- Research article
- Open Access
- Open Peer Review
A qualitative insight into informal childcare and childhood obesity in children aged 0–5 years in the UK
© The Author(s). 2018
- Received: 5 March 2018
- Accepted: 19 October 2018
- Published: 6 November 2018
Previous studies in various countries have found that informal childcare (provided by relatives, friends etc.) was associated with an increased risk of obesity in children aged 0–5 years. However, no qualitative research has been done to explore possible reasons for such a relationship and potential interventions to tackle it. We conducted a qualitative study with both parents and informal carers to explore their 1) experiences in receiving or giving informal childcare for British children aged 0–5 years; 2) perceived explanations of the relationship between informal childcare and childhood obesity and 3) preferred intervention ideas and delivery strategies for preventing obesity among those children under informal care.
Four in-depth focus groups with a total of 14 participants (7 parents, 7 informal caregivers) were conducted in Birmingham and Edinburgh (1 parent group and 1 informal caregiver group in each city). Data were audio recorded, transcribed verbatim and analysed using a thematic approach.
The significance of informal care to parents, carers, and society was recognised (theme one). Informal carers were identified to have practical and emotional support roles for the parents (theme two). Informal care was perceived to contribute to childhood obesity in four ways (theme three): cross-generation conflict preventing adoption of healthy practices; the trade-off for parents between receiving childcare and maintaining control; reduced energy capacity of carers; and increased snacking. Potential intervention ideas and delivery strategies (theme four) were identified. Examples of identified ideas included providing carers with up-to-date weaning advice, and suggestions of healthy snacks and ways to increase physical activity level in informal care. The suggestion of utilising existing primary care platforms (e.g. health visitor check-ups) to reach and deliver low-cost information based interventions, to all children aged 0–5 years who receive informal care, was highlighted.
This exploratory qualitative study provided novel insights into potential explanations for the evidenced link between informal care and childhood obesity in children aged 0–5 years, despite a small size and limited participants in each focus group. Our findings support the idea of and inform the development towards an information based and low-cost intervention delivered through existing primary care platforms.
- Childhood obesity
- Qualitative study
- Health behaviour
- Informal care
- Pre-school children
Childhood obesity has become a global epidemic. In the UK, year on year the number of children who are either overweight or obese is increasing, and the age at which the onset of obesity occurs is reducing . Approximately one in four children are overweight or obese by the age of 3 years . There is an urgent need for more research and policies targeting the prevention of obesity in children aged 0–5 years [3, 4]. The early years are an important time for the development of healthy habits. These include an active lifestyle, a low intake of unhealthy snacks and sufficient sleep time – all of which are protective factors against obesity [5–7], and can be influenced by carers in the early years . Since the majority of young children receive some form of childcare , this period is a crucial target area for obesity prevention, and for the creation of healthy habits .
Informal care - care provided by grandparents, friends, neighbours, nannies [2, 11, 12] - is a popular childcare choice in the UK. By 2010, at least a quarter of British children under the age of three were in informal care, and around three-quarters of informal caregivers were grandparents . There is an increasing body of evidence, including a range of study designs from a number of different countries, to suggest that children in informal childcare are more likely to be overweight or obese than their counterparts in parental care [2, 11, 13–19]. A recent systematic review of the relationship between childcare settings and risk of overweight and obesity, found that before the age of 3 years, informal care was associated with significantly increased BMI or likelihood of overweight and obesity when compared to parental care . However, no qualitative research has been done to explore possible reasons for, or potential interventions to tackle, such a relationship. In addition, according to published reviews of interventions aimed to prevent obesity in young children [3, 20–25], there are currently no interventions specifically designed to encompass informal caregivers of children under five . Previous interventions targeting the early years were often delivered to children or their parents through formal platforms such as child care centres . Further investigation into the obesogenic aspects of informal care is necessary and is at the centre of informing future childhood obesity preventative measures . The success of these measures relies on in-depth understanding of the needs of informal caregivers  and parents who use informal care.
Therefore, in order to inform future development of tailored interventions to prevent obesity in children under five in informal care, we conducted a novel qualitative study with parents and informal caregivers. The aims of this study were to explore their 1) experiences in receiving or providing informal childcare; 2) perceived reasons behind the relationship between informal childcare and childhood obesity and 3) favoured intervention ideas and delivery strategies for preventing obesity in those children.
Informal childcare givers and parents of children under five who were (or used to be) in informal care were recruited into focus groups between September 2016 and January 2017. Participants were recruited from two major cities of the UK (Birmingham and Edinburgh) to provide a range of socio-demographic perspectives.
