When children's writer Mary Koski proudly read her first book to a neighbor's daughter, she wasn't prepared for her reaction.
"Why," asked the little girl, pointing to the book's heroine, "are her feet so huge?"
Koski was surprised that a youngster would focus on such a trivial matter. The book, after all, was about how to dial 911 in an emergency. But when the same question was repeated by children during a subsequent book tour, the reason dawned on her.
"We live in a culture where kids at a young age are focused on their bodies, particularly differences in our bodies," says Koski, 48, the former head of a Duluth, Minn., community college. "They are already wrestling with body-image issues."
In the media-saturated life of children in the '90s, a message has repeatedly been drummed into their heads: Looks count. Increasingly, teachers and family counselors say, they are confronting children as young as elementary-school age who are focused excessively on their physical appearance.
Not only can that lead to self-conscious children with poor self-images who become withdrawn or shy, but more serious problems may develop as well, experts say.
Appearance can become an obsession, children who believe themselves ugly can become depressed, and they can head down the road toward eating disorders, substance abuse and other forms of mental illness, says Bruce A. Bracken, a professor of psychology at University of Memphis and a leading researcher in self-concept.
"Society has put a greater emphasis on image. Just look at television where good looks, flashy clothes, jewelry and the car we drive are paramount," says Bracken. "Well, there are a lot of casualties in this quest to have a positive self-image."
Dr. Vicki N. Bodison, a Baltimore County school psychologist, says children of a generation ago were less likely to have a problem with self-image. They spent more time at home, usually with a stay-at-home mother, insulated from peer pressure.
Today, children are more exposed to alternate role-models and, particularly with the prevalence of day care, must socialize at a younger age, she says.
"Children can have problems with self-image even before they have the language to identify that," Bodison says.
Sometimes it's not the peer group, but parents who are to blame. Dr. John Walkup, a child psychiatrist at Johns Hopkins Children's Center, says some parents simply put too much emphasis on the superficial.
"Not to put the blame on families, but some adults overvalue appearance," Dr. Walkup says.
It can be a problem for attractive children, too, if people relate to them only within that dimension. "A child will grow up thinking that's what's important," Dr. Walkup says.
In a new book, "Impatient Pamela Asks: Why Are My Feet So Huge?" (Trellis Publishing, $15.95), Koski uses the big-footed preadolescent heroine from her first book to explore the issue of body image.
"Impatient Pamela" becomes miserable when a classmates calls attention to the size of her feet. That mirrors the author's real-life experience: Koski was devastated when, on the first day of third grade, the teacher thought she was a misplaced second-grader because she was so much shorter than her classmates.
" 'Oh, Sweetie, you can't possibly be in third grade,' " says Koski, recalling the teacher's exact words.
"I don't remember feeling small until the teacher pointed it out," she says. "It's so often other people pointing out differences that cause us to make a bigger deal about them."
Impatient Pamela does ultimately learn to accept her large feet -- but only after discovering that they make her a good runner and soccer player.
Experts in child development say there is much parents can do to help their child feel good about their appearance and handle teasing from classmates. Being positive should be a parent's first goal, says Bracken.
"Celebrate accomplishments, incremental gains by your child, and how they compare favorably to other kids," he says. "Explain to them that everyone develops at their own rate. Because so-and-so is tall and you're short doesn't mean you'll always be short."
Children who are frequently teased can develop defenses. Ignoring taunts is still the best one, says Rebecca Landa, an associate professor of child psychiatry at Hopkins, although "that's often tough to do."
Landa advises children to avoid taunting others ("If you're a nasty kid, you invite it on yourself"), keep a distance from children who tease, and call on an adult, preferably a school guidance counselor, when teasing gets out of hand.
"Kids can also try to laugh along with other kids," she says. "Interaction takes two. When someone says something negative, the only way the interaction can be sustained is if you give something back to the other person."
Parents should keep something else in mind, too: Most children can handle criticism of their appearance with no permanent emotional scars, says Dr. Walkup.
"I would love it if there was no teasing of any child, but I'm realistic," he says. "There's always going to be a certain amount of pecking order and social buffeting that takes place in peer groups."