Influencing factors of posttraumatic stress disorder in Shidu parents who have lost their only child: a cross-sectional survey.

BACKGROUND: In China, parents who have lost their only child are referred to as Shidu parents (SDPs). This study aimed to investigate the prevalence and risk factors of post-traumatic stress disorder (PTSD) and investigate the influence of depressive and anxiety symptoms on the development of PTSD. METHOD: Four hundred and thirty-six SDPs completed assessments of PTSD (Structured Clinical Interview for DSM-IV Disorders, SCID-IV; The Clinician-Administered PTSD Scale-IV, CAPS-IV), depression (Hamilton depression scale), and anxiety (Hamilton Anxiety Scale) via in-person interviews. Logistic regression and hierarchical multiple linear regression analyses were used to explore the association of demographic characteristics, depression, and anxiety symptoms with PTSD. RESULTS: The prevalence of PTSD in SDPs was 14.45%. The comorbidity of depression and anxiety symptoms was 87.30% in the SDPs with PTSD. The logistic regression model, which included factors of gender, age, education, depression, and anxiety, which contributed to the development of PTSD, was significant [χ² (11) = 122.47, p < 0.001]. The hierarchical multiple linear regression analysis indicated that female gender and the severity of comorbidities (depression and anxiety) were positively associated with the severity of PTSD. CONCLUSION: This study found that the severity of depression and anxiety was closely related to the severity of PTSD, supporting that SDPs are highly prone to the co-occurrence of PTSD, depression, and anxiety after bereavement. Our findings may provide more insights into the development of individualized interventions for parents who have experienced the loss of their only child.

Factors associated with the quality of life of Chinese parents who have lost their only child.

This study used the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) to assess the quality of life (QOL) of Chinese Shidu parents (who have lost their only child) and conducted an in-depth investigation into the factors affecting their QOL using non-parametric tests and the Tobit regression model. A total of 651 Shidu parents were enrolled in this study. The questionnaire included a general information survey, the Geriatric Depression Scale-15 (GDS-15), the Social Support Rating Scale (SSRS), and the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L). The results revealed that approximately 60% of Shidu parents reported no problems in all five dimensions. Pain and discomfort were the most frequently reported problems among Shidu parents, affecting 23.35% of participants. The Tobit regression model revealed that GDS-15 scores, marital status, education, and self-reported health status were significantly associated with EQ-5D scores. Additionally, SSRS scores, GDS-15 scores, and self-reported health status were significantly associated with EQ-VAS scores. Based on the study's findings, relevant recommendations were proposed.

Defining and Identifying Only Children: A Research Note on the Concept and Measurement Illustrated With UK Survey Data.

Despite increasing interest in the circumstances and outcomes of only children in the demographic literature, the conceptualization of this group has received limited scholarly attention. This research note argues for greater engagement by demographers and social scientists in the conceptualization and identification of only children by addressing three aims. First, we outline potential definitions of only children, present a framework to guide researchers' decisions, and evaluate whether only children can be reliably identified using the British birth cohort studies. Second, we show that the prevalence estimates are contingent on the timing of measurement in childhood, indicating the need for caution when deriving only-child status from cross-sectional household grid data. Third, we demonstrate that both the size and the characteristics of the only-child group may differ across definitions, highlighting that the accurate operationalization of some definitions is particularly restricted by survey designs that prioritize mothers for data collection on children and families. We argue that researchers interested in sole children's outcomes must choose the most appropriate measure for a given research question and, given that many datasets limit how accurately any indicator of only children can capture the chosen definition, reflect on how the operationalization of their measure might affect the results.

The role of imaginary companion in the life of only children: a qualitative study.

INTRODUCTION: An imaginary companion is an invisible or personified entity created by children for themselves. An imaginary companion typically serves as a companion to the child and plays a significant role in their life, especially for only children who may experience more loneliness compared to other children. This research was conducted to investigate the role of an imaginary companion in the lives of only children. METHOD: The present study was conducted using a qualitative method and a content analysis approach. Through purposeful sampling, a total of 34 preschool and primary school children, aged 6 to 9 years, from schools in Mashhad city, were selected until saturation was reached. They were subjected to semi-structured interviews. After data collection, the data were coded, and then the main and sub-themes were extracted. RESULTS: The research findings were represented in the form of 196 statements, 28 sub-themes, and 9 main themes. The main themes included the role of an imaginary companion in alleviating loneliness, the role of an imaginary companion in amusement, the role of an imaginary companion in emotional regulation, conversations with an imaginary companion, guidance from an imaginary companion for good and bad behaviors, the assistance of an imaginary companion in tasks, helping to generate new scenarios, the advantages of having an imaginary companion, and the disadvantages of having one. CONCLUSION: Based on the aforementioned findings, it can be concluded that the presence of an imaginary companion can not only support children but also promote creativity and distance them from the virtual space and realities of the real world. Parental awareness of this matter can aid in the child's growth, fulfill their needs, and, on the other hand, prevent potential harm to children.

