How do grandparents influence child health and development? A systematic review
Abstract
Grandparents are often a key source of care provision for their grandchildren, yet they are sidelined in caregiving research and policy decisions. We conducted a global, systematic review of the literature to examine the scope and quality of studies to date (PROSPERO database CRD42019133894). We screened 12,699 abstracts across 7 databases, and identified 206 studies that examined how grandparents influence child health and development. Indicators of grandparent involvement were contact, caregiving behaviors, and financial support. Our review focused on two research questions: how do grandparents influence child health and development outcomes, and what range of child outcomes is reported globally? We examined study design, sample characteristics, key findings, and outcomes pertaining to grandchildren's physical health, socio-emotional and behavioral health, and cognitive and educational development. Our search captured studies featuring grandparent custodial care (n = 35), multigenerational care (n = 154), and both types of care (n = 17). We found substantial heterogeneity in the data provided on co-residence, caregiving roles, resources invested, outcomes, and mechanisms through which "grandparent effects" are manifested. We identified two important issues, related to operationalizing indicators of grandparent involvement and conceptualizing potential mechanisms, leading to gaps in the evidence base. Currently, our understanding of the pathways through which grandparents exert their influence is constrained by limited data on what grandparents actually do and insufficient attention given to interpersonal and structural contexts. We present a conceptual framework to explicitly measure and theorize pathways of care, with a view to inform research design and policy implementation. We underscore the need for more robust data on three indicators of caregiver involvement-contact, behavior, and support-and for careful description of structural and interpersonal contexts in caregiving research.
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In multigenerational families, grandparents and parents provide care for the children together, through involvement or resources.
“A systemic review addressing grandparents co-residing with grandchildren reports that in multigenerational families, grandparents and parents provide care for the children together, through involvement or resources.16”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [16]
Childcare by grandparents is associated with increased parental labour-force participation, school attendance, educational attainment, and communication skills.
“Childcare by grandparents is associated with increased parental labour-force participation, school attendance, educational attainment, and communication skills.16”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [16]
To date, little attention has focused on children who suffer COVID-19-associated death of parents and coresiding grandparents serving as caregivers and the attendant loss of salient nurturing, financial support, and care.
“To date, little attention has focused on children who suffer COVID-19–associated death of parents and coresiding grandparents serving as caregivers and the attendant loss of salient nurturing, financial support, and care.1,2,5”
From COVID-19–Associated Orphanhood and Caregiver Death in the United States (2021) · cites this paper as [5]
Grandparents frequently provide psychosocial, practical, or financial support for their grandchildren.
“Grandparents, who are often the most vulnerable to COVID-19, frequently provide psychosocial, practical, or financial support for their grandchildren.16”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [16]
Adult deaths might further decrease household consumption because of lost income and loss of childcare, which limits a surviving adult's ability to work.
“These might further decrease household consumption because of lost income and loss of childcare, which limits a surviving adult's ability to work.16, 38”
From Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study (2021) · cites this paper as [16]
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Hillis, S. D., Unwin, H. J. T., Chen, Y., Cluver, L., Sherr, L., Goldman, P. S., Ratmann, O., Donnelly, C. A., Bhatt, S., Villaveces, A., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01253-8 · Cited by 299 · see citing works
“16 Because the death of a parent or abrupt death of a close family member is the most frequently cited type of trauma exposure experienced by children, we considered the abrupt death of either co-residing grandparents or other co-residing extended family aged 60 years or older to represent a…”
InfluentialCOVID-19–Associated Orphanhood and Caregiver Death in the United States
Hillis, S. D., Blenkinsop, A., Villaveces, A., Annor, F. B., Liburd, L., Massetti, G. M., Demissie, Z., Mercy, J. A., Nelson III, C. A., Cluver, L., et al. (2021) · Pediatrics · doi:10.1542/peds.2021-053760 · Cited by 235 · see citing works
- Authors
- Sadruddin, A. F. A., Ponguta, L. A., Zonderman, A. L., Wiley, K. S., Grimshaw, A., & Panter-Brick, C.
- Affiliations
- Yale University (US)
- University of Chicago (US)
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 239
- Pages
- 112476
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2965542920
- Cited by
- 228
- References
- 249
- Citations by year
- 2026: 20 · 2025: 44 · 2024: 57 · 2023: 33 · 2022: 33 · 2021: 30 · 2020: 11
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Jacobs Foundation
- Topics
- Social Sciences › Sociology and Political Science › Intergenerational Family Dynamics and Caregiving
- Social Sciences › Demography › Family Dynamics and Relationships
- Social Sciences › Sociology and Political Science › Social Policies and Family
- Keywords
- grandparents, grandparent involvement, child health, child development, caregiver behavior, financial support, social-emotional development, behavioral health, cognitive development, educational development, conceptual framework
- MeSH terms
- Grandparents, Child Health, Adolescent, Behavior, Child, Child Development, Child, Preschool, Cognition, Custodial Care, Educational Status, Humans, Income, Infant, Socioeconomic Factors, Global Health, Health Behavior, Intergenerational Relations, Caregivers
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