Abstract
It has become increasingly common for young children to be taken care of by multiple caregivers in China after the socio-economic reforms. Complex migration patterns and high female labour force participation have led to children receiving care from various individuals in different contexts. However, little is known about how childcare arrangements are associated with child health well-being. This study examines various early childhood caregivers and their influences on children’s physical health in China. Using data from the China Health and Nutrition Survey (CHNS 1991–2011) with 3,470 children aged 2 to 6, we first identified different types of childcare arrangements in and outside of the household based on who provides the care, where they provide the care, and the intensity of the care. Then we examined the relationship between various childcare arrangements and health outcomes for children. Overall, household members undertook early childhood care tasks in China, with an increase in grandparents as primary caregivers between 1991 and 2011. The proportion of children receiving formal childcare fluctuated around 20% during this period. The findings suggest that: 1) primary caregiver in the household other than parents is not associated with undesirable physical health outcomes; 2) formal childcare outside the household is associated with higher height and lower BMI scores; 3) primary caregivers in the household, particular grandparents, moderate the association between childcare arrangements outside the household and children’s health outcomes. It yields an implication that early childhood care policies incorporating multiple caregivers would benefit children’s well-being in China.
Similar content being viewed by others
References
Allen, K. R., & Henderson, A. C. (2017). Family theories: Foundations and applications. John Wiley & Sons.
Bégin, F., Frongillo, E. A., & Delisle, H. (1999). Caregiver behaviors and resources influence child height-for-age in rural Chad. The Journal of Nutrition, 129(3), 680–686. https://doi.org/10.1093/jn/129.3.680
Black, L., Matvienko-Sikar, K., & Kearney, P. M. (2017). The association between childcare arrangements and risk of overweight and obesity in childhood: A systematic review. Obesity Reviews, 18(10), 1170–1190. https://doi.org/10.1111/obr.12575
Bramlett, M. D., & Blumberg, S. J. (2007). Family structure and children’s physical and mental health. Health Affairs, 26(2), 549–558. https://doi.org/10.1377/hlthaff.26.2.549
Britto, P. R., Lye, S. J., Proulx, K., Yousafzai, A. K., Matthews, S. G., Vaivada, T., Perez-Escamilla, R., Rao, N., Ip, P., Fernald, L. C. H., MacMillan, H., Hanson, M., Wachs, T. D., Yao, H., Yoshikawa, H., Cerezo, A., Leckman, J. F., & Bhutta, Z. A. (2017). Nurturing care: Promoting early childhood development. The Lancet, 389(10064), 91–102. https://doi.org/10.1016/S0140-6736(16)31390-3
Bronfenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. Developmental Psychology, 22(6), 723–742. https://doi.org/10.1037/0012-1649.22.6.723
Chen, F., Liu, G., & Mair, C. A. (2011). Intergenerational ties in context: Grandparents caring for grandchildren in China. Social Forces, 90(2), 571–594. https://doi.org/10.1093/sf/sor012
Cislak, A., Safron, M., Pratt, M., Gaspar, T., & Luszczynska, A. (2012). Family-related predictors of body weight and weight-related behaviours among children and adolescents: A systematic umbrella review. Child: Care, Health and Development, 38(3), 321–331. https://doi.org/10.1111/j.1365-2214.2011.01285.x
Cunha, F., & Heckman, J. J. (2010). Investing in our young people (No. 5050; IZA Discussion Paper). https://doi.org/10.1017/CBO9780511762666.021
Cunningham, S. A., Chandrasekar, E. K., Cartwright, K., & Yount, K. M. (2019). Protecting children’s health in a calorie-surplus context: Household structure and child growth in the United States. PLoS ONE, 14(8). https://doi.org/10.1371/journal.pone.0220802
Du, F., & Dong, X. Y. (2013). Women’s employment and child care choices in urban China during the economic transition. Economic Development and Cultural Change, 62(1), 131–155. https://doi.org/10.1086/671714
Engle, P., Lhotská, L., & Armstrong, H. (1997). The care initiative: Assessment, analysis and action to improve care for nutrition. New York: UNICEF Nutrition Section.
