Introduction

Poor nutrition has been highlighted as a key modifiable factor that plays a crucial role in the development and maintenance of multiple non-communicable diseases [1]. The promotion of a diet characterised by (i) adequate consumption of fruit, vegetables, and wholegrains and (ii) infrequent consumption of energy-dense nutrient-poor foods and beverages is thus considered important to health outcomes, with such a diet reducing the risk of all-cause mortality and diseases such as type 2 diabetes and cancer [2,3,4,5,6].

Given that dietary habits established early in life track into adulthood [7], the promotion of a healthy diet in childhood to reduce the risk of diet-related chronic disease at all stages of the life course has been identified as a global health priority [8]. A range of individual, familial, social, and environmental factors shape children’s eating behaviours [9]. The role of parents is considered particularly important. Parents influence their children’s diet directly as gatekeepers of the eating environment and indirectly through their role as nutrition educators and modellers of food choice [10,11,12]. Although parents remain critical, recent decades have seen societal factors such as increased maternal participation in the workforce and the reduced affordability, availability, and flexibility of formal childcare arrangements contribute to worldwide increases in grandparents’ involvement as secondary care providers to their grandchildren [13,14,15,16,17]. Accordingly, it has been suggested that grandparents be considered important stakeholders in the promotion of healthy eating among children [18•]. The purpose of this review was to examine and synthesise recent work exploring the role of grandparents in shaping children's dietary health and eating behaviours.

Method

Search Strategy and Selection Criteria

A comprehensive search of the following databases was conducted for original research articles published from 1st January 2013 to the 31st December 2022: Google Scholar, EBSCO, Medline, PubMed, ProQuest, Science Direct, SCOPUS, and Web of Science. The search terms were (grandparents OR grandcarers OR grandmothers OR grandfathers) AND (grandchildren OR grandkids) AND (diet OR nutrition OR feeding). To be included in this review, studies must have been available in full text and published in English. Only studies exploring the role of non-custodial, non-residing grandparents were eligible for inclusion; studies involving custodial or co-residing grandparents were excluded. A separate search was conducted for meta-analyses and systematic reviews. These are not included in this narrative review, but a list of relevant reviews is presented in the online supplementary material.

A total of 2,167 studies was identified. After screening these for relevance and eligibility, 25 studies remained.

Findings

A summary of each of the studies reviewed is presented in Table 1. The influence of grandparents on children’s dietary health was evident across all studies. The sections below outline the findings according to specific areas of influence.

Table 1 Summary of studies reviewed
Full size table

Provision of Meals and Snacks

Grandparents were found to frequently provide their grandchildren with meals and snacks [18•, 19]. For example, a study by Jongenelis et al. [18•] found that 98% of surveyed grandparents reported ‘usually’ providing at least 1 meal or snack to the grandchildren for whom they provide care. Snack provision was most common (82%), followed by lunch provision (57%) and then dinner (48%). McArthur et al. [19] examined the number of snacks provided by grandparents, with an average of 2.75 snacks provided by grandparents each caregiving occasion. Nearly one-fifth of grandparents reported providing 4 or more snacks per caregiving occasion.

Types of Foods Provided

The provision of ‘treat foods’ high in sugar or fat (e.g. chocolate, sweets, ice-cream, and sugary drinks) was explored in multiple studies [20,21,22,23,24,25,26,27]. Such foods were found to play a significant role in grandparents’ food provision [22]. Indulging children with treat foods was considered by both parents and grandparents to be part of the grandparental role, with grandparents reporting that it was their right to spoil their grandchildren with such foods [24,25,26, 28, 29••, 30••]. Treats were found to be embedded in grandparent–grandchild routines and relationships, with many studies finding the provision of such foods to be a means through which grandparents expressed their love and care [21,22,23, 29••, 30••]. Nutritious meals were still prepared by grandparents for their grandchildren, but treat foods were used to strengthen the relationship bond.

Some grandparents believed it was acceptable to indulge their grandchildren as they were not primarily responsible for food provision [25, 30••, 31, 32]. They sought to counterbalance the strict rules of parents with a more lenient approach to grandchild feeding [30••]. Other motivators behind treat provision included (i) the belief that restricting treat foods created a desire for them, and that exposure provided an important means by which children learnt about moderation and self-control [29••] and (ii) rewarding good behaviour and accomplishments [22, 29••, 30••].

