International Perspectives on Grandparents Raising Grandchildren: Contextual Considerations for Advancing Global Discourse

Longitudinal Correlates of Grandparenting with Depressive Symptoms and Poor Sleep Quality Among Middle-Aged and Older Women and Men in South Africa

OBJECTIVES

The study aimed to assess the impact of grandparenting on incident depressive symptoms and incident poor sleep quality among aging women and men in rural South Africa.

METHODS

This longitudinal community study enrolled 3,237 adults (≥40 years) from the "Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)."

MEASUREMENTS

Grandparenting was assessed by self-report at wave 1, and depressive symptoms and poor sleep quality at waves 1 and 2. Outcomes were incident depressive symptoms and incident poor sleep quality at wave 2. Logistic regression was utilized to estimate the associations between grandparenting and incident depressive symptoms and incident poor sleep quality.

RESULTS

Almost half of the grandfathers (44.6%) and 68.4% of the grandmothers were parenting 7/days/week. In the final adjusted models, among grandmothers, compared to 0 days/week grandparenting, 7 days/week grandparenting reduced the odds of incident depressive symptoms (AOR: 0.71, 95% CI: 0.55 to 0.91) and reduced the odds of incident poor sleep quality (AOR: 0.58, 95% CI: 0.40 to 0.82).

CONCLUSION

Grandparenting significantly reduced poor mental health among grandmothers but not among grandfathers.

CLINICAL IMPLICATIONS

Practitioners may encourage grandparent caregiving, among grandmothers, to reduce poor mental health in South Africa.

Research Review: Grandparental care and child mental health - a systematic review and meta-analysis

BACKGROUND

The number of children residing in grandfamilies is growing worldwide, leading to more research attention on grandparental care over the past decades. Grandparental care can influence child well-being in various forms and the effects vary across contexts. In this systematic review and meta-analysis, we synthesize the evidence on the relation between grandparental care and children's mental health status.

METHODS

We identified 5,745 records from seven databases, among which 38 articles were included for review. Random effects meta-analyses were used to synthesize evidence from eligible studies. We also examined the variability across study and participant characteristics, including study design, recruitment method, child age, child gender, study region, family type, comparison group, and outcome rater.

RESULTS

The meta-analysis consisted of 344,860 children from the included studies, whose average age was 10.29, and of which 51.39% were female. Compared with their counterparts, children being cared for by their grandparents had worse mental health status, including more internalizing problems (d = -0.20, 95% CI [-0.31, -0.09], p = .001), externalizing problems (d = -0.11, 95% CI [-0.21, -0.01], p = .03), overall mental problems (d = -0.37, 95% CI [-0.70, -0.04], p = .03), and poorer socioemotional well-being (d = -0.26, 95% CI [-0.49, -0.03], p = .03). The effects varied by study design and child gender.

CONCLUSIONS

The findings highlight that grandparental care is negatively associated with child mental health outcomes with trivial-to-small effect sizes. More supportive programs and interventions should be delivered to grandfamilies, especially in disadvantaged communities.

Continuity in Socialization Styles: Typologies of Socialization in the Different Life Stages of Older People

The purpose of this research was to identify the socialization styles of the older person (such as authoritative, indulgent, authoritarian, and negligent) in three different roles: (1) nowadays as a grandparent, (2) considering the style used to educate their own children in the past; and (3), considering the socialization style they received when they were children. The sample (317 people over 65 years old with at least one grandchild aged up to 16 years old participated) received the questionnaire on socialization styles in those roles. The results showed the predominance of the indulgent style in their role as grandparents. Almost 80% showed intergenerational continuity between at least two roles, with the exception of those with a neglectful style. Continuity in socialization style is crucial to understanding the dynamics within family relationships, which have highly durable intergenerational ties.

Feasibility and Acceptability of an ABCD Program for Child Development Among Skipped Families in Rural Thailand: A Pilot Study

Introduction

The study aimed to develop and examine the aesthetic, bedtime story, connecting with nature, and drawing (ABCD), community based, program for grandparents to help them promote their grandchildren's development.

Methods

The action research was conducted in two phases. In the first phase, semi-structured interviews and focus group discussions were utilized to gather information from healthcare providers, teachers, and community leaders to develop the ABCD program. This was followed by a critical evaluation of the program's activities, materials, and contents. The second phase was to examine the program's effectiveness. A one-group pretest-posttest design was used to study the effectiveness of the program among 20 dyads of grandparents and grandchildren.