Participant selection and recruitment
Participants were recruited using a purposive sampling method. Initial recruitment strategies included advertising via a grandparent carer charity, a childcare website and a mailing list of staff at the University. Inclusion criteria included: (a) informal carers or parents who were providing/using or had used/provided informal childcare, (b) the child was aged 0–5 years at time of care, and (c) willingness to participate in a focus group. There was no time limit on how long ago the care took place. All participants had a comprehensive information sheet emailed to them prior to attending a focus group, and had a chance to ask questions. Interested and eligible participants were contacted to arrange a convenient time and place to run the focus group. For practical reasons, participants read and signed an informed consent form at the beginning of the focus group. Each participant received a £10 voucher as a token of appreciation for taking part, and parking expenses were compensated.
Slow and difficult recruitment was anticipated, and occurred, owing to the unique characteristics of the research population (i.e. informal carers had no or minimal connections with any formal childcare organisations or settings). A number of strategies and media were applied to overcome the challenges in participant recruitment. These included: advertising via local baby and toddler groups; and putting up posters in community centres.
Data collection process
Summary of Focus Group Topic Guide
1. What do you think informal care is? What types of informal care have you used or given and why?
2. Carers: Can you describe your typical day with the child you look after?
Parents: Can you describe a typical day your child will have with the carer?
(Making special attention to Who? What? Where? When? Why?)
3. Do you receive/give any suggestions as to how the child should be looked after in relation to health or health behaviour?
4. Do you think that there is a problem with pre-school aged children being overweight?
5. What knowledge or support do informal caregivers need to help prevent obesity in the children they care for?
6. Moderator provides existing evidence on the relationship between informal childcare and obesity. Can you think of any possible explanations for this evidenced association?
7. What are parents and informal caregivers perceptions of potentially feasible and effective intervention targets and ideasa?
(Making special attention to Who? What? Where? When/how often/how long? )
8. What would be feasible ways to recruit suitable participants for future questionnaire surveys that aim to research this topic further?
9. Summary and closing
Data collection was continued until a range of responses had been collected in the different focus groups; however it was not deemed necessary to achieve data saturation as our analysis aimed to capture parents’ and carers’ experiences and understandings rather than develop theory .
Given a scarce knowledge basis on why informal care is linked to childhood obesity, an inductive thematic analysis approach was chosen to analyse the data set, as described by Braun and Clarke . Focus group recordings were anonymised and transcribed verbatim. Each participant was assigned a unique ID relating to their identity and group number (for example PG1M1: Parent Group 1 Mother 1; CG1G2: Carer Group 1 Grandparent 2); this ID is reported alongside the relevant quotes in the results. To aid the generation of initial codes, the first author became familiar with the data by repeatedly reading the transcripts. Initial codes were produced systematically with the help of NVivo computer software . A coding book was first developed by the first author, with guidance and contributions from the other authors, based on the richest dataset. This was expanded and refined as it was applied to the rest of the transcripts. The authors made use of visual representations, such as mind-maps and theme piles (codes on small pieces of paper which are arranged with similar codes), to develop initial higher-level themes from the descriptive codes and to begin to identify those with added significance. To increase the authenticity and credibility of the results, analyst triangulation, with three researchers from a range of backgrounds, was adopted in the final stages. This involved reviewing the finalised codebook and reaching a group consensus on the definition and content of the final themes. The analysts ensured that the dataset within each theme was connected whilst also being sufficiently different to the data within the other themes . In order to minimise researcher bias, a reflexivity journal was maintained by the author to reveal their thinking process behind the development of codes and emerging patterns, and to reflect on how their opinions may impact on the analysis.
Parent (n = 3)
Carer (n = 4)
Parent (n = 4)
Carer (n = 3)
60 or older
Annual household income
< 30 K
> 100 K
Did not specify
Level of education
Relationship of carer to child
Age of the child (mean in years, range)
Length of time the child was in informal care (mean in years, range)
Number of days a week the child was in informal care (mean in days, range)
Average number of hours a day the child was in informal care (mean in hours, range)
Four core themes emerged from the analysis: (1) the importance of informal care to families and society; (2) practical and emotional roles of informal carers; (3) potential explanations for the link between childhood obesity and informal care and (4) potential intervention opportunities and strategies. Detailed results are presented below and illustrated with quotes.
Theme 1: The importance of informal care to families and society
Both parents and carers consistently discussed how vital informal care was to both their family and to society.
“It was sort of to help with the cost if you’ve got 2 children we didn’t put them both into nursery for 3 days a week so my mum ended up having both children when I came back to work” (PG2M1).
“Certainly I wouldn’t be happy passing him to somebody I didn’t know and in a nursery that was one of my main concerns cos the staff turnover can be quite high” (PG1M3).
“I didn’t mind cos I prefer to look after her and know that she’s being looked after properly and being treated properly and happy” (CG1G1).
“Oh no I wouldn’t miss it [caring for her grandchild] for the world” (CG1G2).
“Grandparents care of children… is worth about fourteen point seven billion to the state every year because people are able to work and all that type of thing, we are a really useful resource” (CG1G3).
Theme 2: Practical and emotional roles of informal carers
“I get the children dressed” (CG2G4).
