Abstract
Body dissatisfaction and dietary restraint have been demonstrated in children as young as 5 years. Internalization of a thin-ideal is theorized to occur before the onset of body dissatisfaction and both have the potential to influence self-worth and impact multiple aspects of life. Across childhood, body dissatisfaction tends to increase while there is a parallel decline in positive self-concepts. Social comparisons also become more critical after the age of 7 years. Research suggests that early childhood (aged 3–8 years) may be the ideal time to expose children to content that counters unhealthy, unrealistic media ideals about body shape and size. This Practice Note describes the process of creating an evidence-based online storybook, Tiny or Tall, Mighty or Small—Music for All!, written to promote positive body image in children. Multiple steps were taken to complete this project, which required collaboration among experts across fields of public health, children’s literature, and music. The storybook can be downloaded as a PDF file for free, online, and integrates sound clips for each instrument to more fully engage readers. We hope that this electronic platform overcomes potential logistical and financial barriers of accessing a print copy and therefore allows the message of body positivity to reach a wider audience.
Body Image in Children: A Public Health Need for Early Intervention
Body image is a multidimensional concept including thoughts, feelings, and behaviors related to one’s body (Hosseini & Padhy, 2019). Body dissatisfaction, or low body esteem, describes negative thoughts and feelings in relation to weight and shape (Paxton & Damiano, 2017). It is one of the most robust cognitive risk factors for the development and maintenance of eating disorders (Stice et al., 2011). Body image can also be viewed as a reflection of overall self-worth, and it has the potential to impact multiple areas of life.
Children are particularly vulnerable to the unhealthy, unrealistic media ideals, and sociocultural pressures associated with internalization of a thin-ideal (Perez et al., 2018). When children enter formal schooling, there is even greater opportunity for them to compare themselves to peers. Such findings suggest that the seeds of body dissatisfaction may take root earlier than once believed. There is a need for creative public health approaches that normalize body differences to support the development of positive body image. This Practice Note documents the steps taken to create, and make available online, a research-based storybook that promotes body positivity in children.
Getting Started
We first surveyed available children’s literature on body image and self-esteem to examine the quantity, and quality, of resources offered for young children on these topics. This phase of information gathering included visiting public libraries to see how easily accessible these books are for the general public. Although resources on the topic of body positivity have become more available for children in recent years, accessibility is limited to people who are able to afford to buy the books or know to search for them. This persuaded our team to use an online platform for the storybook and to make it available to be downloaded online as a free PDF (protable document format) file.
During the formative research and scientific literature review, we found that an evaluation of the body positive children’s book, Shapesville, significantly increased children’s appearance satisfaction, decreased stereotyping on the basis of weight and internalization of media ideals (Dohnt & Tiggemann, 2008). This further encouraged us to develop this project.
The Production Process
As lead director on this project, I am a dual degree DO/MPH student with an undergraduate degree in music and psychology. I am also a classically trained harpist and performed with the Brown University Orchestra for 4 years. Creating this storybook allowed me to draw on my diverse background and interests by highlighting different musical instrument characters with their unique body shapes, sizes, and sounds. A rhyme scheme was used throughout the text to set an energetic, playful sensibility appropriate for the music theme and young readers. The following 13 instruments were selected and developed into characters to display their variety of shapes and talents: violin, viola, cello, double bass, harp, flute, piccolo, clarinet, oboe, timpani, trumpet, French horn, and piano. Each instrument was given its own page and poetic stanza with words that described how their physical characteristics enable them to produce their special musical sound. Our writing sought to convey that both instruments and children have unique bodies, no shape is superior to another, and multiple shapes can be both beautiful and healthy. This aims to establish positive norms around body differences and encourages children to love themselves just the way they are.
This project would not have been possible without the collaboration of many talented individuals, including a colleague who was able to bring the instrument characters to life through illustrations. From January through March 2020, we met periodically to review images. Figure 1 displays a collage of images on different pages of the storybook. The concluding image emphasizes the message to love your body and all it allows you to do. By placing instrument and children characters together on the stage in this final image, we hoped to convey the importance of honoring and appreciating the beautiful differences among all types of bodies.
Collage of Pages From Tiny or Tall, Mighty or Small—Music for All!
During Spring 2020, a former colleague—now music doctoral student—connected our team to musicians who eagerly volunteered to contribute short sound clips of their respective instruments for incorporation into the book. The purpose of this aspect of the project was to engage children in the story and introduce them to instrument sounds they may not have heard before. Once the text, illustrations, and sound clips were complete, these were integrated into a PDF file so that readers could click a music note symbol near each instrument to hear its specific sound. Instructions for this were included at the beginning of the book, as was a “Note to Parents, Caregivers and Educators” to explain the project. “Questions for Discussion” at the end aimed to be a springboard for conversation and to foster dialogue about body positivity.
Families from our social networks volunteered to preview the complete PDF. We also coordinated a live reading via Zoom for a children’s theater. Feedback from children, parents, and professional mentors across disciplines of public health, music, pediatrics, and psychology, was integrated into a final version of the PDF: https://tinyurl.com/ycbbzxcx. To view interactively and hear sound, it is necessary to open the file in Adobe Acrobat Reader, which is also freely available for download. A video of the author reading the story, paired with storybook pages flipping, can be viewed on YouTube at https://www.youtube.com/watch?v=LxWHhNisHdg
Next Steps
Immediate next steps include wider dissemination of this free resource. It will also be important to evaluate the storybook’s effectiveness and whether it promotes measurable changes to body positivity outcomes. Future projects may include creating multiple iterations of the story highlighting nonclassical music genres. This could potentially include music of specific geographical regions (i.e., Africa, Asia) or styles (i.e., Jazz, Blues, Folk, or Rock). We may also explore using nonbinary genders and names of instruments. Such changes could broaden accessibility of the important topic of body image and encourage body positivity cross-culturally and among diverse communities.
Footnotes
Authors’ Note:
The authors would like to thank Julia Burns who illustrated the story, children’s author Christine Kendall who offered feedback and guidance, all musicians who contributed sound clips (individuals listed by name and affiliation in the back of the book), Ben Kapilow for his edits, and Dante Morgnanesi who assembled text, illustrations, and sound clips into the PDF (Portable Document Format) version.