Results

All grandparents attended and completed the program. The grandparents' knowledge increased significantly (p = 0.024), and satisfaction with the program was high (X = 9, SD = 0.93) while children's development was not statistically different (p = 0.317).

Conclusion

The ABCD program was found to be feasible and acceptable to grandparents of skipped families to promote their grandchildren's development. The importance of healthcare providers, teachers, and community leaders in providing ABCD programs must also be recognized.

"Health Outcomes of Grandparents Caring for Double Orphans in South Africa": What Are the Determinants?

In the 21st century, grandparenthood is a significant phenomenon in the fields of demography, gerontology, and sociology. It is mainly explored in the context of ageing, as it is poised to become one of the most significant demographic phenomena and social issues in contemporary South Africa. Therefore, this study examined the determinants associated with grandparents who are parenting as caregivers and the health challenges they are exposed to as caregivers. The National Income Dynamics Study (NIDS) Wave 5 dataset was utilised, and a total of 302,476 grandparents aged 25 years and older, who were reported to be primary caregivers of double orphans, were included in the analysis. Both bivariate and multivariate binary logistic regressions were performed to determine the predictors of the determinants of grandparents parenting as caregivers and their health challenges in South Africa. Estimated odds ratios (ORs) with 95% confidence intervals (CIs) were used, and the threshold for statistical significance was established at ρ < 0.05. A majority of the male and female grandparent caregivers were aged 24-34 years, were Black Africans (69.8%), had secondary education (46.9%), reported health challenges (HC) (59.7%), with 26.4% reporting headaches in the last 30 days. Logistic regression revealed that grandparent caregivers aged 55-64 years were 8.9 times more likely to report health challenges compared to those aged 25-34 years. Non-Black African grandparent caregivers were found to be 0.61 times less likely to report health challenges, compared to Black African grandparent caregivers. Those with perceived poor health status were 3.3 times more likely to report health challenges, compared to those with excellent perceived health status. Therefore, there is an urgent need to redesign health interventions to address these health burdens among grandparent caregivers and to take cognisance of providing economic and social support for these vulnerable populations.

Influence of different caregiving styles on fundamental movement skills among children

Purpose

This study investigated the influence of parenting and grandparenting caregiving styles on fundamental motor skills (FMS) of preschool children.

Method

A total of 1,326 preschool children (698 boys, 628 girls) aged 4-6 years were recruited from the kindergartens of Jinhua City, China. Locomotor skills (LM), ball skills (BS), and total fundamental movement skills (TS) of children were assessed by the Test of Gross Motor Development-3rd edition (TGMD-3).

Results

There were 978 children in parenting and 348 children in grandparenting caregiving styles. The LM, BS and TS scores of children were considerably (p < 0.001) increased with age (irrespective of sex or caregiving style). For the sex comparisons, BS scores of boys were significantly higher than girls (p < 0.001), while LM and TS scores were not different between boys and girls. For the caregiving style comparison, parenting is superior to grandparenting in developing of children's FMS. Parenting boys of 4-, 5-, and 6-years old showed better BS compared to age-matched parenting girls, whereas boys of 5-years old in grandparenting only showed better BS compared to same-age grandparenting girls (p < 0.05). Furthermore, parenting boys of 6-years reported higher LM (p < 0.01), BS (p < 0.001), and TS (p < 0.001) scores compared to grandparenting boys, but girls' FMS at all ages were not significantly different between the caregiving styles.

Conclusion

Parenting caregiving style is positively associated with proper development of FMS among children. Girl children with poor FMS in grandparenting may need a special care or intervention programs to promote their FMS.

