The role of grandparents as providers of food to their grandchildren

The Influence of Grandparents on Children's Dietary Health: A Narrative Review

PURPOSE OF REVIEW

To examine and synthesise recent evidence on the role of grandparents in shaping children's dietary health.

RECENT FINDINGS

The influence of grandparents on children's dietary health was evident across studies. Grandparents frequently provide their grandchildren with meals and snacks, and engage in many of the same feeding practices used by parents. Although grandparents report providing their grandchildren with healthy foods, the provision of treat foods high in sugar or fat was a common finding. This provision led to family conflict, with the indulgent behaviours of grandparents seen by parents as a barrier to healthy eating. Grandparents are exerting significant influence on child dietary health. Efforts are needed to ensure these care providers are considered key stakeholders in the promotion of healthy eating and are targeted in policies and programs addressing children's diets. Research that determines how to best support grandparents to foster healthy behaviours in children is critical.

Investigating the efficacy and feasibility of using a whole-of-diet approach to lower circulating levels of C-reactive protein in postmenopausal women: a mixed methods pilot study

OBJECTIVE

Chronic inflammation is associated with obesity and is an underlying pathophysiology for cardiovascular disease (CVD) development in postmenopausal women. This study aims to determine feasibility and efficacy of an anti-inflammatory dietary intervention to lower levels of C-reactive protein in weight stable postmenopausal women with abdominal obesity.

METHODS

This mixed-methods pilot study used a single arm pre-post design. Thirteen women followed a 4-week anti-inflammatory, dietary intervention, optimizing consumption of healthy fats, low glycemic index wholegrains, and dietary antioxidants. Quantitative outcomes included change in inflammatory and metabolic markers. Focus groups were undertaken and thematically analyzed to explore participants lived experience of following the diet.

RESULTS

There was no significant change in plasma high-sensitivity C-reactive, protein. Despite discouraging weight loss, median (Q1-Q3) body weight decreased by -0.7 (-1.3 to 0 kg, P = 0.02). This was accompanied by reductions in plasma insulin (0.90 [-0.05 to 2.20] mmol/L), Homeostatic Model Assessment of Insulin Resistance (0.29 [-0.03 to 0.59]), and low-density lipoprotein:high-density lipoprotein ratio (0.18 [-0.01 to 0.40]) ( P ≤ 0.023 for all). Thematic analysis revealed that postmenopausal women have a desire to improve meaningful markers of health status that do not focus on weight. Women were highly engaged with learning about emerging and innovative nutrition topics, favoring a detailed and comprehensive nutrition education style that challenged their proficient health literacy and cooking skills.

CONCLUSIONS

Weight-neutral dietary interventions targeting inflammation can improve metabolic markers and may be a viable strategy for CVD risk reduction in postmenopausal women. To determine effects on inflammatory status, a fully powered and longer-term randomized controlled trial is required.

Exploring grandparents' receptivity to and preferences for a grandchild nutrition-focused intervention: A qualitative study

OBJECTIVE

Interventions promoting healthy eating in children typically overlook the critical role of grandparent caregivers. Utilising a co-design approach, this study (i) assessed the receptiveness of grandparents to a nutrition-focused resource aimed at promoting healthy eating in their grandchildren and (ii) explored grandparents' preferences for resource delivery and dissemination.

METHODS

Seventy-nine grandparents (58% female; mean age=69.37 years) who were secondary carers to a grandchild aged 3-12 years participated in one of 10 focus groups. Focus group transcripts were imported into NVivo for coding and semantic thematic analysis.

RESULTS

The vast majority of focus groups (n=9) were receptive to receiving a nutrition-focused resource. Participants indicated that such a resource should contain strategies that help grandparents promote healthy eating in their grandchildren rather than outline what grandchildren should be fed. A range of delivery (pamphlets, seminars and fridge magnets) and dissemination (online, email) methods were suggested.

CONCLUSIONS

A nutrition resource that equips grandparents with the strategies they need to promote healthy eating in their grandchildren would likely be welcomed.

IMPLICATIONS FOR PUBLIC HEALTH

Results provide program developers with the preliminary information required to tailor childhood lifestyle interventions to the needs of grandparents, thus helping increase acceptability and uptake.

The effects of received grandmothers' affection on adult grandchildren's health behaviors using affection exchange theory

BACKGROUND

Affection exchange theory (AET) explains the value of received affection for overall wellbeing in family relationships. However, this study extends prior work by investigating AET in grandmother-grandchild relationships and grandchildren's individual well-being. This study seeks to understand the relationships between adult grandchildren's received grandmother affection and health-related behaviors such as diet, exercise, substance abuse, and sleep.

METHODS

This cross-sectional study included 229 university student participants. Multiple regression analyses were performed to analyze received grandmother affection and grandchildren's health behaviors.