“They’ve got gymnastics class booked so granny takes (name of daughter) to that” (PG1M1).
“No mum’s gonna go for me because ((laughs)) so my informal child carer is going to go to his 27 month check, so that’ll be quite good” (PG1M4).
“They were well looked after and I didn’t have to worry” (CG1G1).
“It’s to enable them to continue their careers when they really needed to work just to pay their mortgage” (CG2G1).
“With my mum even though she wasn’t there all the time she’d phone me and I was upset ‘oh is she still not sleeping just give her some baby rice’” (PG2M2).
Theme 3: Potential explanations for the link between childhood obesity and informal care
Cross-generation conflict preventing adoption of healthy feeding practice in family
“I would definitely tell my mum how I’d want them to be fed especially when they were younger only because we had different views about weaning and stuff like that” (PG2M1).
“Cos we did baby led weaning that was a bit controversial with both grandmas so particularly my mum there was a lot of ‘well shall I just give him some puree that I bought from the shop’ and (the participant replied) ‘I’d rather you didn’t’ sort of thing” (PG2M3).
“My mum actually encouraged me to wean early which I think a lot of mums do because (name of daughter) was struggling and she wasn’t sleeping… so I did start a little bit early” (PG2M2).
“My mum was like ‘well give him some baby rice give him some baby rice’ and I remember at 5 months I was pushed that hard that I offered him baby rice and he didn’t want it and I was like ‘see he doesn’t want it’” (PG2M1).
“No my mother-in-law was the same yeh she didn’t agree with breastfeeding at all… it was really hard cos she was the only other person I had as support apart from my husband” (PG2M2).
“I think with her it’s because she bottle fed me and my sister and I think she felt it was a bit of a personal well are you saying it wasn’t good enough what I did” (PG2M3).
“And it’s really hard cos you don’t trust your own instincts do you… I used to have to have a book to sort of back it up… because otherwise you do feel so peer-pressured that you have to justify yourself don’t you as to why you do things” (PG2M1).
“Do you know what that’s quite interesting cos my mum’s not English, no my mums Dutch and they are very forthright people and she is less respectful of my opinions than my mother-in-law who is English” (PG2M3).
“I don’t think she (referring to her mother) does believe that bottle feeding is much better but that it is a lot easier, it means she could have helped so like especially when I used to have it really rough in the nights” (PG2M5).
Trade-off between receiving childcare support and maintaining control
“Yeh rock the boat or be too critical, it’s the relationship that is there as well as the kind of helping you yeh giving you care so it would be very difficult” (PG1M4).
“You know my mum is doing me a huge favour by helping me out with this I can’t really say to her ‘come on down and I’ve got something stuck to the wall” (PG1M3, referring to an intervention suggestion given by another parent in the focus group).
“Yeh find that easier to say to someone I’m paying for it, but when it is a favour yeh to help you out its harder to say what you really want maybe” (PG1M1).
“I know that she wouldn’t leave him crying because she knows that I don’t and it’s not her child and she is very good like that so maybe that does actually come from working with other people’s children and being used to that advice” (PG2M3).
Fewer opportunities for physical activity
“Certainly if grandparents as they are shortening their working day but they’re still at work to look after the kids then I think they’re probably knackered” (CG1G3).
“I think as people get older they do get tireder and looking after kids as you get older is harder work you are more likely not to play with them you are more likely to… say ‘go and watch the tv or what about your computer or even do some drawing’ rather than playing outside” (CG1G3).
“You wouldn’t have those hours where they would be sat down” (PG1M1).
“I think when it’s your grandchildren they say ‘please granny can I have it’ it’s very hard to not to be totally sort of ‘nope’” (CG2G1).
“Well I must say I always had to prevent granddad buying packets of sweets… he would be thinking he was being kind” (CG2G2).
Theme 4: Potential intervention opportunities and strategies
Why are interventions needed?
“People will argue ‘oh well you’ve done it already because you had your own kids’ but actually society and we’ve talked about the screens and so on has changed so much” (CG1G3).
“Yeh there’s always different sort of nutritional advice changing and it’s always handy to know the up to date information” (PG1M2).
“It’s almost like back up you say ‘this is the way I want you to do it, this (imitating a leaflet) is where I got the information from’ it might be quite helpful” (PG2M2).
What should be included in the intervention?
The participants also recognised that the intervention programme must be tailored to the different needs of the child at different ages and suggested that the content of the intervention should be divided into information for: 1) zero to 5 years; 2) under 1 year; and 3) over 1 year.
“New recipes… to help people think of different things to do for their children” (CG2G1).
“Say random days out and things to do” (PG1M1).
“Healthy snacks is always a good thing, I think carers, not in my case, they’re the ones that ‘oh well give him a biscuit give him a bag of crisps’ you know cos you just run out of ideas sometimes” (PG2M2).
