# Maternal Misperception of Child Body Size and Its Association with Information-Seeking Opportunities and Information Sources in Japanese Preschool Children

## TL;DR

Many Japanese mothers misjudge their preschool children's body size, and using healthcare providers as an information source is linked to overestimation.

## Contribution

This study identifies healthcare providers as a unique factor associated with maternal overestimation of child body size in Japan.

## Key findings

- Maternal misperception of child body size is common among Japanese preschool children.
- Using healthcare providers as an information source is independently linked to maternal overestimation of child body size.

## Abstract

What are the main findings?
Maternal misperception of child body size, including both overestimation and underestimation, is prevalent among Japanese preschool children.Use of healthcare providers as an information source was independently associated with maternal overestimation of child body size.

Maternal misperception of child body size, including both overestimation and underestimation, is prevalent among Japanese preschool children.

Use of healthcare providers as an information source was independently associated with maternal overestimation of child body size.

What are the implications of the main findings?
Contact with healthcare providers may reflect maternal concern regarding child growth and warrants further investigation in longitudinal studies.Support strategies that help caregivers interpret objective growth indicators are needed to reduce maternal misperceptions.

Contact with healthcare providers may reflect maternal concern regarding child growth and warrants further investigation in longitudinal studies.

Support strategies that help caregivers interpret objective growth indicators are needed to reduce maternal misperceptions.

Background/Objectives: This study examined associations between maternal misperception and information-seeking opportunities, behaviors, and sources among Japanese mothers of preschool children. Methods: A cross-sectional online survey was conducted among mothers registered with a nationwide research panel. Mothers of children aged 3–5 years were included because, in Japan, this period follows the last early-childhood health checkup at age 3, after which caregivers are required to monitor child growth independently. In total, 1358 mothers were analyzed. Child anthropometric data were reported by mothers with reference to the Maternal and Child Health Handbook or childcare records. These measurements were originally obtained during routine health checkups conducted by healthcare professionals or childcare staff. Body mass index z-scores were categorized as high, middle, or low, and maternal perception as accurate, overestimated, or underestimated. Information-seeking behaviors were assessed using study-specific items informed by prior literature and reviewed by experts to ensure content and face validity. Health literacy was measured using the validated 12-item Japanese Health Literacy Scale, which has demonstrated reliability and validity in previous studies. Multinomial logistic regression was used. Results: Among children with high body size, 150/188 (80.8%) of mothers underestimated body size; among those with low body size, 20/35 (57.1%) overestimated it. In multivariable analyses, use of healthcare providers as an information source was statistically associated with maternal overestimation of child body size. Conclusions: Maternal misperception was common across body size categories. Further research is needed to determine whether support in interpreting objective growth indicators is associated with improved perception accuracy.