RESULTS

Using cross-sectional survey methods, it was found that grandchildren's reports of received memories and humor, and celebratory affection influenced grandchildren's dietary behaviors. Received love and esteem, memories and humor, and celebratory affection was also associated with grandchildren's exercise behaviors.

CONCLUSIONS

Grandchildren who receive grandmother affection may be likely to engage in the well-being process by engaging in health behaviors, while those who are not receiving affection might suffer the health consequences in adulthood. These findings support the assumption of affection exchange theory that received family affection, in this case, grandmother affection leads to positive health outcomes such as enhanced dietary and exercise behaviors among grandchildren.

Stunting among kindergarten children in China in the context of COVID-19: A cross-sectional study

BACKGROUND

The impact of COVID-19 has most likely increased the prevalence of stunting. The study aimed to determine the prevalence of stunting among kindergarten children in the context of coronavirus disease 2019 (COVID-19) in Longgang District, Shenzhen, China, and its risk factors.

METHODS

A cross-sectional study was conducted to identify children from 11 sub districts of 481 kindergartens in the Longgang District of Shenzhen City from May to July 2021. In the context of COVID-19, an online survey was conducted to gather demographic information, height, birth information, and lifestyle. The prevalence of stunting was calculated, and the risk factors were analyzed using binary logistic regression with three stepwise models.

RESULTS

A total of 118,404 subjects were included from May to July 2021, with a response and questionnaire effective rates of 85.75% and 95.03%, respectively. The prevalence of stunting and severe stunting were 3.3% and 0.8%, respectively. Model 3 showed that risk factors for stunting were male sex [odds ratio (OR) = 1.07], low birth weight (OR = 2.02), insufficient sleep time (OR = 1.08), less food intake than their peers (OR = 1.66), slower eating than their peers (OR = 1.16), accompanied by grandparents alone or non-lineal relatives (reference: parents accompanying) (OR = 1.23, 1.51), and children induced to eat (OR = 1.17). Protective factors included only-child status (OR = 0.66), reported high activity (OR = 0.37, 0.26, 0.23), parents with high education levels (father: OR = 0.87, 0.69; mother: OR = 0.69, 0.58), high monthly income per capita of the family (OR = 0.88, 0.74, 0.68), and allowing children to make food choices (OR = 0.82).

CONCLUSION

The stunting rate of children in kindergartens in Longgang District is 3.3%, close to the level of developed countries but higher than the average level of developed cities in China. The relatively high stunting rate in children under 3 years old in 2021 may be associated with the influence of COVID-19. Appropriate policies should be formulated for individuals and families with children to help children establish good living habits and reduce stunting.

[Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile]

Objetivo

Explorar las influencias de integrantes del grupo familiar en las prácticas de alimentación de madres hacia preescolares, en familias de barrios vulnerables en la Región Metropolitana de Santiago, Chile.

Diseño

Estudio cualitativo.

Lugar

Nueve jardines infantiles de la Región Metropolitana, Santiago, Chile.

Participantes

Veinticuatro madres y un padre de hijos preescolares.

Método

Se realizaron 25 entrevistas semiestructuradas con técnica de foto-elicitación y su posterior análisis temático inductivo de las influencias familiares.

Resultados

Las participantes describieron que las influencias familiares sobre las prácticas de alimentación que aplicaban en sus hijos preescolares dependían de la estructura familiar y de la cercanía entre familiares. Algunas de estas influencias afectan directamente la conducta alimentaria del niño, especialmente en familiares que cohabitan juntos, mientras que otras estaban mediadas por las relaciones generadas entre padres y otros miembros de la familia. El padre, en familias biparentales, y abuelos del preescolar son los familiares más influyentes. Los padres participan en la alimentación del niño y generalmente se alinean a las prácticas de alimentación con la madre. Los abuelos enriquecen la experiencia alimentaria de preescolares ofreciendo preparaciones caseras, expresando afecto con los alimentos, incluso opciones poco saludables, y apoyando a padres a diversificar y estructurar la alimentación del niño.

Conclusiones

El impacto de familiares y sus dinámicas en las prácticas alimentarias parentales y la alimentación de preescolares varían según la cercanía o cohabitación entre familiares. El desarrollo de estrategias de prevención y tratamiento de obesidad infantil debería considerar un enfoque familiar en familias vulnerables.