“And like about the drinks and stuff and… sugar in drinks” (PG2M1).
“Once they get to sort of from 3 to 5 I think you really need to focus on steering away from like tablets which are an easy thing to do” (PG2M1).
How can the intervention be delivered?
“Even like a little leaflet book and it’s actually for carers outside parents so that you could give it to them and they could flick through it in their own time” (PG2M1).
“Make it friendly and not as if they’re being criticised” (CG2C1).
“I think it kind of would make it less awkward to approach my mother if ‘oh (name of son) got this at nursery and it’s for grandparents’” (PG1M3).
“I think if it’s somebody like a health care professional or somebody that is sort of qualified at the children’s centre I think they’re more likely to take what they say is the right thing” (PG2M1).
When and where should the intervention be delivered?
“The health visitor could say oh you know ‘who’s going to look after your child’… so that could be through a health visiting situation they could feed out you know because they would be talking to them hopefully… but you know if people are maybe thinking about going back to work just feed that into the information that’s available from a year on if you are going to have (an informal carer} these are the packs you can get” (CG2C1: Carer Group 2 Child-minder 1).
The participants also suggested using radio, newspapers and social media to distribute educational and supportive information on healthy weight promotion among children under 5 years in informal care, to reach people of all socio-economic classes.
Informal childcare is a popular choice for British parents. Despite the well-documented link between informal childcare and childhood obesity in children aged 0–5 years, no studies have explored potential explanations for this link. Moreover, no intervention programmes have been designed specifically for children outside formal care. This UK-based exploratory qualitative study explored the informal childcare arrangement from both parents and carers’ perspectives. It obtained insights into possible explanations for the relationship between informal childcare and obesity among children aged 0–5 years. Moreover, potential intervention opportunities and delivery strategies to support informal carers and parents to promote healthy weight in those children were also identified.
The importance of informal care to families and society was highlighted. We have identified that carers want to care, and they value the special bond they develop with the child in their care. This reasoning for caring was found in a previous study .
Informal carers were identified to provide practical, emotional and financial support for the family. Informal childcare, especially that provided by grandparents, is appreciated by parents and is an important source of financial support that permits parents to undertake paid employment . In addition, grandparents may be able to spend more time with their grandchildren than the parents, enabling good social and emotional wellbeing in the grandchildren .
Four potential explanations for the evidenced link between childhood obesity and informal care were identified. The first relates to cross-generation conflict preventing adoption of healthy feeding practices within the family. Our findings have shown that grandparents may be influencing parents with out-dated information due to personal experience or preference, especially regarding breastfeeding and weaning. Initial breastfeeding [35, 36] and baby-led weaning (as evidenced by case-control  and cohort studies ) have both been noted as significant protective factors against obesity in children. Formal and informal childcare is associated with a reduced likelihood of breastfeeding, when compared to parental care . The influence grandparents have on breastfeeding initiation and early introduction of solid food is significant and is well documented in the literature. A recent systematic review of 13 studies from a range of low and high-income countries, found that if grandmothers had their own breastfeeding experience or were positively inclined towards it, then this would have a positive impact on the mother breastfeeding . In addition, a German cohort study of 3822 mothers noted that if the maternal grandmother had a negative attitude towards breastfeeding the mother was up to 3.62 times more likely not to initiate breastfeeding . Our finding that lack of emotional support from grandparents, due to differences in opinion, can have a negative impact on breastfeeding initiation and continuation is supported by the literature [41, 42]. If friends, and family perceive that the mother should exclusively breastfeed the infant, the mother’s intention will be the same as that of the people around her . Another reason for early weaning has been hypothesised. Grandparents often care for a group of children of different ages, so they may be more likely to encourage early introduction of solids to make mealtimes easier [14, 16].
Participants described that despite instances of cross-generation conflict, grandparents respected the parents to have the final decision. However, participants reported this respect was cultural, with British grandparents being more respectful than those from other cultures. For example, in Chinese culture the infant feeding preferences of significant others in the family (especially the mother-in-law) are often followed by new mothers, even when they are different to the mother’s desires . Recognising the impact of culture on parental and family decisions is of importance when designing future interventions, as Britain has a culturally diverse population.
A second potential explanation for obesity in informal care relates to the trade-off between parents receiving childcare for their children and losing control over feeding and activity choices. This trade-off has also been documented in two qualitative studies in the US. One of those reported that parents felt they had limited ability to control grandparents’ feeding practices as they relied on their care . The other reported that mothers who accept support from their mothers may lose control over the food their children eat . Future interventions should recognise this trade off that parents are balancing and should try to minimise the cross generation knowledge gap in childcare practice (as evidenced by this study) by providing the necessary knowledge and skills that grandparents need. This would help parents in receiving the valuable support from grandparents in terms of childcare without compromising the relationship.