Not all findings suggested that grandparents’ food provision was problematic [18•, 22, 23, 29••, 32, 33]. In a study by Jongenelis et al. [18•], grandparents reported serving their grandchildren healthy foods and beverages (e.g. fresh fruit; milk, cheese, or yoghurt; vegetables; grain and cereal foods) more frequently than unhealthy foods and beverages (e.g. sugary drinks). In a study by Knight et al. [32], some children and their mothers reported consuming a greater variety of food because of grandparents’ direct involvement in providing them with meals. In other studies, some grandparents reported feeling a strong sense of responsibility to assist parents with raising healthy children and thus engaged in food provision practices they believed enhanced their grandchildren’s wellbeing [23, 29••].

Comparisons Between Grandparents and Parents

Mixed results were observed in studies that compared grandparents’ and parents’ food provision [22, 28, 34••]. In a study by Marr et al. [34••], there were no significant differences in the nutritional content of meals and snacks served by grandparents compared to parents. By contrast, in a study by Eli et al. [28], both grandparents and parents reported that grandparents were more likely than parents to provide children with unhealthy foods and beverages on a regular basis. In a study by O’Donohoe et al. [22], both grandparents and parents agreed that grandparents generally had more time for cooking meals from scratch whereas busy parents did not.

Feeding Practices

Several studies explored the feeding practices of grandparents [22, 24, 25, 29••, 34••, 35••, 36,37,38,39]. Grandparents appeared to use positive feeding practices (i.e. practices that lead to favourable dietary behaviours) more often than negative feeding practices (i.e. practices that lead to unfavourable dietary behaviours). The promotion of balance and variety was the most frequently used positive feeding practice [34••, 35••]. Other positive feeding practices in which grandparents engaged included modelling healthy eating, monitoring children’s food intake, providing a healthy eating environment by making healthy foods available and limiting the amount of unhealthy foods available, teaching about nutrition, and praising children for healthy eating [22, 24, 25, 29••, 34••, 35••, 36, 37].

In terms of negative feeding practices, a study by Jongenelis et al. [35••] observed scores above the midpoint for just one negative feeding practice—control over eating. All other negative feeding practices (pressure to eat, instrumental feeding, emotional feeding) were below the midpoint. Similarly, most studies have found that using food to ameliorate negative emotions is an uncommon feeding practice among grandparents [29••, 34••, 38].

Just one study appears to have examined the association between grandparents’ feeding practices and the diet quality of their grandchildren. In this study by Jongenelis et al. [35••], positive feeding practices were identified as being more important correlates of diet quality than negative feeding practices. The provision of a healthy food environment emerged as the most important positive feeding practice; it was found to be positively associated with grandchild fruit and vegetable consumption and negatively associated with grandchild savoury and sweet snack consumption. Limit setting was also found to be important, with grandparents who engaged in this feeding practice reporting that their grandchild consumed fewer savoury snacks and sugary drinks. Mixed results were observed for other feeding practices.

Comparisons Between Grandparents and Parents

Some studies compared the feeding practices of grandparents and parents [34••, 36, 38]. In terms of positive feeding practices, findings suggested that grandparents were significantly more likely than parents to report creating a healthy eating environment [34••, 36]. They were also more likely to allow children to have control during mealtimes [36]. However, grandparents were less likely to encourage balance and variety, model healthy eating, monitor child food intake, and teach about nutrition [34••, 36, 38]. In terms of negative feeding practices, grandparents were less likely than parents to report using food as a reward [36]. However, they were more likely than parents to report (i) using food to regulate emotions and (ii) restricting food due to weight concerns [36, 38].

Feeding Style

Just one study examining the feeding styles of grandparent care providers was found. In this study by Marr et al. [34••], the most common feeding style reported by grandparents was ‘indulgent’ (41%), followed by authoritative (23%), then uninvolved and authoritarian (both 18%).

