Background China’s internal migration has left 61 million rural children living apart from parents and usually being cared for by grandparents. Given different caregiving beliefs and practice across generations, children’s dietary behaviours and nutritional intake may differ depending on who is caring for them. This study aims to explore caregivers’ beliefs about healthy eating for left-behind children (LBC) in rural China.

Methods Twenty-six children aged 6–12 (21 LBC and 5 non-LBC) and 32 caregivers (21 grandparents, 9 mothers, and 2 uncles/aunts) were recruited in rural China. Children were encouraged to keep food diaries followed by in-depth, semi-structured face-to-face qualitative interviews with caregivers drawing on Grounded Theory principles and procedures.

Results Distinct intergenerational differences in beliefs about healthy eating emerged: the grandparent generation tended to emphasise the importance of starchy foods for children’s growth due to their past experiences during the Great Famine, whereas the parent generation paid more attention to protein-source foods including meat, eggs and milk. Parents were also more likely to offer their children high-energy food which was seen more as a sign of economic status than part of a balanced diet. Lack of remittances from migrant parentscompromised LBC’s food choices. LBC left in the care of grandparents, especially those influenced by the memory of the Great Famine, can be at greater risk of malnutrition compared with children who were cared for by parents.

Conclusion Our study suggests two separate types of nutritional risks for children: over-emphasis on starchy foods for children cared for by grandparents leading to malnutrition; and offering high-energy foods for children cared by parents contributing to overweight or obesity. A balanced diet is needed for LBC regardless of their caregivers. Interventions aimed at improving LBC’s healthy development should take into account caregivers’ experiences and beliefs.