Reduced energy capacity of informal carers, leading to decreased activity levels in the children, has been identified as a third perceived cause of childhood obesity. Parents consistently stated that their children were less active in informal care compared to formal care. This is a consistent finding with current British literature . Interventions should incorporate a physical activity component, as physical inactivity and sedentary behaviours, including television watching, are repeatedly reported in the literature as being linked to childhood obesity [47–50]. Interestingly a mixed methods study, including both qualitative and cross-sectional aspects, conducted in China, offered a different explanation for decreased energy levels in informal care . The study reported that due to the single-child family structure, grandparents tended to overprotect their grandchildren from household chores, therefore limiting their physical activity levels.
Increased food consumption in informal care was identified as a final perceived cause of obesity. These findings are in line with literature from Asia. A Japanese Cohort study found that compared to parental care, children who were cared for by grandparents at the age of 3 years had a higher prevalence of snacking and subsequently had a higher mean BMI over time . Cross-sectional data of dietary habits and physical activity of 497 schoolchildren in China found that children who were primarily cared for by a grandparent consumed over two or more portions of unhealthy snacks per week than those children who were primarily cared for by their parents or other adults . Qualitative data from the same study reported that grandparents overindulged their grandchildren and had misperceptions about what comprises a healthy diet in children.
The final theme of this study referred to potential intervention opportunities and strategies.
We identified that in order for informal carers to provide appropriate support to parents and to encourage healthy habits, their knowledge needs updating on current best practices. Grandparents have been reported to be the second most commonly cited source for information, after health visitors . As the majority of informal carers are grandparents , this highlights the need to target up to date information and advice to this group. Participants identified that a way of achieving this could be via a brief intervention, centred on a leaflet, targeted to carers with the aim of preventing obesity in children in informal care. An intervention feasibility study that delivered an antenatal session centred on a leaflet written specifically for fathers and grandmothers about breastfeeding, found this to be acceptable, useful and enjoyable by all participants . In addition, a recent English randomised control trial found a low-cost opportunistic 30-s brief intervention, delivered by primary care physicians, was acceptable to patients and an effective way to reduce weight in patients with obesity . This intervention strategy could be adopted by future interventions targeting informal carers and adapted to include more topics related to healthy weight promotion in young children.
Adopting this approach would mean an existing primary care communication platform (such as a community midwife, health visitor or GP appointment) could be used, making it virtually cost neutral. Most previous interventions that aimed to prevent childhood obesity were labour intensive and required certain equipment or facilities. However, none of the recently completed large trials of childhood obesity prevention programmes in the UK showed evidence of effectiveness [56, 57]. Involving informal carers in routine antenatal and postnatal appointments provided by the NHS may provide a window to access this hard to reach population, which would increase intervention uptake. Findings from a recent qualitative study in Canada support this idea . The authors found that both physicians and parents engaged with and welcomed the idea of childhood obesity prevention interventions based within the primary care setting. However, two systematic reviews from the US that assessed paediatric primary care-based obesity interventions found that the majority of studies were based on obesity treatment, rather than focusing on obesity prevention [59, 60]. This signifies that the evidence base regarding childhood obesity prevention in primary care is insufficient in terms of study quantity and quality, which highlights a need for a greater number of randomised control trials based in primary care that assess obesity prevention interventions.
Strengths and limitations
This is the first qualitative study specifically designed to explore potential explanations for the link between informal childcare and childhood obesity in children aged 0–5 years as evidenced by previous epidemiological studies in various countries. The study also generated rich insights into potential components and delivery strategies of future interventions. These findings could inform the development of tailored obesity prevention strategies targeted to informal caregivers and parents of children aged 0–5 years in this country. The suggestion for delivering interventions (e.g. educational information) to this difficult to reach target audience through existing points of contact with health care providers may be useful for example for, general practitioners, health visitors, and nurses who have direct and regular contacts with children under the age of five and their families. Moreover, multiple steps were taken to ensure the credibility of the results. These included involving a number of different researchers with mixed disciplinary backgrounds and experience in the data analysis process, and reporting the analysis methods and results transparently. Finally, gaining opinions from two sources, parents and carers, would allow tailored development of future interventions to both groups’ needs and wants, this may help uptake and success of the intervention in the future.
However, the results of this study should be interpreted with certain limitations. Firstly, despite numerous efforts to recruit both parents and carers into this study, only 14 participants took part in this study within our project’s limited timeframe. However, all the focus groups generated rich data and as discussed earlier, our findings are largely consistent with relevant, previously published literature. This indicates a level of validity of the study. Challenging recruitment has also provided valuable lessons for future studies whose success depend on the participation of informal carers. Effective recruitment strategies included advertising via social media, University mailing lists and word of mouth. Secondly, participants were mainly of Caucasian origin, thus potential cultural variations in the results could not be explored fully. This is significant due to the wide cultural diversity of the British population. Thirdly, all participants reported to have university or college level education so they might be more comfortable with educational interventions, compared to those with a lower level of educational achievement. Future studies should aim to include participants from more varied ethnic and socio-economic backgrounds.