Falkingham, J., Evandrou, M., Qin, M., & Vlachantoni, A. (2020). Informal care provision across multiple generations in China. Ageing and Society, 40(9), 1978–2005. https://doi.org/10.1017/S0144686X19000369
Fellmeth, G., Rose-Clarke, K., Zhao, C., Busert, L. K., Zheng, Y., Massazza, A., Sonmez, H., Eder, B., Blewitt, A., Lertgrai, W., Orcutt, M., Ricci, K., Mohamed-Ahmed, O., Burns, R., Knipe, D., Hargreaves, S., Hesketh, T., Opondo, C., & Devakumar, D. (2018). Health impacts of parental migration on left-behind children and adolescents: A systematic review and meta-analysis. The Lancet, 392(10164), 2567–2582. https://doi.org/10.1016/S0140-6736(18)32558-3
Glaser, K., Stuchbury, R., Price, D., Di Gessa, G., Ribe, E., & Tinker, A. (2018). Trends in the prevalence of grandparents living with grandchild(ren) in selected European countries and the United States. European Journal of Ageing, 15(3), 237–250. https://doi.org/10.1007/s10433-018-0474-3
Gong, X., Xu, D., & Han, W.-J. (2016). The effects of preschool attendance on adolescent outcomes in rural China. Early Childhood Research Quarterly, 37, 140–152. https://doi.org/10.1016/j.ecresq.2016.06.003
Guo, Q., Sun, W., & Wang, Y. (2017). Effect of parental migration on children’s health in rural China. Review of Development Economics, 21(4), 1132–1157. https://doi.org/10.1111/rode.12289
Gwozdz, W. (2016). Is maternal employment related to childhood obesity? In IZA World of Labor (Issue June). https://doi.org/10.15185/izawol.267
Han, W., Whetung, T., & Mao, X. (2020). One roof, three generations: Grandparental co-residence and child outcomes in China. Family Process, 59(3), 1144–1160. https://doi.org/10.1111/famp.12484
Härkönen, J., Bernardi, F., & Boertien, D. (2017). Family dynamics and child outcomes: An overview of research and open questions. European Journal of Population, 33(2), 163–184. https://doi.org/10.1007/s10680-017-9424-6
He, Q., Li, X., & Wang, R. (2018). Childhood obesity in China: Does grandparents’ coresidence matter? Economics & Human Biology, 29, 56–63. https://doi.org/10.1016/j.ehb.2018.02.001
Hu, Z., & Peng, X. (2012). China’s family policies in the context of family changes. Population Research, 36(2), 3–10.
Jiang, J., Rosenqvist, U., Huishan, W., Greiner, T., Guangli, L., & Sarkadi, A. (2007). Influence of grandparents on eating behaviors of young children in Chinese three-generation families. Appetite, 48(3), 377–383. https://doi.org/10.1016/J.APPET.2006.10.004
Leung, J. T. Y., & Fung, A. L. C. (2021). Editorial: Special issue on quality of life among children and adolescents in Chinese societies. Applied Research in Quality of Life. https://doi.org/10.1007/s11482-021-09915-9
Leung, J. T. Y., & Shek, D. T. L. (2019). The influence of parental expectations and parental control on adolescent well-being in poor Chinese families. Applied Research in Quality of Life, 14(4), 847–865. https://doi.org/10.1007/s11482-017-9540-9
Li, B., Adab, P., & Cheng, K. K. (2015). The role of grandparents in childhood obesity in China - evidence from a mixed methods study. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 1–9. https://doi.org/10.1186/s12966-015-0251-z
Lippman, L. H., Moore, K. A., & McIntosh, H. (2011). Positive indicators of child well-being: A conceptual framework, measures, and methodological issues. Applied Research in Quality of Life, 6(4), 425–449. https://doi.org/10.1007/s11482-011-9138-6
Liu, L., Fan, L., Hou, X. Y., Wu, C. A., Yin, X. N., Wen, G. M., Sun, D., Xian, D. X., Jiang, H., Jing, J., Jin, Y., & Chen, W. Q. (2018). Family childcare types and conduct problem behaviors in young children: The mediation role of caregiver-child interaction. Frontiers in Pediatrics, 6(August), 1–11. https://doi.org/10.3389/fped.2018.00217
McLaren, L., Zarrabi, M., Dutton, D. J., Auld, M. C., & Emery, J. C. H. (2012). Child care: Implications for overweight/obesity in Canadian children? Chronic Diseases and Injuries in Canada, 33(1), 1–11.
Mo, X., Xu, L., Luo, H., Wang, X., Zhang, F., & Gai Tobe, R. (2016). Do different parenting patterns impact the health and physical growth of ‘left-behind’ preschool-aged children? A cross-sectional study in rural China. The European Journal of Public Health, 26(1), 18–23. https://doi.org/10.1093/eurpub/ckv181
Monasta, L., Batty, G. D., Cattaneo, A., Lutje, V., Ronfani, L., Van Lenthe, F. J., & Brug, J. (2010). Early-life determinants of overweight and obesity: A review of systematic reviews. Obesity Reviews, 11(10), 695–708. https://doi.org/10.1111/j.1467-789X.2010.00735.x
Mu, R., & de Brauw, A. (2015). Migration and young child nutrition: Evidence from rural China. Journal of Population Economics, 28(3), 631–657. https://doi.org/10.1007/s00148-015-0550-3
Murrin, C. M., Kelly, G. E., Tremblay, R. E., & Kelleher, C. C. (2012). Body mass index and height over three generations: Evidence from the Lifeways cross-generational cohort study. BMC Public Health, 12(1), 81. https://doi.org/10.1186/1471-2458-12-81
Navsaria, N., Gilbert, K., Lenze, S., & Whalen, D. J. (2017). Effects of early environment and caregiving: Risk and protective factors in developmental psychopathology. In J. L. Luby (Ed.), Handbook of Preschool Mental Health: Development, Disorder, and Treatment (2nd ed., pp. 27–72). The Guilford Press.