Grandparental dietary provision, feeding practices and feeding styles when caring for preschool-aged grandchildren: A systematic mixed methods review

Grandparents are frequently relied upon to care for their preschool-aged grandchildren. These early years are a crucial age in the development of dietary habits and preferences. This review aims to determine grandparental dietary provision, feeding practices and feeding styles when caring for their preschool-aged grandchildren. Medline, PsycInfo and Web of Science were searched in January 2020. A systematic mixed methods approach was used to synthesize the qualitative (n = 13) and quantitative (n = 7) articles describing grandparents' feeding styles (n = 9), feeding practices (n = 14) and dietary provision (n = 18). Grandparents are serving large portion sizes and encouraging their grandchildren to eat frequently. Results are mixed for the types of foods provided; grandparents provide discretionary foods high in sugar and fat, and some also choose more expensive core foods as treats (e.g., berries). Grandparents engage in feeding practices that promote healthy eating (e.g., creating a healthy feeding environment) and promote autonomy and independence (e.g., considering their grandchild's preferences). However, they also use some coercive feeding practices (e.g., using food as a reward) and may be using indulgent feeding styles, which can be conducive to obesogenic dietary intakes. Interventions targeting grandparents could be an effective way to improve dietary-related health outcomes in young children.

Fulfilling food practices: Applying the capability approach to ethnographic research in the Northern Netherlands

Often, food practices are evaluated in terms of their healthiness or lack thereof, but fulfilling food practices based on other values and influenced by family members' capabilities are overlooked. This study analyses food practices in families with low socio-economic status, and aims to explain how family households come to prioritise one food practice over another. We conducted an ethnographic study using the capability approach as an analytical framework. In-depth interviews and observations concerning food patterns and health-related choices with family members from three generations were analysed. Two dimensions of fulfilling food practices which emerged from our study are having a healthy as well as harmonious meal. The families under study tended to prioritise having harmonious meals over having healthy meals, despite the attempts by mothers to serve healthy meals. This choice can be understood from the perspective of capabilities, such as being able to enjoy meals, eating what everybody else eats in the region, avoiding conflicts, creating good relationships with children and serving and organising meals with ease. Within the cultural environment, there prevailed a tendency not to care too much about nutritional outcomes, which also supported the preference for harmonious over healthy meals. In the decision about whether to have a healthy or a harmonious meal, children's agency often outweighed the voices of parents and grandparents. The capability approach helped unravel the complexity of family food practices and the role of intergenerational family dynamics in a setting of low socio-economic status. Acknowledging the multi-dimensional nature of food practices, and including dimensions beyond the food domain, such as harmony at the dinner table, contribute to a better understanding of this complexity. It also helps to shed new light on opportunity deprivation in households, for example in relation to agency, which should be accounted for in health interventions.

Grandparents' perceptions of the barriers and strategies to providing their grandchildren with a healthy diet: A qualitative study

Grandparents are playing an increasingly important role in shaping their grandchildren's nutritional environment. Evidence-based interventions tailored to grandparents thus constitute a potential means of promoting healthy eating among children. For such interventions to be effective, they must account for the unique issues encountered by grandparents. However, research examining the potential needs of grandparents is limited. The present study thus explored (i) grandparents' perceptions of the barriers to providing their grandchildren with healthy food and minimizing consumption of unhealthy food and (ii) the strategies grandparents believe help increase their grandchildren's consumption of healthy food and reduce intake of unhealthy food. Seventy-nine grandparents, each of whom provided care to at least one grandchild aged 3-12 years, participated in one of ten focus groups. Transcripts from each of the groups were imported into NVivo for qualitative coding and semantic thematic analysis. The food preferences of their grandchildren, the promotion of unhealthy food consumption by their grandchildren's parents, advertising of unhealthy food, and peer pressure were the most frequently cited barriers to healthy food consumption. Grandparents reported using multiple strategies to increase their grandchildren's fruit and vegetable consumption and minimize unhealthy food intake. The most common were disguising vegetables, making fruit and vegetables appealing, managing child eating (e.g., limiting access to unhealthy food), saying no to requests for unhealthy food, involving grandchildren in meal planning and cooking, and using rewards. Findings suggest that grandparents may need support with managing food preferences and navigating and negotiating complex relations with parents regarding child feeding.

Nutrition and oral health in early childhood: associations with formal and informal childcare

OBJECTIVE

To examine associations between childcare type and nutrition and oral health indicators.

DESIGN

Cross-sectional data extracted from a longitudinal birth cohort. Parent-completed FFQ and questions regarding oral health and childcare use. The associations between childcare type, classified into four groups: parent care only (PCO), formal childcare only (FCO), informal childcare only (ICO) or combination of care (F&I), and nutrition and oral health indicators were examined.

SETTING

Home and childcare.

PARTICIPANTS

Families with children aged 3 years (n 273) and 4 years (n 249) in Victoria, Australia.