Who cares? The grandmother kinship carers shouldering the burden within a gendered care economy

It is estimated that around half of all kinship carers in the UK are grandparents. International studies show that when broken down by gender, these carers are predominantly grandmothers. However, there is little research exploring the gender dimensions of kinship carers' experiences. Drawing on data from qualitative interviews with 27 grandparent kinship carers, this article highlights the gendered context in which the grandparents we spoke to found themselves. The grandparents - the majority of whom were grandmothers - described lives filled with multiple unpaid caring commitments and demands. We discuss the ways that gender norms, roles and stereotypes, alongside economic models and policies that invisiblise women's care work, shaped the experiences of the grandmothers who took part in our research. We argue that, despite their undeniable determination and commitment to love, nurture and care for their grandchildren in very difficult circumstances, and the money they are saving the state in doing so, grandmother kinship carers are penalized in multiple ways. Economically, emotionally, socially, physically and practically, grandmother kinship carers are unsupported and undervalued. We need a social, economic and cultural shift around the value of care and a redistribution of care work across genders. The situations of grandmother kinship carers need to be part of this shift, so that grandmothers who care for their grandchildren are no longer penalized, and all kinship carers are properly supported and valued.

Family quality of life and children with disability in Ethiopia: The role of support providers

Background

Family quality of life (FQOL) is an important outcome for families of children with disabilities globally and provision of support is associated with enhanced FQOL. However, FQOL research primarily focuses on conceptualisation and measurement, and originates from high-income contexts despite the fact that most children with disabilities live in low-income countries.

Objectives

The authors examined how Ethiopian disability support providers practically contribute to meeting the needs of families of children with disabilities to enhance FQOL.

Method

Building on a previous study exploring Ethiopian families' perspectives on FQOL, the authors used an exploratory descriptive qualitative approach to interview various support providers. Interviews were conducted virtually (because of the coronavirus disease 2019 [COVID-19] pandemic) in English or with interpreting assistance. Audio-recorded interviews were transcribed verbatim and analysed thematically.

Results

Support providers affirmed what families had described as important for FQOL - spirituality, relationships, self-sufficiency - and recognised their enormous support needs. They described various ways to support families - emotionally, physically, materially and informationally. They also expressed challenges and their need for support to meet families' needs.

Conclusion

Ethiopian families of children with disabilities need holistic support that incorporates spirituality, the whole family's needs and disability awareness-raising. Collaborative and committed engagement from all stakeholders is necessary to support Ethiopian families to flourish.

Contribution

This study contributes to global understandings of FQOL and describes practical approaches to support families of children with disabilities in an African context. The findings of this study highlight the influence of spirituality, relationships, self-sufficiency, poverty and stigma and the need for holistic support and disability awareness-raising to enhance FQOL.

Mental/behavioural health and educational outcomes of grandchildren raised by custodial grandparents: A mixed methods systematic review

Grandparents caring for grandchildren has increased globally in the past two decades, but we have a limited understanding of its effects on custodial grandchildren's mental/behavioural health and educational outcomes. This mixed methods systematic review aims to synthesise mental/behavioural health and educational outcomes of custodial grandchildren within custodial grandparent-headed families and with comparison to other types of household structure and further examine factors associated with these outcomes. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched ERIC, Family Studies Abstracts, PsycINFO, PubMed, Scopus, Social Work Abstract and SocINDEX in March 2021 and screened 14,515 articles, which resulted in the inclusion of 42 studies, including 33 quantitative, seven qualitative and two mixed methods studies. The quality of included studies was assessed. This review covered 10 countries, yet most studies revealed that grandchildren raised by grandparents had adverse mental/behavioural health and educational outcomes compared to their peers raised by biological parents. This review further identified multi-level factors contributing to custodial grandchildren's adverse outcomes. Methodological limitations and implications for future practice and research were discussed.

Child-parent relationship during the Wuhan COVID-19 lockdown: Role of changes in preschool children's daily routines

Objective

We examined the impact of the strict lockdown on 130 preschool-age children's daily routines and how their routine changes from pre-lockdown were related to child-parent relationship quality during the lockdown.

Background

To contain the spread of the COVID-19, the city of Wuhan underwent a strict 76-day lockdown, during which children's routines were drastically altered, yet families did not have a frame of reference to use to determine how changes in children's routines would be related to their family dynamics.

Method

Parents provided survey data on the amount of time their children spent daily on learning, screen devices, play and exercise, and nighttime sleep before, during, and after the lockdown. The also described general family functioning, child-parent closeness, and child-parent conflict during the lockdown.

Results

The lockdown led to changes in all four routines, but all returned to pre-lockdown level after the lockdown was lifted. Regression analyses showed that decrease in play and exercise time was related to less child-parent closeness, and decrease in learning time and increase in nighttime sleep time were related to more child-parent conflict.

