Background: Little is known about parental recognition of their child's overweight status over time. The aim of this study was to examine the prevalence of parental misperceptions related to preschool children's weight in the last two decades.

Methods: Data come from the National Health and Nutrition Examination Survey from 1988 to 1994 (early survey;n=3839) and 2007 to 2012 (recent survey; n=3153). Parents were asked whether they considered their child, ages 2–5 years, to be overweight, underweight, or just about the right weight. We estimated the probability ratio (PR) between the two surveys for parents perceiving their overweight child as overweight.

Results: Percentages of parents who inappropriately perceived their overweight child as just about the right weight was 96.6% and 94.9% for the early and recent survey, respectively. As high as 78.4% of parents perceived their obese child as just about the right weight in the recent survey. The probability of overweight/obese children being perceived as overweight in the early survey was 0.18 (95% confidence interval [CI]=0.14–0.22) and further lowered to 0.14 (95% CI=0.11–0.17) in the recent survey. After adjustment for sociodemographics and BMI z-scores of directly measured body weight, probability of being appropriately perceived by the parents declined by 30% between surveys (PR=0.70 [0.63, 0.78]).

Conclusions: There was a declining tendency among parents to perceive overweight children appropriately. Strategies are needed to explore how to encourage clinician discussions with parents about appropriate weight for their child and strengthen capacity for childhood obesity prevention.