The relationship between perceived stress and prolonged grief disorder among Chinese Shidu parents: effects of anxiety and social support.

BACKGROUND: Shidu parents refer to the couple who have lost their only child and have not given birth or adopted another child in China. The number of Shidu parents is increasing annually. The aim of this research was to examine the mediating role of anxiety and the moderating role of social support between perceived stress and prolonged grief disorder (PGD) among Chinese Shidu parents. METHODS: A cross-sectional study was carried out with 505 participants who completed a questionnaire including the Prolonged Grief Questionnair-3 (PG-13), the Perceived Stress Scale-10 (PSS-10), the Self-Rating Anxiety Scale (SAS) and the Duke-UNC Functional Social Support Questionnaire (FSSQ). SPSS PROCESS macro was employed to examine the mediating role of anxiety and the moderating role of social support. RESULTS: The mediation analysis showed anxiety partially mediated the link between perceived stress and PGD, and the proportion of mediation of anxiety was 39.22%. The moderated mediation analysis revealed the second stage of mediating effects of anxiety on the link between perceived stress and PGD was moderated by social support. Specifically, compared with Shidu parents with higher social support, the association between anxiety and PGD was closer for those with lower social support. CONCLUSIONS: The moderated mediation model can broaden our understanding of how and when perceived stress, anxiety and social support work together to affect PGD. The interventions aimed at improving mental health of Chinese Shidu parents need to work on reducing stress and enhancing social support.

Associations between resilience and symptoms of depression and anxiety among adolescents: Examining the moderating effects of family environment.

Depressive and anxiety symptoms in adolescents have experienced increase their risk of peripheral mental health and social problems. For adolescents, the role of family environmental factors should be taken into consideration. This study aimed to explore the association between resilience and depressive and anxiety symptoms in adolescents and to extend the findings by examining the moderating effects of family environment. A total of 35,573 adolescents in middle schools were recruited in China. Childhood abuse, resilience, and symptoms of depression and anxiety were evaluated in adolescents. We found a significant association between resilience and symptoms of depression and anxiety [OR = 0.976 (0.975-0.978), P < 0.001; OR = 0.980 (0.978-0.981), P < 0.001]. The adjusted ORs (95 % CIs) for mental health across the categories of resilience were as follows: 1 (reference) for low resilience, 0.660 (0.620-0.703) for medium resilience, 0.309 (0.286-0.333) for high resilience. The relationship between resilience and depressive symptoms was stronger for girls, non-only children, and those without child abuse experience compared to boys, only child, and those with child abuse experience (all p < 0.05). Our findings of a nationally representative sample in China suggest that gender, only child, parent-child relationship and child abuse moderated the relationship between resilience and symptoms of depression and anxiety.

Time course of attentional bias and its relationship with PTSD symptoms in bereaved Chinese parents who have lost their only child.

Background: The death of a child is a highly traumatic event for parents and often leads to posttraumatic stress disorder (PTSD). Attentional bias has been demonstrated in the onset and maintenance of PTSD symptoms.Objective: This study aimed to investigate the time course of attentional bias among bereaved Chinese parents who have lost their only child (Shidu parents), and to examine its relationship with PTSD symptoms and symptom clusters.Methods: Shidu parents (n = 38; 50-72 years of age) completed a dot-probe task with negative (trauma-related), positive, and neutral images at four stimulus presentation times (250, 500, 750, and 1250 ms). PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5).Results: We observed difficulty in disengaging from both negative and positive stimuli at 750 ms and attentional bias away from negative stimuli at 1250 ms. At 1250 ms, attentional avoidance of trauma-related stimuli was positively correlated with PCL-5 total and intrusion scores. Difficulty in disengaging from positive stimuli was negatively correlated with PCL-5 total and intrusion scores as well as negative alterations in cogniti and mood scores.Conclusions: These findings enhance our understanding of attentional bias and cognitive-affective processing in PTSD. This study provides evidence that attentional bias (difficulty in disengaging from positive stimuli and bias away from negative stimuli) are correlated with PTSD symptoms and certain symptom clusters.