Further research should explore the views of primary and community health care providers (e.g. antenatal midwives, health visitors, GPs and nurses) regarding potential opportunities and barriers for them to support or deliver an intervention programme that targets children under the age of 5 years in informal care for obesity prevention in those children.
This qualitative study, with both informal carers and parents of children aged 0–5 years, provided novel insights into the informal care arrangement. Potential explanations for the previously evidenced link between informal care and childhood obesity were identified. Conflicting opinions between older members of the family and healthcare professionals made adoption of healthy feeding practices, such as breastfeeding and baby-led weaning, difficult and almost impossible for some parents if they were not getting the support they needed. Parents reported a balancing act between receiving childcare for their children but in return losing control over the child’s feeding and activity levels, as they felt indebted to their carer. Both parents and carers identified that children in informal care have less physical activity than their peers in formal care, potentially due to advancing age of many informal carers, and eat more energy-dense snacks. Our findings highlight that education targeted towards informal carers will help them to support the parents, and also to prevent obesity in the children in their care. We propose that future childhood obesity prevention interventions aimed at this population are delivered via existing primary care platforms (such as midwife, health visitor or GP appointments) in order to provide a cost-effective approach to reach as many families as possible. Future research should explore the feasibility and acceptability of this intervention idea to healthcare professionals who have contact with children under five and their families.
The authors gratefully acknowledge the contribution from all study participants.
University of Birmingham. The funder played no role in any part of the study.
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
BL (Principal Investigator) conceived the study idea and obtained the study funding. BL and AL (Co-Investigator) advised on the study design and implementation (data collection and analysis). EL recruited study participants and moderated all focus groups with support from BL. Data analysis was done by EL with contributions from BL and AL. EL produced the first draft of the manuscript which was critically revised by BL. All authors contributed to the revisions of the manuscript and approved the final version of the manuscript.
Ethics approval and consent to participate
Ethical approval was obtained from the Life and Health Sciences Ethical Review Committee at the University of Birmingham (reference ERN_16–0531). Participants provided informed written consent to participate.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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- Centre for Longitudinal Studies. Millennium Cohort Study Briefing 14: Childhood overweight and obesity 2010 [Cited 2016 September 28]. Available from URL: http://www.cls.ioe.ac.uk/library-media%5Cdocuments%5Cbriefing14_web(2).pdf
- Pearce A, Li L, Abbas J, Ferguson B, Graham H, Law C, Millenium Cohort Study Child Health Group. Is childcare associated with the risk of overweight and obesity in the early years? Findings from the UK Millenium Cohort Study. Int J Obes. 2010;34:1160–8.View ArticleGoogle Scholar
- Dattilo AM, Birch L, Krebs NF, Lake A, Taveras EM, Saavedra JM. Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions. J Obes. 2012;2012:18.View ArticleGoogle Scholar
- Cattaneo A, Monasta L, Stamatakis E, et al. Overweight and obesity in infants and pre-school children in the European Union: a review of existing data. Obes Rev. 2010;11(5):389–98.View ArticleGoogle Scholar
- Costa S, Adams J, Gonzalez-Nahm S, Benjamin Neelon SE. Childcare in infancy and later obesity: a narrative review of longitudinal studies. Curr Pediatr Rep. 2017;5(3):118–31.View ArticleGoogle Scholar
- Tremblay MS, Chaput JP, Adamo KB, Aubert S, et al. Canadian 24-hour movement guidelines for the early years (0-4 years): an integration of physical activity, sedentary behaviour, and sleep. BMC Public Health. 2017;17(Suppl 5):874.View ArticleGoogle Scholar
- Okely AD, Lubans DR, Morgan PJ, Cotton W, et al. Promoting physical activity among adolescent girls: the girls in sport group randomized trial. Int J Behav Nutr Phys Act. 2017;14:81.View ArticleGoogle Scholar
- Bell LK, Perry RA, Prichard I. Exploring grandparents’ roles in young Children’s lifestyle behaviors and the prevention of childhood obesity: an Australian perspective. J Nutr Educ Behav. 2018;50:516–21.View ArticleGoogle Scholar
