Development and validation of a toddler silhouette scale.

The purpose of this study is to develop and validate a toddler silhouette scale. A seven-point scale was developed by an artist based on photographs of 15 toddlers (6 males, 9 females) varying in race/ethnicity and body size, and a list of phenotypic descriptions of toddlers of varying body sizes. Content validity, age-appropriateness, and gender and race/ethnicity neutrality were assessed among 180 pediatric health professionals and 129 parents of toddlers. Inter- and intrarater reliability and concurrent validity were assessed by having 138 pediatric health professionals match the silhouettes with photographs of toddlers. Assessments of content validity revealed that most health professionals (74.6%) and parents of toddlers (63.6%) ordered all seven silhouettes correctly, and interobserver agreement for weight status classification was high (kappa = 0.710, r = 0.827, P < 0.001). Most respondents reported that the scale represented toddlers aged 12-36 months (89%) and was gender (68.5%) and race/ethnicity (77.3%) neutral. The inter-rater reliability, based on matching silhouettes with photographs, was 0.787 (Cronbach's alpha) and the intrarater reliability was 0.855 (P < 0.001). The concurrent validity, based on the correlation between silhouette choice and the weight-for-length percentile of each toddler's photograph, was 0.633 (P < 0.001). In conclusion, a valid and reliable toddler silhouette scale that may be used for male or female toddlers, aged 12-36 months, of varying race/ethnicity was developed and evaluated. This scale may be used clinically or in research settings to assess parents' perception of and satisfaction with their toddler's body size. Interventions can be targeted toward parents who have inaccurate perceptions of or are dissatisfied with their toddler's body size.