Birth Weight Abnormalities And The Pitfall Of Ongoing Childhood Weight Perception Errors
Overview
Abnormal birth weight (BW) in young children may influence a mother’s perception of her child’s weight, potentially affecting health management. This study aimed to examine how children’s BW impacts maternal misperceptions of their child’s weight during early childhood.
A retrospective analysis was conducted on a sample of 485,095 children aged 54-60 months, born between 2011 and 2013, who participated in South Korea’s Sixth National Health Screening Program for Infants and Children (NHSPIC). Data collected included BW, current weight, sex, birth year, preterm birth status, breastfeeding history, maternal age, maternal perceptions of the child’s weight, and socioeconomic status. These data were integrated through linkage between the NHSPIC and Korean healthcare claims information.
Multiple logistic regression analysis was used to assess the impact of BW on maternal misperceptions of their child’s weight, adjusting for all relevant variables.
Introduction
Mothers typically act as the primary caregivers for young children, creating an environment that supports their healthy growth and development. They significantly influence their children’s health behaviors, making an accurate perception of a child’s weight crucial for fostering healthy development. However, it is well-documented that many parents, especially those with children under six years old, often misjudge their child’s weight status. Previous research has predominantly focused on mothers recognizing overweight or obesity in their children, as accurate recognition can lead to the promotion of healthier behaviors, like increased physical activity. In contrast, a failure to identify overweight status has been linked to rising childhood obesity rates.
Birth weight is a key indicator of health at birth and predicts morbidity and survival during infancy. Infants with low birth weight (LBW) face greater risks of growth, developmental challenges, and various health issues. Consequently, mothers of LBW infants often stress about their child’s size and may overcompensate by encouraging excessive weight gain, potentially leading to overweight, obesity, and associated health problems in adulthood. Thus, accurate maternal assessment of a child’s weight, particularly for LBW infants, is essential for proper weight management.
There is limited research on the relationship between a child’s birth weight and maternal perception of body weight, with scant studies addressing how perceptions differ among low, normal, and high birth weight (HBW) groups. Factors such as the child’s gender, gestational age, current age, and parental socioeconomic status are proposed predictors of maternal perception accuracy, but findings have been inconsistent. Most studies on parental perception of child weight are from Western countries, with few conducted in Asia, particularly South Korea.
This study aimed to investigate the differences in maternal perceptions of young children’s weight relative to their birth weight and identify predictors of maternal misperceptions in South Korea. The research utilized data from the National Health Screening Program for Infants and Children (NHSPIC) and healthcare claims from the National Health Insurance Sharing Service (NHISS) in South Korea.
The study had three specific objectives: (1) to assess differences in maternal perceptions of children’s weight status (thin, normal, or overweight) in relation to birth weight (LBW, normal, or HBW); (2) to explain variations in the accuracy of these perceptions (accurate, underestimate, or overestimate) based on birth weight; and (3) to identify factors, including birth weight, that contribute to maternal misperceptions of their child’s weight.
Also read; Childhood Obesity: Targeted Dietary Interventions
Methods
Inclusion criteria:
- Children aged 54-60 months.
- Children who were born and enrolled in the NHSPIC between 2011 and 2013.
- Children who participated in the sixth NHSPIC health checkup.
- Data linkage with maternal information from the Korean NHISS and healthcare claims data.
Exclusion criteria:
- Children not within the 54-60 month age range at the time of the sixth NHSPIC health checkup.
- Children born outside the 2011-2013 timeframe or not enrolled in the NHSPIC during this period.
- Participants without complete data linkage to maternal information from the Korean NHISS and healthcare claims data.
- Any cases where necessary data for analysis, such as birth weight, maternal perceptions, or breastfeeding history, were incomplete or missing.
Analysis
All data analyses were conducted using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Initially, the general characteristics of the participants were assessed by calculating frequencies and percentages. To understand the distribution of children’s actual weight and mothers’ perceptions of their child’s weight based on birth weight categories (low, normal, or high), frequencies and percentages were estimated for children’s actual weight classifications (underweight, normal weight, overweight/obese) and mothers’ weight perceptions (thin, normal, overweight). Differences between birth weight and actual weight or maternal perception of the child’s weight were analyzed using the chi-square (χ2) test.
The accuracy of mothers’ weight perceptions (accurate, underestimate, overestimate) in relation to their child’s birth weight was also evaluated. This involved calculating frequencies and percentages for accurate perceptions as well as for overestimations and underestimations. The relationship between birth weight and the accuracy of maternal weight perceptions was further analyzed using the chi-square (χ2) test.
Also read; Infant Formula Protein Content And Childhood Obesity
To examine the impact of birth weight on maternal misperceptions (underestimation and overestimation) of their child’s weight, multiple logistic regression analysis was employed. This analysis adjusted for variables including the child’s actual weight, sex, birth year, preterm birth status, breastfeeding history, maternal age, and socioeconomic status. These variables were incorporated using an “enter” method. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to determine the likelihood of maternal misperception of the child’s weight status. The logistic regression model was selected based on the smallest Akaike information criterion and tested for model fit. A p-value of less than 0.05 was considered statistically significant in all tests.