Conclusion

Findings suggested changes in the children's play and exercise time, learning time, and nighttime sleep time were related to negative child-parent relationship (i.e., less closeness or more conflict), but favorable general functioning was a protective factor.

Implications

Our study highlighted family resilience in restoring the children's routines after the lockdown, as well as family vulnerability during the lockdown, as changes in three of the four routines examined were linked to negative child-parent relationship.

A qualitative study on the perspectives of Turkish mothers and grandmothers in the Netherlands regarding the influence of grandmothers on health related practices in the first 1000 days of a child's life

BACKGROUND

Given the importance of the first 1000 days of a child's life in terms of laying the foundations for healthy growth and development, parents are a logical target group for supporting health-related practices with regard to young children. However, little attention is paid to the influence of the wider social community on the health and development of young children during this crucial period. This includes grandmothers, who often have a significant influence on health-related practices of their grandchildren. The aim of this study was therefore to explore the influence of grandmothers on health related practices of their grandchildren during the first 1000 days, from the perspectives of both grandmothers and mothers with a Turkish background.

METHOD

This qualitative study in the Netherlands collected data during focus group discussions with grandmothers (N = 3), interviews with grandmothers (N = 18) and interviews with mothers (N = 16), all with a Turkish background. Data was collected in the period between June 2019 and April 2021 and analysed using a thematic content analysis.

RESULTS

The influence of grandmothers and the wider social community on health related practices during the first 1000 days of a child's life is substantial and self-evident. The support of grandmothers is often rooted in various socio-cultural norms and practices. The mothers of young children can experience the guidance and pressure they receive from grandmothers and the wider social community as quite stressful. Conflicting views and practices tend to arise between grandmothers and mothers when a grandmother babysits. Both mothers and grandmothers often find it difficult to discuss these differences openly, for fear this might lead to a family conflict.

CONCLUSION

This study shows that grandmothers and the wider social community play an influential role in supporting a healthy first 1000 days of a child's life. The strong involvement of grandmothers may lead to tension between the mothers and grandmothers when their ideas about healthy practices are not in agreement and may lead to unhealthy practices. In targeting this wider social community, it is important to consider the various socio-cultural factors that underlie the advice, support, practices and beliefs of the individuals involved.

Between familism and neoliberalism: the case of Jewish Israeli grandmothers

In this article, we employ grandmothers’ childcare as a lens to explore the changing relations between familism, individualism and neoliberalism. More generally, we examine the connections between the political economy and the intimate moral economy of childcare work performed by grandmothers. Based on semi-structured in-depth interviews with twenty retired women in Israel, we examine how they negotiate, comply and resist the expectations that they will help ‘fill in’ the ‘care deficit’ resulting from neoliberal policies and labour market practices. We show how grandmothers navigate between family ideologies and individualistic cultural imperatives, constituting themselves as agentive subjects who can determine the conditions in which they meet their families’ care expectations while challenging the invisibility of their work. Thus, using Israel as a case study, we argue that familism and individualism, working against each other as well as together, create tensions while mediating the political economy and the intimate moral economy based on the love, commitment and ideology of the ‘good mother’. More broadly, we assert that neoliberalism strengthens family and familism and, at the same time, familism facilitates the neoliberal labour market and economy while also freeing the state from having to support families with children.

Understanding older peoples' chronic disease self-management practices and challenges in the context of grandchildren caregiving: A qualitative study in rural KwaZulu-Natal, South Africa

While chronic diseases are amongst the major health burdens of older South Africans, the responsibilities of caring for grandchildren, by mostly grandmothers, may further affect older people's health and well-being. There is a paucity of information about chronic disease self-management for older people in the context of grandchildren caregiving in sub-Saharan Africa. Guided by the Self-Management Framework, the purpose of this qualitative methods study was to explore the chronic disease self-management practices and challenges of grandparent caregivers in rural KwaZulu-Natal, South Africa. Eighteen repeat in-depth interviews were carried out with six grandparent caregivers aged 56 to 80 years over 12 months. Thematic analysis was conducted based on the Self-Management Framework. Pathways into self-management of chronic illnesses were identified: living with a chronic illness, focusing on illness needs, and activating resources. Self-perceptions of caregiving dictated that grandmothers, as women, have the responsibility of caring for grandchildren when they themselves needed care, lived in poverty, and with chronic illnesses that require self-management. However, despite the hardship, the gendered role of caring for grandchildren brought meaning to the grandmothers' lives and supported self-management due to the reciprocal relationship with grandchildren, although chronic illness self-management was complicated where relationships between grandmothers and grandchildren were estranged. The study findings demonstrate that grandchildren caregiving and self-management of chronic conditions are inextricably linked. Optimal self-management of chronic diseases must be seen within a larger context that simultaneously addresses chronic diseases, while paying attention to the intersection of socio-cultural factors with self-management.

