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To explore whether childcare type (parent, informal, formal) is associated with overweight in children, and whether this differs by socio-economic background.
Nationally representative prospective cohort study.
Children born in the UK in 2000–2002.
12 354 children with information on childcare between 9 months and 3 years, and height and weight data at age 3.
Main Outcome Measure
Overweight (including obesity) at age 3 defined by the International Obesity Task Force cut-offs for body mass index.
Children who were cared for in informal childcare were more likely to be overweight than those cared for by a parent (risk ratio (RR) 1.14, 95% CI 1.04 to 1.25), particularly if they were in full-time child care (RR 1.36, 1.16 to 1.59). The risk of overweight in children who were cared for in formal childcare did not differ from those cared for by a parent (1.05, 0.95 to 1.15). These associations remained after controlling for confounders. When stratifying by socio-economic background the increased risk of overweight in informal childcare (compared to parental care) was limited to children from more advantaged groups. Children were at increased risk of overweight if they were cared for in informal childcare and their mother was from a managerial or professional background (RR 1.24, 1.04 to 1.47), had a degree (RR 1.48, 1.19 to 1.84), or lived in a couple household (RR 1.16, 1.05 to 1.28), whereas there was no increased risk seen for informal childcare if the mother was from a routine or manual background, had no educational qualifications or was a lone parent. Further exploration revealed that the increased risk associated with informal childcare was experienced by children who were cared for by grandparents (1.15, 1.04 to 1.27) and not in other types of informal care. However, after taking into account hours per week spent in childcare, an increased risk was seen for full-time care by grandparents (RR 1.34, 1.12 to 1.56) (and not part-time care), and also for other full-time informal childcare (RR 1.41, 1.09 to 1.82).
Evidence from the US indicates that informal childcare is associated with a greater risk of childhood overweight. Our findings are consistent with this, although only for children from more advantaged groups. Whilst further research is required, these results suggest that the UK government’s drive to support parents into paid employment should be accompanied by health related information and support for informal as well as formal carers such as nurseries. The recent announcement to provide grandparents with National Insurance credits for caring for grandchildren provides a potential opportunity for health promotion.
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