Pilarz, A. R., & Hill, H. D. (2014). Unstable and multiple child care arrangements and young children’s behavior. Early Childhood Research Quarterly, 29(4), 471–483. https://doi.org/10.1016/j.ecresq.2014.05.007
Qi, X., & Melhuish, E. C. (2017). Early childhood education and care in China: History, current trends and challenges. Early Years, 37(3), 268–284. https://doi.org/10.1080/09575146.2016.1236780
Richter, L. (2004). The importance of caregiver-child interactions for the survival and healthy development of young children: A review. World Health Organization. https://www.who.int/publications/i/item/924159134X
Sear, R. (2016). Beyond the nuclear family: An evolutionary perspective on parenting. Current Opinion in Psychology, 7, 98–103. https://doi.org/10.1016/J.COPSYC.2015.08.013.
Sear, R. (2018). Family and fertility: Does kin help influence women’s fertility, and how does this vary worldwide? Population Horizons, 14(1), 18–34. https://doi.org/10.1515/pophzn-2017-0006
Sear, R., & Coall, D. A. (2011). How much does family matter? Cooperative breeding and the demographic transition. Population and Development Review, 37, 81–112. https://www.jstor.org/stable/41762400
Shek, D. T. L. (2006). Chinese family research: Puzzles, progress, paradigms, and policy implication. Journal of Family Issues, 27(3), 275–284. https://doi.org/10.1177/0192513x05283508
Shek, D. T. L. (2014). Applied Research in Quality of Life (ARQOL): Where are we and issues for consideration. Applied Research in Quality of Life, 9(3), 465–468. https://doi.org/10.1007/s11482-014-9340-4
Shek, D. T. L. (2020). Chinese adolescent research under COVID-19. Journal of Adolescent Health, 67(6), 733–734. https://doi.org/10.1016/j.jadohealth.2020.09.011
Shek, D. T. L., & Siu, A. M. H. (2019). “UNHAPPY” environment for adolescent development in Hong Kong. Journal of Adolescent Health, 64(6), S1–S4. https://doi.org/10.1016/j.jadohealth.2019.01.007
Shi, H., Zhang, J., Du, Y., Zhao, C., Huang, X., & Wang, X. (2020). The association between parental migration and early childhood nutrition of left-behind children in rural China. BMC Public Health, 20(1), 246. https://doi.org/10.1186/s12889-020-8350-4
Sleddens, E. F. C., Gerards, S. M. P. L., Thijs, C., de Vries, N. K., & Kremers, S. P. J. (2011). General parenting, childhood overweight and obesity-inducing behaviors: A review. International Journal of Pediatric Obesity, 6(2–2), e12–e27. https://doi.org/10.3109/17477166.2011.566339
Slot, P. (2018). Structural characteristics and process quality in early childhood education and care: A literature review (No. 176; OECD Education Working Paper, Issue 176). https://doi.org/10.1787/edaf3793
Tan, C., Luo, J., Zong, R., Fu, C., Zhang, L., Mou, J., & Duan, D. (2010). Nutrition knowledge, attitudes, behaviours and the influencing factors among non-parent caregivers of rural left-behind children under 7 years old in China. Public Health Nutrition, 13(10), 1663–1668. https://doi.org/10.1017/S1368980010000078
Tanskanen, A. O. (2013). The association between grandmaternal investment and early years overweight in the UK. Evolutionary Psychology, 11(2), 147470491301100. https://doi.org/10.1177/147470491301100212
Tian, X., Ding, C., Shen, C., & Wang, H. (2017). Does parental migration have negative impact on the growth of left-behind children? - New evidence from longitudinal data in rural China. International Journal of Environmental Research and Public Health, 14(11), 1308. https://doi.org/10.3390/ijerph14111308
Timonen, V., & Arber, S. (2012). A new look at grandparenting. In S. Arber & V. Timonen (Eds.), Contemporary grandparenting: Changing family relationships in global contexts (pp. 1–24). Policy Press.
