black. "Disparities associated with household food insecurity and caregiver depressive symptoms disrupt these building blocks and can compromise children's health, resulting in lifelong negative consequences to their health and well-being."
"Evidence presented here illustrates that family stress is associated with child health risks and that WIC attenuates both family stress and the child health risks associated with household family stress," Black explained. "To reduce disparities and promote children's health, WIC is an excellent investment. The next steps are to examine why some WIC-eligible families do not participate in the program and to examine innovative strategies of implementing nutritional counseling."
Economic hardship occurs among increasingly large segments of the national population, undermining children's health and well-being, and leading to poor adult health, social disparities, and limited human capital. Without adequate economic resources, families must make difficult choices among basic needs, such as food, housing, energy, and health care, often resulting in frustration and emotional distress. Emotional distress, particularly when it occurs with other stressors, interferes with care-giving practices and adversely impacts children's well-being.
Food insecurity, meaning uncertain access to enough food for all household members to sustain an active and healthy life, is a major public health problem. Not only has food insecurity increased during the current economic downturn, but it threatens young children's well-being by increasing the risk for nutritional deficiencies, hospitalizations, delayed development, and poor health.
The Special Supplemental Nutrition Assistance Program for WIC provides food and nutrition counseling to almost 9 million low-income women, infants, and children nationwide. The study examined how WIC participation relates to family stress and to children's health in 26,950 WIC-eligible families with children under age 3 from seven urban medical centers across the country.
The first finding is that mothers who receive WIC have lower rates of food insecurity and maternal depression than mothers who are eligible but not receiving WIC, even after adjusting for other environmental factors, such as education, race/ethnicity, and immigration status. The second finding is that in the face of food insecurity and maternal depression, children in WIC-receiving families have better health indicators than children in families that are eligible but not receiving WIC.