The current study examined the time course of attentional bias among bereaved Chinese parents who have lost their only child through a dot-probe task and investigated its relationship with PTSD symptoms and symptom clusters.Participants exhibited difficulty in disengaging from both trauma-related and positive stimuli at 750 ms and exhibited attentional avoidance of trauma-related stimuli at 1250 ms.Attentional avoidance of trauma-related stimuli was positively correlated with PCL-5 total and intrusion scores. Difficulty in disengaging from positive stimuli was negatively correlated with PCL-5 total and intrusion scores as well as negative alterations in cognition and mood scores.

Longitudinal changes in brain structure and their relationship with subclinical psychiatric symptoms in parents who lost their only child in China.

BACKGROUND: Losing an only child (Shidu) is a grievous traumatic event that may affect brain structure, even if it does not lead to psychiatric disorders. However, longitudinal changes in brain structure and their relationship to subclinical psychiatric symptoms (SPS) have not been well investigated in Shidu parents without any psychiatric disorders (SDNP). OBJECTIVES: This study aimed to investigate cross-sectional and longitudinal changes in cortical thickness and surface area in SDNP, and to explore their relationship with SPS. METHODS: A total of 50 SDNP and 40 matched healthy controls (HC) were enrolled. All participants underwent structural MRI scans and clinical assessment at baseline and at the 5-year follow-up. Differences in brain structural phenotypes (cortical thickness, surface area, and their annual rate of change) between the SDNP and HC groups were compared using FreeSurfer. Correlations between significant brain structural phenotypes and SPS in the SDNP group were evaluated using multiple linear regressions. RESULTS: The SDNP group showed a smaller surface area in the left inferior parietal cortex than the HC group at baseline and follow-up. The SDNP group showed slower rates of cortical thinning and surface area loss in several brain regions than the HC group from baseline to follow-up. Moreover, slower rates of cortical thinning in the left insula, superior frontal cortex, and superior temporal cortex were associated with greater reductions in avoidance, depression, and trauma re-experiencing symptoms scores over time in the SDNP group, respectively. CONCLUSIONS: Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms. The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.

This study focused on longitudinal changes in cortical thickness and surface area and their relationship with subclinical psychiatric symptoms in Shidu parents without any psychiatric disorders.Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms.The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.

Pathways of TB Transmission in Children-A Systematic Review of Molecular Epidemiological Studies.

The widespread paradigm that younger children usually do not transmit M. tuberculosis complex (Mtbc) to their contacts has not yet been proven by genotypically confirmed transmissions. Therefore, we undertook a systematic review of molecular-epidemiological studies to investigate documented source and secondary TB (tuberculosis) cases among children. We searched the literature published before August 2022 using PubMed, Cochrane, and Google Scholar databases. PRISMA statement was used for systematic review. Of 312 records retrieved, 39 studies including children aged below 15 years offered epidemiological links between cluster members. In the 39 studies from 16 countries, 225 children were reported as cluster members of whom the overwhelming majority were infected by adults. Only 3 children-of those were 2 children aged below 10-were reported to be the definite source cases of 11 other children and 1 adult with genotypically matched Mtbc isolates. To date, molecular-epidemiological studies involving children with verified transmission links are scarce. As far as the heterogeneity of the studies we identified allows, we could conclude that the results confirm the paradigm that children aged below 10 hardly ever transmit Mtbc to others. The true extent of TB transmission through children may, however, be underestimated by those selected studies.

Health and Social Constraints for Elderly Chinese Women Who Lose Their Only Child and Spouse: A Perspective of Resilience.

Aging Chinese people who lose their only child are a newly developed vulnerable group as the result of the one child policy in China. As an integral part of this group, women who have lost their only child and their spouse are more vulnerable and have their own particularity. This study uses qualitative methods to explore the resilience of women who have lost their only child and their spouse based on the interaction of risk factors and protective factors at individual and environment levels. From the perspective of resilience, this article examines the psychological suffering and the health and social constraints experienced by elderly women who lose their only child and their spouse and who lack appropriate support from the government and society. It analyses how the internal protective factors of the resilience of such women include being hard-working and able to bear hardships, and showing forbearance and a good ability to seek social support, while the external protective factors include care from relatives and the support from multiple social relationships. Women who have lost their only child and their spouse demonstrate many forms of resilience, including traditional positive resilience and recessive resilience, such as complaining and somatization, indicating profound health and social implications that require the development of appropriate policies in China.

