Objective: To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices. Setting: Pudong District, Shanghai, China. Participants: A convenience sample of 1164 mothers who were primary caregivers of preschool children. Results: Sixty percent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0.212, P < 0.001). Structural equation modeling (SEM) indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0.035, P < 0.001), restriction (β = 0.022, P < 0.001), and food as a reward (β = -0.017, P < 0.05). Conclusion: Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

We aimed to examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and non-responsive feeding practices. We recruited a convenience sample of 1164 mothers who were primary caregivers of preschool children. Child body mass index (BMI) Z-score was calculated to assess child weight. The Chinese version of the Child Feeding Questionnaire (C-CFQ) was used to measure four common non-responsive feeding practices, weight perception and weight concern. Structural equation modeling (SEM) was used to examine the associations between child BMI Z-scores, maternal feeding practices, and other covariates. Sixty percent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0.212, P < 0.001). SEM indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0.035, P < 0.001), restriction (β = 0.022, P < 0.001), and food as a reward (β = -0.017, P < 0.05).ConclusionChild weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.What is KnownNon-responsive feeding practices may contribute to childhood obesity or eating disorders.Relationships between maternal weight perception and concern, child weight, and feeding practices have been mixed.What is NewChild weight may influence maternal non-responsive feeding practices through maternal weight perception and concern.Interventions are needed to increase the accuracy of caregivers’ perception of child weight which may influence maternal feeding practices and thereby contribute to child health.