Grandparents caring for grandchildren in rural China: consequences for emotional and cognitive health in later life

In rural China, where families serve as critical safety-nets for their vulnerable members, grandparents play an essential role caring for the offspring of their migrant children. Evidence is mixed as to whether caring for grandchildren provides health benefits or incurs health risks. In this article, we used six waves of data from a study in rural China to examine the impact of caregiving for grandchildren on grandparents' emotional and cognitive health. Further, we examined financial transfers from adult children as a resource that potentially moderates the impact of high intensity caregiving on these outcomes. Data derived from six waves (2001-2015) of the Longitudinal Study of Older Adults in Anhui Province, China. We constructed 2,835 person-interval observations derived from 1,067 grandparents to examine lagged change in depressive symptoms and cognitive ability. Results show that caregiving frequency is not by itself harmful or beneficial to the emotional and cognitive health of grandparents, but it does appear to be harmful in the context of custodial care that is less economically supported by adult children. These results are discussed in terms of their relevance to intergenerational reciprocity in a filial culture, time-for-money exchange expectations, and the need for financial resources among caregiving grandparents in rural China.

Grandchild Caregiving and Cognitive Health Among Grandparents in Rural South Africa

Objectives: We investigate how caregiving for grandchildren is associated with cognitive function among rural South Africans, and whether the association differs by gender. We further investigate whether measures of physical activity or social engagement mediate this association. Methods: Data were from interviews with 3668 Black, South African grandparents in the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" study, conducted between 2014 and 2015. Results: We find that caregiving grandparents have better cognitive function than non-caregiving grandparents, and this association does not differ by grandparent gender. Although grandchild caregiving is associated with physical activity and social engagement measures, and some of these measures are associated with cognitive function, we do not find conclusive evidence of mediation. Discussion: Providing care for grandchildren may stimulate cognitive function for both grandmothers and grandfathers. Neither physical activity nor social engagement explains the association between caregiving and cognitive function.

Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study

BACKGROUND

The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation.

METHODS

We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60-84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection-fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers.

FINDINGS

Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000-1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000-1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15-50 years. Between two and five times more children had deceased fathers than deceased mothers.

INTERPRETATION

Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children.

FUNDING

UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.

Should I Do This? Factors Influencing the Decision to Raise Grandchildren Among Custodial Grandparents

BACKGROUND AND OBJECTIVES

Grandparents often step in to raise grandchildren when the middle generation is unavailable or unwilling. Although the consequences of raising grandchildren are well researched, little is known about the factors influencing grandparents' decisions to raise grandchildren. The objectives of this study were to (a) explore the factors that influence decision-making processes among grandparent caregivers, and (b) investigate the extent to which these factors reflect a multifaceted, dualistic framework.

RESEARCH DESIGN AND METHODS

Data were collected from 108 custodial grandparents who answered an open-ended question about their decision to raise grandchildren.

RESULTS

Content analyses of participants' answers yielded 15 factorial dimensions defined in terms of their negative/push or positive/pull poles, as it related to their decision to raise grandchildren. Chi-squared tests were used to examine each dimension to the extent to which elicited frequencies were differentially represented for positive versus negative poles. For 12 dimensions, the negative decisional parameters outweighed those that were positive.

DISCUSSION AND IMPLICATIONS

Grandparents report both positive and negative parameters when reflecting on their decision to raise grandchildren. These results call for further research to advance the understanding of the decision-making processes that caregiving grandparents make and the role that they may have on their experiences.

Cognitive Impairment in Grandparents: A Systematic Review

OBJECTIVE

To evaluate the relationship between grandparenting and the cognitive impairment in older persons.

