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Shaping Her Self-Image

The first few times it happened to me, I thought it was about puberty and sex. I'd be doing a routine physical exam on a healthy 8- or 9-year-old girl and would ask the mother if she had any concerns. But instead of answering straightforwardly, the mom would hem and haw: She was a little concerned -- "You know what I mean, doctor. Could you speak to my daughter?" Her eyes would shift. Gradually, I realized that it wasn't about puberty at all. It was about weight. What those mothers meant was, "I'm afraid my daughter is getting fat." Or even, "I'm afraid my daughter might get fat."

Now, there are certainly parents who have legitimate anxieties about their children's weight -- and, even more important, there are parents who should be worried and aren't. Childhood obesity is a major problem in America, and by all accounts, it's getting worse. But I'm talking about the mothers who shouldn't be concerned and are, who focus on the largely theoretical weight problems of their normally shaped prepubescent daughters. And even as I show these moms the pediatric growth charts on which their daughters' heights and weights plot out as perfectly proportioned and age-appropriate, I see the doubt in their eyes. And in their daughters' eyes, I see the beginnings of self-doubt.

Young children inhabit their bodies, round or angular, with a happy lack of self-consciousness that is part of what we call innocence. Look at a 3- or 4-year-old, supremely comfortable in her own skin. Watch how a 5-year-old takes up space, exulting in the joy of motion. But then something happens, particularly to girls. An 8-year-old girl recently confided to me that she avoids swimming because she doesn't want people to look at her in a bathing suit. Maybe someone in her class made a cruel remark; maybe the insanely thin bodies in magazines and music videos got to her. And for one hot, angry moment, I wanted to storm the barricades, incinerate the Barbie dolls, do anything that would keep this child happy and comfortable. And I was deeply grateful for her mother's good sense as she piped in, "You're beautiful, and anyone who says anything different is talking nonsense." It may not be enough to counter all those negative messages, but it's a start, right at home, where it matters most of all.

Then there are the mothers who cannot look at their daughters in bathing suits without alarm, who are already policing their 10-year-olds' eating habits. The truth is that much of the anguish these moms feel is related to their beliefs about their own grown-up bodies. And when these mothers lose perspective, their daughters may never be able to look at themselves in the mirror and see what's really there. Our children conjure up memories of our own development, so in the exam room, I often ask parents how they feel about the issues they've raised: Is this an old problem in your family? In your life? One mother confided that she believes her own adolescence was ruined by "baby fat," and she doesn't want that to happen to her little girl. But the truth is, it's hard enough to be a kid without having to live your mother's adolescence all over again -- and to get it right this time.

Part of the problem stems from not understanding that girls between the ages of 9 and 12 are supposed to pass through a somewhat padded stage as their bodies prepare for the growth spurt that will leave them stretched out (and taller than most of the boys for a while). Many moms mistake this development for a sign that their daughters are getting fat.

And that's too bad, because this is also when girls are especially vulnerable emotionally. Lots of normal 9-year-olds are experiencing early pubertal changes and are correspondingly self-conscious. But they are also still children -- and parental wisdom can be a powerful remedy against the messages bombarding them from the larger culture. Remind everyone (including yourself) that successful, happy, attractive adults come in all shapes and sizes. It's not terrible for children to see a parent trying to make changes in her eating habits, but it's better to talk about choosing healthy food than about dieting or counting calories. There's something troubling about a child who uses artificial sweeteners, but there's nothing wrong with the message that fruit is a better snack than candy. Discuss feeling good as well as looking good, and avoid jokes: "Puppy fat" is never an affectionate term, heaven knows.

Talk to your daughter about how she feels about her body. Yes, the opinions of her peers are going to have more and more impact, but you shouldn't bow out of the conversation. Above all, tell your daughter that it makes you proud to see her growing up. She may seem to shrug and turn away, but your voice will echo in her head and help her along in difficult moments.

Most important, weigh in with positive messages: Eat nutritiously so that you'll stay strong and grow. Pursue the sports you enjoy, so you can use your body in a way that brings you satisfaction. And yes, you can't say it too often: You're beautiful, beautiful, beautiful.

Pediatrician Perri Klass, M.D., is a mom of three. Her short story collection, Love and Modern Medicine, will be published in April.