- United Nations Children’s Fund (UNICEF). The Childcare Transition Innocenti Report Card 8. 2008 [Cited 2016 November 23]. Available from URL: https://www.unicef-irc.org/publications/pdf/rc8_eng.pdf
- OECD. Starting Strong 2017: Key OECD indicators on early childhood education and care. Paris: OECD Publishing. p. 2017.Google Scholar
- Geoffroy MG, Power C, Touchette E, Dubois L, Boivin M, Séguin JR, et al. Childcare and overweight or obesity over 10 years of follow-up. J Pediatr. 2013;162:753–8.View ArticleGoogle Scholar
- Lehto R, Maki P, Ray C, Laatikainen T, Roos E. Childcare use and overweight in Finland: cross-sectional and retrospective associations among 3- and 5-year-old children. Pediatr Obes. 2016;11(2):136–43.View ArticleGoogle Scholar
- Lin Lin S, Leung GM, Ling Hui L, Hing Lam T, Schooling CM. Is informal childcare associated with childhood obesity? Evidence from Hong Kong’s “children of 1997” birth cohort. Int J Epidemiol. 2011;40:1238–46.View ArticleGoogle Scholar
- Alberdi G, McNamara AE, Lindsay KL, Scully HA, Horan MH, Gibney ER, et al. The association between childcare and risk of childhood overweight and obesity in children aged 5 years and under: a systematic review. Eur J Pediatr. 2016;175(10):1277–94.View ArticleGoogle Scholar
- McLaren L, Zarrabi M, Dutton DJ, Auld MC, Emery JCH. Child care: implications for overweight/obesity in Canadian children? Chronic Dis Inj Can. 2012;33(1):1–11.PubMedGoogle Scholar
- Benjamin S, Rifas-Shiman S, Taveras E, Haines J, Finkelstein J, Kleinman K, et al. Early child care and adiposity at ages 1 and 3 years. Paediatr. 2009;124(2):555–62.View ArticleGoogle Scholar
- Maher EJ, Li G, Carter L, Johnson DB. Preschool child care participation and obesity at the start of kindergarten. Pediatr. 2008;122(2):322–30.View ArticleGoogle Scholar
- Kim J, Peterson K. Association of infant child care with infant feeding practices and weight gain among US infants. Arch Pediatr Adolesc Med. 2008;162(7):627–33.View ArticleGoogle Scholar
- Black L, Matvienko-Sikar K, Kearney PM. The association between childcare arrangements and risk of overweight and obesity in childhood: a systematic review. Obes Rev. 2017;18:1170–90.View ArticleGoogle Scholar
- Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity. 2010;18(S1):S27–35.View ArticleGoogle Scholar
- Skouteris HMM, Swinburn B, Newgreen V, Sacher P, Chadwick P. Parental influence and obesity prevention in pre-schoolers: a systematic review of interventions. Obes Rev. 2011;12(5):315–28.View ArticleGoogle Scholar
- Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;12.Google Scholar
- Laws R, Campbell KJ, van der Pligt P, et al. The impact of interventions to prevent obesity or improve obesity related behaviours in children (0–5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review. BMC Public Health. 2014;14(1):1–18.View ArticleGoogle Scholar
- Knowlden AP, Sharma M. Systematic review of family and home-based interventions targeting paediatric overweight and obesity. Obes Rev. 2012;13(6):499–508.View ArticleGoogle Scholar
- Peters J, Sinn N, Campbell K, et al. Parental influences on the diets of 2–5-year-old children: systematic review of interventions. Early Child Dev Care. 2012;182(7):837–57.View ArticleGoogle Scholar
- Chambers SA, Rowa-Dewar N, Radley A, Dobbie F. A systematic review of grandparents’ influence on grandchildren’s cancer risk factors. PLoS One. 2017;12(11):e0185420.View ArticleGoogle Scholar
- Morgan DL. Focus groups as qualitative research. California: Sage publications; 1988.Google Scholar
- Wilkinson S. Focus group methodology: a review. Int J Soc Res Methodol. 1998;1(3):181–203.View ArticleGoogle Scholar
- Mason M. Sample size and saturation in PhD studies using qualitative interviews. Forum Qual Soc Res. 2010;11 Art 8.Google Scholar
- Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.View ArticleGoogle Scholar
- QRS International. NVivo. Version 11, 2015.Google Scholar
- Braun V, Clarke V. Successful qualitative research: a practical guide for beginners. London: Sage publications; 2013.Google Scholar
- Lakó JH. The issues of the relationship of grandparents and grandchildren in the light of physical activity. EJMH. 2014;9(2):178–94.View ArticleGoogle Scholar
- Mitchell W. The role played by grandparents in family support and learning: considerations for mainstream and special schools. Support Learn. 2008;23(3):126–35.View ArticleGoogle Scholar
- Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatr. 2005;115(5):1367–77.View ArticleGoogle Scholar
- Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014;14:1267.View ArticleGoogle Scholar
- Townsend E, Pitchford NJ. Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample. BMJ Open. 2012;2:e000298.View ArticleGoogle Scholar