METHODS

The protocol was submitted to the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD42018105849. Authors conducted a systematic review, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) recommendations. Electronic databases were accessed through august 2018: PubMed, ISI Web of Knowledge, Scopus, and EBSCOhost. Selection of records and quality appraisal were made by two reviewers, independently.

RESULTS

A total of 178 records was found, after removing duplicates. From those, 17 were considered eligible for integral text reading and eight were included: five original studies, one classic review and two editorials. From the five original studies included, four suggested a positive effect on cognition resulting from grandparenting and one suggested that there was no evidence for a causal effect. Though the boundary was not consensual, some studies suggested that a higher frequency of grandparenting has a negative impact on cognition.

CONCLUSION

Overall, studies suggested a trend towards a positive effect of grandchild care on grandparents' cognition. However, there was a significant heterogeneity between methodologies and a significant risk of bias which can hamper conclusions, indicating the need for further and more robust research.

The situation and well-being of custodial grandparents in Myanmar: Impacts of adult children's cross-border and internal migration

Custodial care for grandchildren left behind by migrant parents is an important contribution made by grandparents for their families and societies, given rising migration flows and increasing prominence of skipped-generation households in low- and middle-income countries. Yet, little is known about the scope and consequences of custodial grandparenting in developing settings. Analyzing unique data from the 2017 Myanmar Grandparents Caring for Grandchildren Survey, this study examines the extent to which the middle generation's cross-border and internal migration are associated with caregiving intensity, perception towards grandchild care, and psychological well-being among grandparents. Results suggest limited negative impacts of the middle generation's migration on the situation and well-being of grandparent caregivers. Custodial grandparents, particularly those caring for children of cross-border migrant mothers, experience heightened caregiving responsibilities and perceived difficulties in grandchild care. Nevertheless, all else equal, the middle generation's migration is not significantly associated with grandparents' psychological well-being. Remittances from migrant children and care support from non-coresident family members are found to reduce grandparents' caregiving intensity, improve caregiving perception, and lower psychological distress. In sum, findings echo Myanmar's widespread norms of grandchild care provision by grandparents and underscore mutual interdependence across generations, as evidenced in the importance of remittances from migrant children and informal care support networks in determining the well-being of Myanmar grandparents. This study extends current theoretical perspectives that emphasize custodial grandparenting either as a response to family crises or as a household strategy to facilitate middle-generation migration. Instead, our evidence suggests that, when conceptualizing custodial grandparenting practices in developing settings, it is instructive to consider not only opportunities but also challenges and ambivalent situations associated with the middle generation's diverse migration patterns.

Grandparental care and sleep disturbances in preschool children: a population-based prospective cohort study

OBJECTIVES

Sleep disturbances are common in preschoolers, and profoundly affected by parenting. Grandparents are increasingly involved in childcare and have attracted worldwide attention for their potential impacts on child well-being. However, no studies have explored child sleep health within the context of grandparental care. We aimed to explore the association between grandparents as primary caregivers and children's sleep disturbances.

METHODS

Participants included 20,324 preschoolers from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) in Shanghai, China. They were initially assessed in November 2016 and were reassessed in April 2018 and April 2019. Children's primary caregivers were collected at each survey. Sleep disturbances were assessed by the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

At baseline, 84.4% of children had global sleep disturbances (CSHQ total score >41). Compared with parents, random-effects model indicated that grandparents as primary caregivers increased the adjusted odds ratio (OR) for children's global sleep disturbances by 30% (OR [95%CI]: 1.30 [1.21, 1.40]). To the specific domains of CSHQ, two-way repeated-measures ANOVA showed significant "caregiver transition" group × wave interaction in the behavioral sleep disturbances, such as "Bedtime Resistance" (p < 0.001). At each survey, children with grandparents as primary caregivers demonstrated significant higher behavioral sleep disturbances than their counterparts with parental care.

CONCLUSIONS

Grandparental care is associated with increased sleep disturbances, particularly behavioral sleep disturbances, in preschoolers. Future studies should explore the underlying mechanisms and whether sleep programs targeting grandparents can decrease children's sleep disturbances.

Intergenerational Comparison of Food Parenting of Home Eating Behaviors of Schoolchildren

OBJECTIVE

To explore intergenerational differences on key factors of food parenting practices (FPPs) related to home eating behavior of schoolchildren.