Social support and prolonged grief disorder symptoms in parents who lost their only child from urban and rural China.

OBJECTIVE: The one-child policy has existed in China for more than 30 years. It brought benefits to the country's economic development and reduced the magnitude of the population within a short period. However, it has led to the emergence of a significant number of parents who have lost their only child, referred to as shiduers (). This study explored the symptoms of prolonged grief disorder (PGD) among shiduers and their relationship with the social support shiduers received after they lost the child, specifically accounting for the disparity between rural and urban areas. METHOD: In total, 405 participants were recruited with a mean age of 60.37 years (SD = 7.78). Around 68.75% were female, and 58.66% were urban shiduers. They were asked to complete a series of self-reported questionnaires, including demographic information, the Social Support Rate Scale, and the Prolonged Grief-13. RESULTS: First, 29.63% of the participants (N = 120) fulfilled the International Classification of Diseases (11th rev.) diagnostic criteria for PGD symptoms; second, PGD symptoms of shiduers were negatively related to social support, including objective support, subjective support, and the availability of support; and third, urban/rural location moderated the effect of objective support on the PGD symptoms of shiduers, but not the effect of subjective support on PGD symptoms. Furthermore, the simple-slope tests indicated that the shiduers in rural areas benefited most from objective support. CONCLUSIONS: The present results revealed high rates of PGD symptoms in Chinese shiduers, and our findings highlight the important role of urban/rural location in the relationship between social support and PGD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Health outcomes of only children across the life course: An investigation using Swedish register data.

Only children (with no full biological siblings) are a growing subgroup in many high-income settings. Previous studies have largely focused on the short-term developmental outcomes of only children, but there is limited evidence on their health outcomes. Using Swedish population register data for cohorts born 1940-75, we compare the health of only children with that of children from multi-child sibling groups, taking into account birth order, family size, and presence of half-siblings. Only children showed lower height and fitness scores, were more likely to be overweight/obese in late adolescence, and experienced higher later-life mortality than those with one or two siblings. However, only children without half-siblings were consistently healthier than those with half-siblings, suggesting that parental disruption confers additional disadvantages. The health disadvantage was attenuated but not fully explained by adjustment for parental characteristics and after using within-family maternal cousin comparison designs.

Subtypes of Chinese Shidu parents' (parents who have lost their only child) depressive symptoms and their relationships with resilience and coping styles.

We aimed to examine the subtype classification characteristics of depressive symptoms in Shidu parents (SDPs, parents who have lost their only child) and their associations with resilience and coping styles. The sample comprised 182 SDPs (Mean age = 59.93 ± 7.41 years, 61.5% females). Latent profile analysis and logistic regression analysis were used to analyze the data. Three subgroups of depressive symptoms in SDPs were identified: the depression and pessimism group (38.4%), the low depression symptoms group (30.8%), and the well-adapted group (30.8%). The low depression symptoms group had a lower education level and higher family monthly income than the depression and pessimism group. The low depression symptoms group and the well-adapted group scored significantly higher in resilience, and lower in negative coping style than the depression and pessimism group. The results highlighted that target intervention is needed for SDPs with high education levels, low family monthly income, high negative coping style, and low resilience in the depression and pessimism group.

Peer support experiences among Chinese parents who lost their only child: A qualitative study.

Chinese parents who lost their only child are at high risk of mental health problems. Peer support seems to be a crucial resource for their adaptation. Semi-structured interviews were conducted with 15 participants to explore peer support experiences in this population. Three forms of peer support were identified, namely, online groups, offline activities, and one-to-one contacts. The functions of support included emotional, instrumental, and informational support. Some unique characteristics emerged (e.g., negative experiences). Certain challenges were identified (e.g., lacking professional guidance). The findings indicate that future interventions focused on peer support should be developed.

'Nobody comes to help us': lived experiences and needs of older adults who lost their only child in China.