UNICEF. (2017). Population status of children in China in 2015: Facts and figures. National Bureau of Statistics of China, UNICEF China, UNFPA China. https://www.unicef.cn/en/reports/population-status-children-china-2015
Ventura, A. K., & Birch, L. L. (2008). Does parenting affect children’s eating and weight status? International Journal of Behavioral Nutrition and Physical Activity, 5(1), 15. https://doi.org/10.1186/1479-5868-5-15
Vidmar, S. I., Cole, T. J., & Pan, H. (2013). Standardizing anthropometric measures in children and adolescents with functions for egen: Update. Stata Journal, 13(2), 366–378.
Watanabe, E., Lee, J. S., & Kawakubo, K. (2011). Associations of maternal employment and three-generation families with pre-school children’s overweight and obesity in Japan. International Journal of Obesity, 35(7), 945–952. https://doi.org/10.1038/ijo.2011.82
World Health Organization. (2006). WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. World Health Organization. https://www.who.int/publications-detail-redirect/924154693X
Wu, F. (2018). China country note. In S. Blum, A. Koslowski, A. Macht, & P. Moss (Eds.), International review of leave policies and research 2018. https://www.leavenetwork.org/fileadmin/user_upload/k_leavenetwork/annual_reviews/Leave_Review_2018.pdf
Yarrow, L. J. (1964). Separation from parents during early childhood. Review of Child Development Research, 1, 89–136.
Yue, A., Sylvia, S., Bai, Y., Shi, Y., Luo, R., & Rozelle, S. (2016). The effect of maternal migration on early childhood development in rural China. SSRN Electronic Journal, December. https://doi.org/10.2139/ssrn.2890108
Zahir, N., Heyman, M. B., & Wojcicki, J. M. (2013). No association between childcare and obesity at age 4 in low-income Latino children. Pediatric Obesity, 8(2), e24–e28. https://doi.org/10.1111/j.2047-6310.2012.00125.x
Zhang, B., Zhai, F. Y., Du, S. F., & Popkin, B. M. (2014). The China Health and Nutrition Survey, 1989–2011. Obesity Reviews, 15(S1), 2–7. https://doi.org/10.1111/obr.12119
Zhang, C. (2015). Parents, grandparents and nanny the new care triangle in urban China among families with infants. Harvard Graduate School of Education.
Zhang, J., Emery, T., & Dykstra, P. (2020). Grandparenthood in China and Western Europe: An analysis of CHARLS and SHARE. Advances in Life Course Research, 45(September), 100257. https://doi.org/10.1016/j.alcr.2018.11.003
Zhang, N., & Ma, G. (2018). Childhood obesity in China: Trends, risk factors, policies and actions. Global Health Journal, 2(1), 1–13. https://doi.org/10.1016/s2414-6447(19)30115-0
Zhou, C., Sylvia, S., Zhang, L., Luo, R., Yi, H., Liu, C., Shi, Y., Loyalka, P., Chu, J., Medina, A., & Rozelle, S. (2015). China’s left-behind children: Impact of parental migration on health, nutrition, and educational outcomes. Health Affairs, 34(11), 1964–1971. https://doi.org/10.1377/hlthaff.2015.0150
Zong, X. N., Li, H., Zhang, Y. Q., & Wu, H. H. (2019). Child nutrition to new stage in China: Evidence from a series of national surveys, 1985–2015. BMC Public Health, 19(1), 1–13. https://doi.org/10.1186/s12889-019-6699-z
Acknowledgements
The authors thank the public dataset—China Health and Nutrition Survey (CHNS, the National Institute for Nutrition and Health, China Center for Disease Control and Prevention, Carolina Population Center (P2C HD050924, T32 HD007168), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700) and the NIH Fogarty International Center (D43 TW009077, D43 TW007709) financially supported for the CHNS data collection and analysis files from 1989 to 2015 and future surveys, and the China-Japan Friendship Hospital, Ministry of Health supported for CHNS 2009, Chinese National Human Genome Center at Shanghai since 2009, and Beijing Municipal Center for Disease Prevention and Control since 2011.
Professor Huanmin Peng’s work is supported by the Ministry of Education of China [grant number: 19JHQ011]. Jing Zhang and Tom Emery’s research is supported by the Netherlands Research Council NOW [grant number 467-14-152]. Jing Zhang and Zongye Cai acknowledge financial support from the China Scholarship Council (CSC).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors have no conflict of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Zhang, J., Cai, Z., Peng, H. et al. Early Childhood Care Trends and Associations with Child Health Well-being in China: Evidence from the CHNS 1991 to 2011 Data. Applied Research Quality Life 17, 2789–2807 (2022). https://doi.org/10.1007/s11482-021-09996-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11482-021-09996-6