DESIGN

In-depth interviews with social recognition theory-based semistructured interviews conducted from December 2016 to January 2017.

PARTICIPANTS

Primary caregivers of elementary schoolchildren from 23 households (16 parents, 14 grandparents) in 4 remote areas of Hualien, Taiwan.

PHENOMENON OF INTEREST

Factors related to FPPs hindering micronutrient-dense food group consumption by schoolchildren in a remote area.

SETTING

In-depth interviews were conducted at participants' houses.

ANALYSIS

Interviews were audiorecorded and transcribed verbatim. Inductive thematic analysis was performed to elicit studied phenomenon.

RESULTS

Routine family meals provided adequate staple, protein, and vegetables but inadequate whole grains, dairy, fruits, and nuts. More parents provided breakfast composed of pan-fried and semiprocessed products made of refined flour and sugary beverages. Both parents and grandparents had ambiguous nutrition concepts and inconsistent FPPs but in different aspects. They both reflected expectations for assistance from local schools for nutrition and FPPs education to shape up healthy eating behavior of children.

CONCLUSIONS AND IMPLICATIONS

Study findings pinpoint the strength and barriers of FPPs for primary caregivers. Implementing integrated nutrition education programs tailored for empowering nutrition literacy and FPPs is suggested to enhance the healthy eating behavior of schoolchildren in a remote area.

Effectiveness of healthy eating interventions among children: A quantitative systematic review

AIMS

This review aimed to evaluate the effectiveness of healthy eating interventions among normal-weight children.

DESIGN

A systematic review of randomized controlled trials.

DATA SOURCES

Seven databases were searched from the inception of each database until September 2019.

REVIEW METHODS

A systematic review of quantitative studies was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA extension for reporting a synthesis without a meta-analysis.

RESULTS

Fifteen studies were included in this review. A meta-analysis could not be conducted because of the observed heterogeneity across studies. There were mixed effects of the included interventions on healthy eating habits, ranging from effective to not effective. Only a few studies found behavioural determinants effective in enhancing healthy eating.

CONCLUSION

Because of the observed heterogeneity and varied outcome variables, a meta-analysis could not be conducted, and the overall effectiveness of the included interventions could not be verified. Interventions that were theory based, parent focused, and delivered through the multimodal interactive approach were found to be effective in enhancing healthy eating habits among children. More studies involving peers that are institution based need to be conducted.

Left behind, not alone: feeling, function and neurophysiological markers of self-expansion among left-behind children and not left-behind peers

Four in 10 young rural Chinese children are ‘left behind’ by parents migrating for economic opportunities. Left-behind children do as well academically and imagine as many possible futures for themselves as their peers, implying that they must compensate in some ways for loss of everyday contact with their parents. Three studies test and find support for the prediction that compensation entails self-expansion to include a caregiving grandmother rather than one’s mother in self-concept, as is typical in Chinese culture. We measured self-expansion with feeling, function and neurophysiological variables. Twelve-year-old middle school left-behind children (Study 1, N = 66) and 20-year-old formerly left-behind children (now in college, Studies 2 and 3, N = 162) felt closer to their grandmothers and not as close to their mothers as their peers. Self-expansion had functional consequence (spontaneous depth-of-processing) and left a neurophysiological trace (event-related potential, Study 3). Left-behind participants had enhanced recall for information incidentally connected to grandmothers (Studies 1 and 3, not Study 2). Our results provide important insights into how left-behind children cope with the loss of parental presence: they include their grandmother in their sense of self. Future studies are needed to test downstream consequences for emotional and motivational resilience.

Becoming parents again: Challenges affecting grandparent primary caregivers raising their grandchildren

Background

A growing number of Canadian children live in the care of their grandparents, called skip-generation families. Reasons for this include teen pregnancy, death of a parent, mental/physical illnesses, and addictions. These grandparents and grandchildren are at increased risk of physical and mental illness, yet have few resources available to them.

Objective

Our study aims to describe the lived experiences of skip-generation families to better identify their needs.

Methods

We conducted semistructured interviews of grandparent primary caregivers from ten households in our community to chronicle their experiences raising their grandchildren. Participants were recruited by paediatricians using convenience sampling. Interviews were recorded, transcribed, and coded using Atlas Ti software, and classified into themes by consensus.

