The overall goal of this study is to examine whether infant feeding practices differ between mothers and grandmothers in rural China. We randomly sampled 1383 caregivers of infants aged 18 to 30 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas. Results show that a high fraction of caregivers of 18- to 30-month-old children living in low-income areas of rural China do not regularly engage in positive infant feeding practices. Only 30% of children in our sample achieved adequate dietary diversity. Only 49% of children in our sample were fed meat in the day prior to survey administration. Few caregivers reported giving any vitamin supplements (such as calcium or iron supplements) to their children. We find that 33% of the children were cared for by grandmothers rather than mothers, and that grandmothers feed a less diversified diet to children than do mothers. Most (84%) caregivers rely solely on their own experiences, friends, and family members in shaping their feeding behaviors. Overall infant feeding practices are poor in rural China. Grandmothers engage in poorer feeding practices than do mothers. Grandmothers have improved their feeding practices compared to when their own children were young. Our results suggest shortcomings in the quality of infant feeding practices, at least in part due to an absence of reliable information sources.

Key words: child development, feeding practices, information sources, rural China

Abstract: Social interactions in infancy have implications for long-term outcomes. This study uses data from a sample of 1412 rural Chinese infants aged 6–12 and 24–30 months to examine the relationship between peer interactions and cognitive development. Over 75% of the infants in this sample had less than three peers and around 20% had no peers in both periods. The prevalence of cognitive delays is high within this sample and increases as infants age. Multivariate analysis reveals that peer interaction is significantly associated with cognitive development. Heterogeneous analysis suggests that peer interactions and mental development may be related to the child’s primary caregiver and the distance from the child’s household to the center of their village.

This article explores the problem of cognitive delays among toddlers in rural China and the role of their caregivers in producing low levels of cognition (i.e., low IQ). According to the results of a well-tested international scale of child development, the Bayley Scales of Infant Development (BSID), cognitive delays are alarmingly common, and nearly half the toddlers in our sample score an IQ of less than 84 on the BSID test (more than one standard deviation below the mean). In analyzing the source of this, we find that poor parenting—for example, not reading to, singing with, or engaging in stimulating play with one’s children—is closely associated with these delays. Even though mothers (as opposed to grandmother caregivers), and especially more educated mothers, are more likely to follow good parenting practices, quality parenting is rare overall. We seek to find out why so many young children appear to be neglected when it comes to modern parenting practices. We empirically rule out the hypotheses that caregivers discriminate according to their child’s gender; that the number of children in a given household is associated with the quality of parenting; or that caregivers living in relative poverty parent differently than their wealthier counterparts. According to the qualitative component of our study, we also find that inadequate parenting does not stem from parental indifference. Parents and grandparents obviously love their children and want them to succeed in life. Instead, the barriers appear to be primarily a lack of time and an absence of knowledge about the importance of good parenting practices. As a result, when they grow up, these children may not possess the levels of cognition needed to thrive in China’s increasingly high-skill-based economy. Overall, our findings suggest that China may be facing a national crisis due to inadequate rural early childhood development.

Background: Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China.

Methods: We conducted a cluster-randomized controlled trial in Shaanxi province, enrolling all children aged 6–11 months in target villages. Following a baseline survey, investigators randomly assigned each village/ cluster to a control or treatment group. In the treatment group, caregivers were instructed to give MNPs daily. Follow-up was after 6, 12, and 18 months of intervention. Primary outcomes were hemoglobin concentrations and scores on the Bayley Scales of Infant Development.

Results: One thousand, eight hundred and-two eligible children and their caregivers were enrolled. At baseline 48% (870) of children were anemic and 29% (529) were developmentally delayed. Six hundred and-ten children (117 villages) were assigned to the control group and 1192 children (234 villages) were assigned to the treatment group. Assignment to the treatment group was associated with an improvement in hemoglobin levels (marginal effect 1.77 g/L, 95% CI 0.017–3.520, p-value = 0.048) and cognitive development (marginal effect 2.23 points, 95% CI 0.061–4.399, p-value = 0.044) after 6 months but not thereafter. There were no significant effects on motor development. Zero effects after the first 6 months were not due to low compliance, low statistical power, or changes in feeding behavior. Hemoglobin concentrations improved in both the treatment and control groups over the course of the study; however, 22% (325) of children remained anemic at endline, and 48% (721) were cognitively delayed.

Conclusions: Providing caregivers with MNP sachets modestly hastened improvement in hemoglobin levels that was occurring absent intervention; however, this improvement did not translate into improved developmental outcomes at endline.

Trial registration: ISRCTN44149146; prospectively registered on 15th April 2013.