RESULTS

No associations were observed between childcare type and core food/beverage consumption or oral health indicators. For discretionary beverages, compared with children receiving PCO at age 3 years, children in FCO or F&I were less likely to frequently consume fruit juice/drinks (FCO: adjusted OR (AOR) 0·41, 95 % CI 0·17, 0·96, P = 0·04; F&I: AOR 0·32, 95 % CI 0·14, 0·74, P = 0·008). At age 4 years, children receiving FCO or ICO were less likely to consume sweet beverages frequently compared with children receiving PCO: fruit juice/drink (ICO: AOR 0·42, 95 % CI 0·19, 0·94, P = 0·03; FCO: AOR 0·35, 95 % CI 0·14, 0·88, P = 0·03) and soft drink (ICO: AOR 0·23, 95 % CI 0·07, 0·74, P = 0·01; FCO: AOR 0·14, 95 % CI 0·03, 0·76, P = 0·02).

CONCLUSIONS

Associations between childcare type and discretionary beverage intake were observed. Investigation into knowledge, attitudes and activities in formal and informal childcare settings is required to explore different health promotion practices that may influence nutrition and oral health.

Early Child Care and Weight Status in a Cohort of Predominantly Black Infants in the Southeastern United States

Background: Previous studies show inconsistent relations between child care and obesity, but few assessed longitudinal associations during infancy and even fewer included racially diverse children. We examined associations of time infants spent in child care, both overall and in different types of care, with weight status at 6 and 12 months. Methods: We examined 664 infants living in central North Carolina. We conducted adjusted multivariable linear regressions examining (1) child care from birth to 6 months and 6-month weight-for-length (WFL) z-score, and (2) child care from birth to 12 months and 12-month WFL z-score. We assessed any child care and child care by type, including relative care, informal care by a nonrelative, formal child care, and a combination of care (e.g., relative and informal care). Results: Nearly 70% of infants were black and 49% were female. After adjustment for potential confounders, any child care was not associated with WFL z-score at 6 months (0.07; 95% confidence intervals [CI] -0.02 to 0.16; p = 0.13) or 12 months (0.05; 95% CI -0.02 to 0.12; p = 0.19). However, greater combination care was associated with higher WFL z-score at 6 months (0.68; 95% CI 0.23-1.13; p = 0.003) and greater care by a relative was associated with higher WFL z-score at 12 months (0.16; 95% CI 0.05-0.26; p = 0.005). Conclusions: Although we did not observe associations with any child care, combination care and relative care during infancy were associated with higher weight. Interventions aimed at preventing excessive weight gain in early life may target relatives who provide regular care for infants.

Obesity and Stunting in Childhood. Do Grandparents Play A Role? A Systematic Review

Introduction: Obesity and stunting in childhood has become one of the greatest global health challenges. The impact of this issue is serious and lasting for individuals, their families, communities and countries. Most of the studies on child weight status have only focused on the mother as the primary caregiver, whereas the role and influence of the grandparents has received less attention. Grandparent-provided child care has become a trend in many countries, with reported rates of approximately 40% to 58%. The objective of this systematic review was to analyze whether children become stunted or obese when they are cared for by their grandparents.Methods: The methodological search of the literature was conducted using Scopus, Science Direct, PubMed, Pro Quest and ResearchGate, and it was undertaken using PRISMA guidelines. The search identified 1803 papers and 135 full-text articles were screened for eligibility. Finally, 15 met the inclusion criteria. The keyword chain was as follows: ("obesity" OR "stunting") AND (“children”) AND (“grandparents”).Results: As grandparents take on increasingly responsible roles in the lives of their grandchildren, there is an influence on the higher risk of child obesity rather than stunting.Conclusion: In future, nurses should target not only the mother but also the grandparents to control their child’s health, especially when related to their weight status.

Factors influencing sweet drink consumption among preschool-age children: A qualitative analysis

ISSUE ADDRESSED

Consumption of high sugar foods and drinks are key risk factors for childhood obesity and dental decay. Sweet drinks are the single greatest contributor to the free sugars consumed by Australian children. Little is known about the factors influencing consumption of sweet drinks, particularly among preschool-age children.

METHODS

Focus groups and semi-structured interviews conducted with parents and grandparents (n = 25) residing in different socio-economic areas across metropolitan and regional Victoria, Australia. Thematic analysis identified the factors influencing sweet drink consumption, which were then aligned with the socio-ecological model.

RESULTS

At an individual level, health knowledge, health beliefs, and parenting skills and confidence influenced drink choices. At the social level, peer and family influence, and social and cultural norms emerged as influential. At the environmental level, sweet drink availability, targeted marketing, drink prices and settings-based policies influenced drink choices. Strategies identified by participants to support healthier drink choices included health education at the individual level; positive role modelling at the social level; and restricting unhealthy marketing, improved access to water, decreased availability of sweet drinks and price modification at the environmental level.

CONCLUSION

Sweet drink consumption among preschool-age children is influenced by multiple factors across all domains of the socio-ecological model. Parents and grandparents are calling for education, healthy environments and supportive policies. SO WHAT?: In contrast to common rhetoric, children's sweet drink consumption is often influenced by factors beyond parental control. A multi-component strategy is required to support parents and grandparents in their efforts to make healthy choices for their children.