Results

Five primary themes emerged from the interviews: (1) Changes in family dynamics, (2) Psychosocial impact on grandchild and grandparent, (3) Lack of resources for grandparent caregivers, (4) The challenges of parenting later in life, and (5) Resilience inspired by the love of family. Many participants (n=10) described feeling unsupported after assuming care of their grandchildren and identified a need for additional counselling services, financial support and respite care. All (n=11) highlighted that caring for their grandchildren changed their lives in positive ways.

Conclusion

When grandparents are prioritized as primary caregivers for their grandchildren, our study suggests they receive insufficient community resources to meet their emotional, respite and financial needs. Further research involving this population in Canada is required. Paediatricians can play an essential role in recognizing these vulnerable families and advocating for additional supports and services.

First-generation circular migrants involved in the upbringing of their grandchildren: the case of Turkish immigrants in Germany

Following retirement, older immigrants increasingly tend to engage in circular migration. This back-and-forth movement introduces a variety of challenges affecting the nature of grandparenthood as well as grandparental involvement in the upbringing of grandchildren. For circular migrant grandparents, maintaining intergenerational relationships requires them to overcome not only geographic distances, but also linguistic and cultural differences. In families with circular migrant grandparents, intergenerational conflict often springs from disparate generational exposure to acculturation processes, producing divergent aspirations within the first and second generations regarding the upbringing of the third generation. This study explores how first-generation Turkish circular migrant grandparents attempt to raise grandchildren who reside in Germany by implementing ‘cultural and instrumental transfers’. This study undertakes a qualitative approach: semi-structured interviews with a purposive sample of first-generation Turkish circular migrant grandparents (N = 40). The analysis finds that child-care assistance is characterised by intergenerational conflict – rather than solidarity or altruistic support – between the first and second generations. Moreover, through transnational arranged marriages, as a cultural transfer, and inter vivos gifts, as an instrumental transfer, grandparents encourage their grandchildren to return to Turkey permanently.

Health Care Providers' Perspectives on Family Compliance and Behavior Change in a Childhood Obesity Program

Background. Evidence suggests that children and adolescents growing up in low-income families and those with underrepresented ethnocultural backgrounds tend to have high prevalence rates of obesity and more difficulty adhering to childhood obesity interventions. However, less is known about how intergenerational, family-based approaches to lifestyle interventions for childhood obesity support sustained behavior change. Aims. The aim of this study was to explore the perspectives of health care providers regarding family adherence and behavior change in a childhood obesity program that served ethnoculturally diverse and low-income families. Method. Semistructured in-person interviews were conducted with 18 providers at one of three hospitals participating in a Canadian family-based childhood obesity program. Data were thematically analyzed using a constant comparative approach. Results. The following key themes emerged as challenges from the provider's perspective for family adherence and behavior modification in the childhood obesity program: divergent views about obesity, complicated lives and logistical priorities, parental role modeling, and intergenerational tensions. Discussion and Conclusion. This examination of providers' perspectives on family adherence and behavior modification relevant to the management of childhood obesity highlight the importance of tailoring childhood obesity programs to the complex and diverse needs of families from diverse backgrounds. Recommendations include methods of service delivery that address logistical challenges and are better suited to extended families, particularly grandparents.

Cross-Cultural Differences in the Experience of Grandparent-Grandchild Relationships and Related Psychosocial Outcomes

This study examined grandchildren’s perceptions of the quality of their relationship with their grandmothers and how these perceptions relate to psychosocial outcomes. Eighty-two youth from Mexico and 99 youth from the United States aged between 13 and 16 participated. Results suggested that both cultures benefit in unique ways from positive relationship with their grandmothers. Yet, there were also differences in the relational experience of grandmother–grandchild relationships across cultures. Specifically, grandchildren in the U.S. sample reported higher relationship quality, relational competency, and self-efficacy than the grandchildren in the Mexico sample. Within the U.S. sample, relationship quality was associated with grandchildren’s relational competence, while in the Mexico sample, relationship quality was associated with self-efficacy. Limitations of the present study include restricted generalizability to other age groups and to grandfathers and that only one element of the grandparent–grandchild dyad was sampled. Longitudinal research will improve our understanding of the causal dynamics of grandparent–grandchild relationships.