- Santos LP, Assunção MCF, Matijasevich A, Santos IS, Barros AJD. Dietary intake patterns of children aged 6 years and their association with socioeconomic and demographic characteristics, early feeding practices and body mass index. BMC Public Health. 2016;16:1055.View ArticleGoogle Scholar
- Negin J, Coffman J, Vizintin P, Greenow-Raynes C. The influence of grandmothers on breastfeeding rates: a systematic review. BMC Pregnancy Childbirth. 2016;16:91.View ArticleGoogle Scholar
- Kohlhuber M, Rebhan B, Schwegler U, Koletzko B, Fromme H. Breastfeeding rates and duration in Germany: a Bavarian cohort study. Br J Nutr. 2008;99:1127–32.View ArticleGoogle Scholar
- Hoddinott P, Pill R, Hood K. Identifying which women will stop breast feeding before three months in primary care: a pragmatic study. Br J Gen Pract. 2000;50(460):888–91.PubMedPubMed CentralGoogle Scholar
- Emmott EH, Mace R. Practical support from fathers and grandmothers is associated with lower levels of breastfeeding in the UK millennium cohort study. PLoS One. 2015;10(7):e0133547.View ArticleGoogle Scholar
- Nuzrina R, Roshita A, Basuki DN. Factors affecting breastfeeding intention and its continuation among urban mothers in West Jakarta: a follow-up qualitative study using critical point contact for breastfeeding. Asia Pac J Clin Nutr. 2016;25(Suppl 1):S43–51.PubMedGoogle Scholar
- Tarrant M, Dodgson JE, Choi VWK. Becoming a role model: the breastfeeding trajectory of Hong Kong women breastfeeding longer than six months. Int J Nurs Stud. 2004;41(5):535–46.View ArticleGoogle Scholar
- Eli K, Howell K, Fisher PA, Nowicka P. A question of balance: explaining differences between parental and grandparental perspectives on preschoolers’ feeding and physical activity. Soc Sci Med. 2016;154:28–35.View ArticleGoogle Scholar
- Speirs KE, Braun B, Zoumenou V, Anderson EA, Finkbeiner N. Grandmothers’ involvement in preschool-aged children’s consumption of fruits and vegetables. An exploratory study. ICAM. 2009;1(6):332–7.Google Scholar
- Bayer O, Bolte G, Morlock G, Rückinger S, von Kries R, GME-study group. A simple assessment of physical activity is associated with obesity and motor fitness in pre-school children. Public Health Nutr. 2009;12(8):1242–7.View ArticleGoogle Scholar
- Jordan A. Children’s television viewing and childhood obesity. Pediatr Ann. 2010;39(9):569–73.View ArticleGoogle Scholar
- Zhang G, Wu L, Zhou L, Lu W, Mao C. Television watching and risk of childhood obesity: a meta-analysis. Eur J Pub Health. 2016;26(1):13–8.View ArticleGoogle Scholar
- Staiano AE, Harrington DM, Broyles ST, Gupta AK, Katzmarzyk PT. Television, adiposity, ad cardiometabolic risk in children and adolescents. Am J Prev Med. 2013;44(1):40–7.View ArticleGoogle Scholar
- Li B, Adab P, Cheng KK. The role of grandparents in childhood obesity in China – evidence from a mixed methods study. Int J Behav Nutr Phys Act. 2015;12:91.View ArticleGoogle Scholar
- Sata M, Yamagishi K, Sairenchi T, Ikeda A, Irie F, Watanabe H, et al. Impact of caregiver type for 3-year-old children on subsequent between-meal eating habits and being overweight from childhood to adulthood: a 20-year follow-up of the Ibaraki Children’s cohort (IBACHIL) study. J Epidemiol. 2015;25(9):600–7.View ArticleGoogle Scholar
- Gildea A, Sloan S, Stewart M. Sources of feeding advice in the first year of life: who do parents value? J Community Pract. 2009;82(3):27–31.Google Scholar
- Ingram J, Johnson D. A feasibility study of an intervention to enhance family support for breast feeding in a deprived area in Bristol, UK. Midwifery. 2004;20(4):367–79.View ArticleGoogle Scholar
- Aveyard P, Lewis A, Tearne S, Hood K, Christian-Brown A, Adab P, et al. Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial. Lancet. 2016;388:2492–500.View ArticleGoogle Scholar
- Adab P, Pallan MJ, Lancashire ER, Hemming K, Frew E, Barrett T, et al. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). BMJ. 2018;361:k1954.Google Scholar
- Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, et al. Effectiveness of the healthy lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial. Lancet Child Adolesc Health. 2017;2:35–45.View ArticleGoogle Scholar
- Bourgeois N, Brauer P, Simpson JR, Kim S, Haines J. Interventions for prevention of childhood obesity in primary care: a qualitative study. CMAJ Open. 2016;4(2):E194–9.View ArticleGoogle Scholar
- Vine M, Hargreaves MB, Briefel RR, Orfield C. Expanding the role of primary care in the prevention and treatment of childhood obesity: a review of clinc- and community-based recommendations and interventions. J Obes. 2013;3:172035.Google Scholar
- Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes GH, Sherwood NE. A review of primary care-based childhood obesity prevention and treatment interventions. Curr Obes Rep. 2015;4(2):157–73.View ArticleGoogle Scholar