Chen Yujia, Qu Fangge, Song Xinyi, Wei Xiaoxue, Wu Ruxing, Wang Jian, Cao Yang, Hua Wenzhe, Tang Xianqing, Zhu Daqiao
Department of Nursing, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
Eur J Pediatr. 2025 Aug 8;184(9):538. doi: 10.1007/s00431-025-06361-9.
Parental perception of their child's weight may influence their feeding practices. However, few studies examined the longitudinal associations and the potential sex differences within it. Considering that parents may perceive and respond differently to boys' and girls' weight status due to biological and sociocultural expectations, it is important to investigate potential sex differences. The prospective cohort study aims to examine the associations between parental weight perception and their non-responsive feeding practices in preschool children and explore child sex differences in the association. Parent-child dyads (n = 426, M = 3.76, SD = 0.50, 53.6%boys) were surveyed at two time points separated by a 2-year interval in China. Generalized estimating equations (GEE) were conducted to examine longitudinal associations between parental weight perception and non-responsive feeding practices (restrictive feeding, food as a reward, and pressure to eat), adjusting for key confounders, including child age, body mass index-for-age z-score (BAZ), having siblings, primary caregiver identity, and grandparent-parent parenting. Sex-stratified analyses were conducted to examine whether the associations differed between boys and girls. Parental underweight perception was associated with restrictive feeding (B = - 0.260, p = 0.004) and pressure to eat (B = 0.350, p < 0.001), but not with food as rewards (B = 0.015, p = 0.868) in the overall sample. However, parental overweight and obesity (OWOB) perception was not associated with restrictive feeding (B = - 0.029, p = 0.819), food as a reward (B = - 0.228, p = 0.146), and pressure to eat (B = - 0.284, p = 0.054). Among boys, underweight perception was associated with restrictive feeding (B = - 0.205, p = 0.023) and pressure to eat (B = 0.362, p < 0.001); OWOB perception was associated with pressure to eat (B = - 0.325, p = 0.024). While no significant associations were observed among girls for restrictive feeding, food as a reward, and pressure to eat.
Findings in this study suggested that the longitudinal associations between parental weight perception and feeding practices differed by sex among Chinese preschool children. Healthcare providers should consider offering anticipatory guidance to parents who perceive their child's weight as abnormal, educating them on evidence-based, sex-specific strategies to promote healthy feeding practices.
• Cross-sectional studies suggest that parental weight perception is associated with non-responsive feeding practices and that these associations may differ by child sex. • In China, cultural beliefs such as "a chubby child is a healthy child" may lead parents to underestimate their child's weight, potentially influencing their feeding behaviors.
• This longitudinal study in urban Chinese preschoolers found that parental underweight perception was associated with increased pressure to eat and reduced restrictive feeding over time. • These associations were observed only among boys, highlighting potential sex-specific mechanisms shaped by cultural norms as early as the preschool years.
父母对孩子体重的认知可能会影响他们的喂养方式。然而，很少有研究探讨其中的纵向关联以及潜在的性别差异。考虑到由于生物学和社会文化期望，父母可能对男孩和女孩的体重状况有不同的认知和反应，因此研究潜在的性别差异很重要。这项前瞻性队列研究旨在探讨父母体重认知与学龄前儿童非顺应性喂养方式之间的关联，并探索这种关联中的儿童性别差异。在中国，对亲子二元组（n = 426，M = 3.76，标准差 = 0.50，53.6%为男孩）在两个相隔两年的时间点进行了调查。采用广义估计方程（GEE）来检验父母体重认知与非顺应性喂养方式（限制喂养、用食物作为奖励、强迫进食）之间的纵向关联，并对关键混杂因素进行调整，包括儿童年龄、年龄别体重指数z评分（BAZ）、是否有兄弟姐妹、主要照顾者身份以及祖父母 - 父母育儿方式。进行了性别分层分析，以检验男孩和女孩之间的关联是否存在差异。在总体样本中，父母认为孩子体重过轻与限制喂养（B = -0.260，p = 0.004）和强迫进食（B = 0.350，p < 0.001）有关，但与用食物作为奖励无关（B = 0.015，p = 0.868）。然而，父母认为孩子超重和肥胖（OWOB）与限制喂养（B = -0.029，p = 0.819）、用食物作为奖励（B = -0.228，p = 0.146）和强迫进食（B = -0.284，p = 0.054）均无关联。在男孩中，体重过轻的认知与限制喂养（B = -0.205，p = 0.023）和强迫进食（B = 0.362，p < 0.001）有关；超重和肥胖的认知与强迫进食（B = -0.325，p = 0.024）有关。而在女孩中，未观察到限制喂养、用食物作为奖励和强迫进食之间有显著关联。
本研究结果表明，在中国学龄前儿童中，父母体重认知与喂养方式之间的纵向关联存在性别差异。医疗保健提供者应考虑为那些认为自己孩子体重异常的父母提供预期指导，向他们传授基于证据的、针对性别的促进健康喂养方式的策略。
• 横断面研究表明，父母体重认知与非顺应性喂养方式有关，且这些关联可能因孩子性别而异。
• 在中国，“胖孩子健康”等文化观念可能导致父母低估孩子的体重，从而潜在地影响他们的喂养行为。
• 这项针对中国城市学龄前儿童的纵向研究发现，父母认为孩子体重过轻与随着时间推移强迫进食增加和限制喂养减少有关。
• 这些关联仅在男孩中观察到，凸显了早在学龄前阶段就受文化规范影响的潜在性别特异性机制。
