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Health problems faced by left-behind children in low/middle-income countries
  1. Zhenggang Zhu1,2,
  2. Yanpei Wang3,
  3. Xiaoyan Pan1
  1. 1School of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan, China
  2. 2School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, kelantan, Malaysia
  3. 3School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
  1. Correspondence to Dr Xiaoyan Pan; 897846734{at}

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Summary box

  • With the unbalanced development of the global economy, millions of left-behind children exist and tend to increase.

  • The physical and mental health of left-behind children globally need more attention and should not be neglected.

  • Poverty and inequality are the fundamental causes of left-behind children, and the widening gap between rich and poor has increased the number of left-behind children.

  • Solving the problem of left-behind children needs support from the joint efforts of the government, parents, schools and society.


Left-behind children are children whose parents, or one of them, have left their children behind in their hometown or home countries for work for more than 6 months and are cared for by grandparents or other relatives.1 The problem of left-behind children is a legacy of uneven global economic development and profoundly impacts children’s growth. As children, they should have had a happy childhood with their parents by their side, enjoying the love and education from their parents. However, many parents worldwide have to be separated from their children for the long term to make a living, and their children are called left-behind children.2 These left-behind children are separated from their families and lack long-term parental companionship, care and education.3 Their physical and mental health and development should have received more attention. A key element of the third target of the 2030 Sustainable Development Goals is to focus on children’s physical and mental health and to eliminate child inequalities in poverty areas. However, the current situation regarding left-behind children worldwide does not seem to have improved, and a large number of left-behind children still exist, and they should not be ignored.

The current situation of left-behind children worldwide

Parental labour migration is common worldwide, leaving millions of left-behind children.4 Parental labour migration includes domestic and international labour migration, and the form of labour migration varies from country to country. For example, China is dominated by internal labour migration, and the Philippines is dominated by international labour migration.5 According to available data, left-behind children are mainly located in low/middle-income countries, including Asia, Eastern Europe, Latin America and Africa, with Asia having the highest number.6 In 2022, more than 33% of children (6.97 million) residing in rural China are left-behind children.7 The Philippines is a typical country of international migration, with 27% left-behind children (8 million).8 There are 6.6% (3 million) left-behind children in Thailand,9 36% in Ecuador10 and more than 40% in rural South Africa.10 Almost 39% of children in Georgia are left-behind children, the highest percentage in the Eastern European region.11 Left-behind children are closely related to parental migration. If uneven global economic development leads to increased labour migration, the number of left-behind children may continue to increase.

Health problems faced by left-behind children

Whether parental migration is beneficial or detrimental to the health of left-behind children is currently debated. A small part of the literature reported that parental migration benefits child development. For example, a study reported that transnational families in Mexico were more likely to receive better quality education and nutritional support due to remittances.12 Conversely, more literature reported that parental migration was detrimental to children’s health. A cross-sectional study in Sri Lanka found that two in five left-behind children surveyed had a psychiatric disorder and showed a greater vulnerability to mental and psychological problems than non-migrant groups.13 Although parental labour migration can provide better economic support for raising children, it brings more potential physical and mental problems to their development.

Recent studies suggest that children affected by migratory separation are at increased risk of developing physical and mental health disorders.14 Parental rural–urban migration created a large number of left-behind children in China. In rural areas, the principal caregivers of left-behind children are elderly grandparents. Due to grandparents’ old age, poor health and lack of caregiving experience, left-behind children’s health may be at risk, such as malnutrition, missed vaccinations and ignorance of diseases.15 As observed in a more recent study in China, the prevalence of intestinal helminth infections among left-behind children in rural areas was one time higher than among non-left-behind children, and the degree of infection was also more severe.16 The prevalence of anaemia among preschool left-behind children in rural Chongqing was reported to be 23.88%.17 The detection rate of dental caries among left-behind children aged 3–6 years in rural Zunyi was as high as 79.61%.18 One study found that left-behind children have lower vaccination coverage than non-left-behind children.19 Children of non-migrating parents (95.7%) were more likely to receive complete vaccination than left-behind children (79.9%).20

Children with migrating parents are at a higher risk of developing poor nutrition, stunting, wasting, overweight or obesity.21 In addition, left-behind children have a higher risk of getting unintentionally injured. The annual injury rate was more than double among left-behind children compared with children living with both parents.22 The frequently reported injuries were falls, road traffic injuries, drowning, contact with sharp instruments, and being bitten or struck by animals.23 The problem of crimes committed by left-behind children cannot be overlooked. The high incidence of juvenile crimes is committed by those 12–15 years old, and if left-behind children in this age group lack parental supervision, they may easily go astray. It has been reported that crimes committed by left-behind children account for 70% of juvenile crimes in China.24 The ratio is staggering.

The mental and psychological problems of left-behind children also seem to be serious. Long-term separation from parents and a lack of parental care, protection and education increase the likelihood that left-behind children experience certain mental and psychological problems, such as depression, loneliness, anxiety, autism, bullying and learning disabilities.25 26 In a meta-analysis of studies from China, left-behind children had a 2.7 times higher prevalence of mental disorders (eg, anxiety disorders) than children not left behind by parental migration.27 Moreover, left-behind children experience 50–80% higher risks of suicidal ideation than children of non-migrant parents.4 One study reported that 31.6% of the left-behind children suffered recurrent bullying victimisation, which is higher than that of their rural counterparts who live with their parents.26 Furthermore, left-behind children are more likely to have poorer peer and family relationships, academic problems and school drop-out than non-left-behind children.28

Why are there so many left-behind children worldwide?