Family Disagreement over Food Provision

An important finding that was identified in many studies was the differing opinions regarding child feeding held by parents and grandparents and the potential for this to (i) prevent the adoption of healthy dietary practices and/or (ii) result in the adoption of unhealthy dietary practices [23, 25, 28, 31, 39, 40]. While grandparents generally believed that parents had ultimate authority over feeding and reported respecting the decisions of parents regarding their grandchildren’s food options [22, 24, 25, 28, 29••, 30••, 41•], the extent to which they complied with parents’ feeding instructions varied. For example, in a study by Bektas et al. [31], most grandmothers reported disagreeing at times with parents’ instructions for what and how to feed their child. They thus ignored these instructions, providing their grandchildren with food and drinks that parents did not allow (e.g. sweets, processed foods, and fruit juice), usually in secret. In other studies, grandparents reported engaging in only “minor subversions” of parents’ feeding rules [22, 28].

In parents’ reports of grandparent feeding, it was noted that grandparents held permissive attitudes towards their grandchildren’s eating habits [40]. This reportedly resulted in (i) restrictions of certain foods being inconsistently enforced and (ii) parents’ efforts to promote healthy eating habits being contradicted [40, 42]. The indulgent behaviours of grandparents were seen as problematic, a barrier to healthy eating, and a source of conflict and frustration [26, 32, 41•]. While parents noted that they had the final say, this did not come easy [41•]. Parents also noted that conflicting beliefs regarding food provision put pressure on them to adopt undesirable feeding behaviours [41•]. Mothers from culturally and linguistically diverse groups additionally reported struggling with their children’s grandparents when they fed children non-traditional foods [42].

Both grandparents and parents were reluctant to discuss their differences openly, fearing family conflict [31]. Parents were reliant on grandparents for childcare and did not want to impose on grandparent–grandchild relationships [32]. Grandparents wished to maintain family harmony and ensure ongoing access to their grandchildren [29••, 30••]. Accordingly, both parties reported complying with the other even when they did not agree [29••, 30••].

Conclusions

Findings from research published over the last decade suggest that grandparents are exerting significant influence on child dietary health. They frequently provide their grandchildren with meals and snacks and engage in many of the same feeding practices used by parents. Although grandparents report providing their grandchildren with healthy foods, the provision of treat foods high in sugar or fat was a common finding across multiple studies. This provision led to family conflict, with the indulgent behaviours of grandparents seen by parents as a barrier to healthy eating and a source of frustration.

As grandparents become increasingly important providers of childcare globally, efforts are needed to ensure they are considered key stakeholders in the promotion of healthy eating and are targeted in policies and programs addressing children’s diets. While grandparents may not perceive themselves to be primarily responsible for child feeding, the high volume of care in which they engage means the frequent provision of treat foods could be problematic. It is promising, however, that grandparents appear motivated to assist parents with raising healthy children. Communicating to grandparents their importance and encouraging them to become champions of healthy eating may be a means by which motivation can be increased.

Research that determines how to best support grandparents to foster healthy lifestyle behaviours in children would make an important contribution to efforts to prevent of poor diet and improve health outcomes. The development of intergenerational programs that recognise the influence of all caregivers and encourage them to contribute to the goal of promoting healthy eating in children is also worthy of consideration. Such programs can assist with identifying caregiver differences that may be undermining efforts to provide children with a healthy food environment. They can also be used to optimise communication between caregivers and thus represent a potential means by which (i) the intergenerational conflict that serves as a barrier to promoting healthy eating in children may be reduced and (ii) the likelihood of children receiving congruent messages from all family members involved in their care can be increased.

It must be noted that this review explored studies published in English and only included work on non-residing grandparents. Accordingly, population groups in which co-residence of grandparents is common (e.g. South-East Asian, Chinese Asian, and South and Central Asian groups) were not represented. The influence of grandparents on grandchildren’s dietary health is likely to differ among these groups [43] and the conclusions drawn here cannot be generalised.

To conclude, the clear contribution of grandparents to children’s dietary health highlights the importance of including these caregivers in family interventions addressing lifestyle behaviours. Efforts are urgently needed to develop appropriate and effective tools that increase grandparents’ engagement in practices that support children to adopt positive behaviours and live healthy lives.