Keywords: Micronutrient supplementation, Anemia, Cognition, Early childhood

This study aims to investigate the developmental status of rural Chinese children, the extent of interactive parenting they receive, and the relation between the two. A sample of 448 six to eighteen-month-old children and their caregivers were randomly selected from two rural counties in Hebei and Yunnan provinces. According the third edition of the Bayley Scales of Infant and Toddler Development, 48.7% of sample children exhibited cognitive delays, 40.6% language delays, and 35% social-emotional delays. According to responses from caregivers, parenting in rural China is largely passive, lacking in interactive practices like storytelling, singing, and playing. Children-with-siblings, left-behind children, and children with less-educated mothers were even less likely to receive interactive practices. Children of caregivers who did engage in best parenting practices showed better cognitive, language, and socialemotional development; however, the public health system provides no platform for learning about optimal parenting.

Nearly a quarter of all children under the age of two in China are left behind in the countryside as parents migrate to urban areas for work. We use a longitudinal survey following young children and their caregivers from 6 to 30 months of age to estimate the effects of maternal migration on development, health, and nutritional outcomes in the critical first stages of life.We find significant negative effects on cognitive development and indicators of dietary quality. Taken together with research showing long-term consequences of early life insults, our results imply that, although the reallocation of labor from rural to urban areas has been a key driver of China’s prosperity in recent decades, it may entail a significant human capital cost for the next generation.

The first years of life comprise a critical period for social-emotional development that has implications for lifelong outcomes. One factor that is thought to impact infant socialemotional development is parenting behavior and practices, such as reading to, singing to, and playing with their child. In this study we examine the situation of parenting practices and infant social-emotional development among a sample of 1,350 infants aged 18-30 months in rural Shaanxi Province, China. Our results show that few parents engage in positive parenting behaviors and social-emotional developmental delays are prevalent among our sample. Our multivariate analysis finds that this high prevalence of social-emotional delay is correlated with this lack of positive parenting behavior. Descriptive analysis suggests that the deficit of positive parenting behaviors may be related to a lack of reliable information on parenting. We suggest that the Chinese government take steps to improve access to information on parenting practices in order to improve the developmental outcomes of infants and young children in rural areas.

Keywords: parenting; social-emotional; infant development; rural China

Background and Objectives: Development during the first two years of life is critical and has a lasting impact on a child’s health. Poor child nutrition can lead to a weakened immune system and deficiencies in essential micronutrients, which in turn have lasting and detrimental impacts on a child’s development. Recent studies in rural Shaanxi Province found an anemia prevalence of 54.3% among rural children aged six to twelve months. While new large-scale, quantitative research has begun to catalogue the extent of child malnutrition and anemia, no effort has yet been made to look more closely at the potential reasons for rural children’s nutritional deficiencies through a more richly textured qualitative analysis. This study aims to elucidate some of the fundamental causes of poor feeding practices that may lead to anemia among children in rural Shaanxi Province, China.

Methodology: We interviewed a total of sixty caregivers from villages participating in a study of 1808 families enrolled in a larger survey of child health and nutrition outcomes. We conducted three waves of interviews with children’s primary caregivers in seventeen rural villages within four nationally-designated poverty counties in the southern part of Shaanxi Province.

Results: The qualitative analysis reveals that poor infant feeding practices are persistent across our qualitative sample. Information gathered from our qualitative interviews suggests that proper feeding practices are impeded by two constraints: a lack of knowledge on infant nutrition and inadequate sources of accurate information on the topic. We find that the poverty does not appear to constrain child feeding practices.

Conclusion: Our research uncovers an absence of accurate information on infant nutrition, which hampers caregiver efforts to provide adequate nutrition to their children. This situation ultimately results in the failure of caregivers to supply an age-appropriate micronutrient-rich diet that can stimulate children’s physical and cognitive development, the absence of which may lead to iron-deficiency anemia among children. We suggest that steps be taken to educate caregivers in nutritional care for their infants

Objectives: To test whether text message reminders sent to caregivers will improve the effectiveness of a home micronutrient fortification program in western China.

Methods: A cluster-randomized controlled trial was carried out in 351 villages in Shaanxi province in 2013-14. We enrolled children aged 6-12 months in target villages. Each village/cluster was randomly assigned into one of three groups: Free Delivery Group (FDG; caregivers received free micronutrient packets); Text Messaging Group (TMG; FDG treatment plus daily text message); and Control Group. We collected information on compliance with treatments and hemoglobin concentrations from all children at baseline and 6-month follow-up. We estimated the intent-to-treat (ITT) effects on compliance and child anemia using a logistic regression model, controlling for infant, caregiver and household characteristics.

Results: There were 1393 eligible children. We found that assignment to TMG led to an increase full compliance (marginal effect = 0.10, 95% CI = 0.03, 0.16) and decrease in the rate of anemia at endline (marginal effect=-0.07, 95% CI= -0.12, -0.01).

Conclusions: Text messages improved compliance of caregivers to a home fortification program and children’s nutrition.