Results
The cohort consisted of 485,095 children, with birth weight distribution as follows: 37,646 (7.8%) had low birth weight (LBW), 430,925 (88.9%) had normal birth weight (NBW), and 16,209 (3.3%) had high birth weight (HBW). In terms of current weight status, 77.4% of the children were of normal weight, 18.1% were overweight or obese, and 4.5% were underweight. The sample had more boys (52.9%) than girls (47.1%), and 5.2% were born prematurely. Additionally, 62.7% of the children were breastfed for more than 6 months, 2.9% of the mothers were over 40 years old, and the most common socioeconomic status was middle level (level 3–4).
Significant differences were found in the distribution of the child’s actual weight (χ2 = 8779.12, p < .0001) and mothers’ perceptions of their child’s weight (χ2 = 4209.02, p < .0001) according to birth weight. Most children across all birth weight groups were of normal weight, but 12.7% of LBW children were underweight, the highest among the groups. NBW children had the highest proportion of normal weight (78.1%), and HBW children had the highest proportion of overweight or obesity (31.5%).
Mothers’ perceptions showed that most children were perceived as normal weight across all birth weight groups. However, 42.1% of mothers perceived LBW children as thin, the highest among the groups. Conversely, 73.8% of mothers perceived HBW children as normal and 9.1% as overweight, the highest among the groups.
The accuracy of maternal perceptions of their child’s weight significantly differed by birth weight (χ2 = 330.01, p < .0001). Overall, mothers correctly identified their child’s weight in 58.8% of cases. The lowest accuracy rate was for mothers of LBW infants, correctly classifying their child’s weight in 57.1% of cases. Notably, when the child’s actual weight was normal, mothers of LBW infants had the lowest accuracy rate (57.8%) and the highest rate of underestimation (41.5%) among the birth weight groups.
Multiple logistic regression analysis identified factors influencing maternal misperceptions. Mothers were more likely to underestimate their child’s weight if the child was overweight (aOR: 5.81, 95% CI: 5.68, 5.94), LBW (aOR: 1.46, 95% CI: 1.41, 1.52), male (aOR: 1.67, 95% CI: 1.64, 1.70), or preterm (aOR: 1.20, 95% CI: 1.15, 1.26), and if the mother was younger than 40 years (aOR: 1.27, 95% CI: 1.21, 1.35). Birth years 2012 and 2011 were also associated with increased risk of underestimation (aOR: 1.11, 95% CI: 1.08, 1.13) compared to 2013. Conversely, the risk decreased for children with HBW (aOR: 0.64, 95% CI: 0.61, 0.67) and those breastfed for 6 months (aOR: 0.96, 95% CI: 0.94, 0.98) or a year (aOR: 0.97, 95% CI: 0.95, 0.99).
For overestimation, the risk was lower for LBW children (aOR: 0.84, 95% CI: 0.73, 0.97), males (aOR: 0.51, 95% CI: 0.47, 0.55), preterm infants (aOR: 0.78, 95% CI: 0.65, 0.93), and mothers younger than 40 years (aOR: 0.78, 95% CI: 0.63, 0.97). The highest risk was observed when the child was underweight (aOR: 12.65, 95% CI: 11.71, 13.67). Socioeconomic status also influenced misperceptions; as socioeconomic status decreased, the risk of maternal underestimation increased in lower quintiles compared to the highest quintile. The risk of overestimation was higher in quintile 2 (aOR: 1.20, 95% CI: 1.05, 1.38) compared to quintile 5.
Conclusions
The study revealed that Korean mothers of young children often struggle to accurately assess their child’s weight, typically underestimating it. This trend is consistent with similar studies from Western countries. Mothers of children with low birth weight (LBW) were particularly prone to underestimating their child’s weight, frequently perceiving them as thin even when they were of normal weight. Conversely, mothers of high birth weight (HBW) children were less likely to underestimate their child’s weight, but still struggled to accurately identify overweight or obese children.
The findings emphasize the significant influence of a child’s birth weight on maternal weight perception, underscoring the necessity for initiatives aimed at improving body weight recognition accuracy, especially among mothers of LBW infants. Nursing strategies should be developed to provide information and support to these mothers, helping them accurately recognize and not underestimate their child’s normal body type during early childhood.
The study also identified the current weight of the child as the most significant factor affecting maternal misperception. Other independent factors included the child’s gender, birth year, prematurity, breastfeeding history, maternal age, and socioeconomic status. Pediatric nurses should incorporate these findings into parent education and counseling strategies. Nursing intervention programs for health promotion and weight management in young children should specifically include measures to improve mothers’ recognition of their child’s body type.
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