Labour migration is a direct cause of left-behind children. However, what causes the massive global labour migration is a question that deserves deeper consideration. Poverty and inequality are the fundamental causes of left-behind children, and the imbalance in the world’s economic development and the widening gap between rich and poor have increased the number of left-behind children. Most left-behind children are found in low/middle-income countries, especially low-income countries, while relatively few left-behind children are in high-income developed countries.

We believe few parents want to be separated from their little children for long periods. However, parents have to go to megacities or more developed countries to seek job opportunities or better salaries when they cannot find jobs in their original communities or countries to provide for their families. This may be the best or even the only way to improve the family’s financial situation.4 In the Philippines, remittances have become an increasingly important source of income for households. There are an estimated 8 million Filipino left-behind children because their parents are overseas Filipino workers.8

In low/middle-income countries, most parental labour migrants are low-skilled and semiskilled workers.4 They are unable to bring their children with them, because they spend most of their time working and do not have enough time to take care of their children. In addition, they cannot afford spacious apartments due to high city costs and have to live in cramped, overcrowded rented houses without enough space to stay with their children.

On the other hand, inequalities in policies between locals and migrants hinder the possibility for parents to bring their children with them. The inequality between locals and immigration policies hinders parents from bringing their children with them. These include low wages combined with higher costs of living in megacities, inaccessible social benefits such as health insurance and unequal education policies such as no access to schools for non-local children. For example, in some megacities in China, the household registration system limits migrant children’s access to more affordable public schools.4 Less-educated immigrants are likely to work in low-paying jobs in the service sector that usually do not provide health benefits. Their children may not be reimbursed for medical expenses for hospitalisation. These make it difficult for migrating parents to care for their children where they work.

How to solve the problem of left-behind children

Solving the problem of left-behind children needs support from the joint efforts of the government, parents, schools and society. The government plays a leading role in solving the problem of left-behind children. Action to provide more working opportunities within the country is essential to decrease child–parent separations.29 Local governments actively develop the local economy and create more opportunities for migrant workers to return to their hometowns for employment, which is the fundamental way to reduce the number of parents leaving to work. In addition, the government should eliminate inequality and discrimination and provide immigrant children with an equal growth environment and educational opportunities. In 2016, China issued a Caring for Left-behind Children Project to strengthen the care and protection of children in rural areas. The project encourages migrant workers to bring their children to live with them instead of staying in their hometown and created favourable conditions to support them. The project has established an enrolment policy based on the residence permit to lower the threshold for enrolment, and children of migrant parents have the same educational rights as children with local registered residences.30

Parents may have to separate from their children to find work in megacities or abroad to make a living. They may not be able to change this dilemma. However, they can make some changes. For example, if circumstances permit, leave one parent with the child at home rather than both parents going to megacities or abroad. One study reported that having a migrant mother might be more harmful than having a migrant father.31 So it may be more appropriate to leave the mother in her hometown with her children than the father. Using modern and convenient communication tools is necessary to enhance their children’s communication. Left-behind children need not only financial support from their parents but also emotional support. Regular and positive contact between parents and left-behind children can promote parent–child relationships and reduce adverse effects. One study reported that parent–child contact protected left-behind children from tobacco and alcohol use.32 Mobile phones and various communication apps, such as WeChat and WhatsApp, have made it easier for migrant parents to keep in touch with their children back home. Frequent parent–child interactions can foster emotional bonds between parents and children and meet their emotional needs, thus reducing their negative emotions.

Schools should conduct a mapping survey of left-behind children, establish a file and designate teachers to provide one-on-one support. Designated teachers provide psychological and emotional support for left-behind children. The school can look for support from social resources, such as contacting caring people who are willing to help the left-behind children and finding social caring mothers for the left-behind children. Caring mothers can provide emotional support for left-behind children. For example, caring mothers can visit the children at school regularly and bring them home on holidays to feel the warmth of family.

Non-governmental organisations provide social and emotional support for left-behind children based on community interventions. For example, UNICEF has been working with governments around the world to provide material assistance and resources to support left-behind children.33 Local non-governmental organisations, such as Atikha in the Philippines, deliver psychosocial and educational services to left-behind children.34 In a migrant-sending area of rural China, community volunteers, college students and retired workers set up children’s clubs to help left-behind children with study, psychological counselling and emotional support. Preliminary outcomes indicated the success of establishing a community care platform to benefit left-behind children’s health and development to enhance the community support networks.35


Children is a vital resource for the sustainable development. The health and development of children are related to the future of all humanity.36 We aim to draw attention to left-behind children in poverty areas of low/middle-income countries. They need more awareness and help and should not be overlooked. Even to this day, millions of left-behind children still cannot enjoy equal education and happy childhood worldwide. This is contrary to the 2030 United Nations Sustainable Development Goals. We call on governments, parents, schools and non-governmental organisations to work together to eliminate the phenomenon of left-behind children.

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  • Contributors XP designed this topic, and ZZ and YW wrote this manuscript, All authors contributed to the development of this manuscript in its current form through various revisions and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.