PURPOSE: This qualitative study aimed to gather insights into the experiences of older adults after losing their only child and explore meaningful life needs as a basis for social interventions. METHODS: We conducted individual face-to-face interviews with 29 participants from 10 communities in Changsha, Hunan Province, China. Interviews were transcribed verbatim and then analysed using the inductive category development of conventional content analysis. RESULTS: The experience of losing an only child was devastating and linked with a helpless life in old age. The analysis generated the following three themes encompassing their lived experiences and needs: afraid of getting sick, lying on the edge of misery and surrounded by loneliness. CONCLUSIONS: Losing an only child triggered older adults' feelings of being misunderstood, disconnected and hopeless. They had an increased likelihood of lacking more on love and belonging, esteem and self-actualization needs than their physiologic and safety needs. Findings from our study will raise awareness on this vulnerable group and help design intervention programmes targeting the specific needs of this neglected segment of the population.

Prevalence of prolonged grief disorder and its symptoms in Chinese parents who lost their only child: A systematic review and meta-analysis.

Background: Parents who lost their only child and cannot have a second child ("Shidu") have been a large population in China. Prolonged grief disorder (PGD) in Shidu parents is of clinical and public health concern but the reported PGD prevalence varies widely. To facilitate the planning of grief counseling services, this meta-analysis estimated prevalence of PGD and its symptoms and identified subgroups at elevated risk for PGD. Methods: We searched English and Chinese literature databases to identify cross-sectional surveys reporting prevalence of PGD or PGD symptoms in Chinese Shidu parents. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data ("JBI") was used to assess risk of bias of included studies. Results: Seven studies with a total of 2,794 Shidu parents were included and their JBI scores ranged from five to eight. The pooled prevalence of PGD and PGD symptoms was 20.9% and 75.0%, respectively. Greater risk of PGD was observed in mothers [vs. fathers, OR (odds ratio) = 1.89, P = 0.001] and in parents with religious beliefs (vs. without religious beliefs, OR = 1.65, P = 0.040). More severe PGD symptoms were presented in parents whose only child died from accidents [vs. illness, MD (mean difference) = 3.99, P < 0.001]. Deceased children of PGD parents were older than those of non-PGD parents (MD = 1.64, P = 0.035) and PGD parents had a shorter duration since the loss than non-PGD parents (MD = -3.26, P = 0.013). Conclusions: PGD is prevalent among Shidu parents. Grief counseling services for Shidu parents would be more effective if they target those who are mothers and have religious beliefs and those whose children died from accidents, lost children are older, and loss occurs more recently.

Factors associated with the depression status of Chinese parents who have lost their only child.

Aim: This study aimed to assess the risk factors for depression among parents who have lost their only child (PLOCs). Methods: We used a cross-sectional survey to reveal the risk factors of depression among PLOCs. Multi-stage, stratified, cluster sampling was used to recruit the participants. The cluster sampling method was used to select PLOCs in Hangzhou, Zhejiang Province, and Wuhu, Anhui Province, while the stratified cluster sampling method was used in Anshun, Guizhou Province. A total of 651 PLOCs were recruited in this study. Participants completed the Social Support Rating Scale (SSRS) and the Geriatric Depression Scale-15 (GDS-15). Socio-demographics were also collected, including age, sex, monthly income, education level, marital status, self-reported health, and a number of diseases were collected as well. Chi-square tests and binary logistic regression were conducted to analyze the influence of these factors on PLOCs' mental status. Results: Two hundred and fifty-eight PLOCs (39.56%) reported depression. Compared to PLOCs living in Wuhu, those living in Hangzhou (OR = 3.374, CI = 2.337-4.870) had a higher risk of depression. Being single (OR = 1.449, CI = 1.019-2.061) and the presence/absence of grandchildren (OR = 0.430, CI = 0.274-0.676)were significantly associated with the depression status of PLOCs. Conclusion: The sampled Chinese PLOCs reported a high prevalence of depression that was influenced by their place of residence, marital status, and presence/absence of grandchildren. This may highlight the need for routine assessment and help of this group by the relevant stakeholders (including government, non-profit social organizations, and professional psychologists) with more attention paid to single and low-income PLOCs that have no grandchildren. It is imperative to build a comprehensive care system of "extended family-community-society-government" for this vulnerable group.

Comparison of educational performance between the only children and children in two-child families.

This paper estimates the causal effect of only-child status on educational performance among junior high school students from only-child and two-child families in China. It uses the dataset of the China Education Panel Survey 2013-14. The results show that the only children's educational outcomes are significantly low than students from two-child families. Only children's willpower and extraversion are weaker than children's from two-child families. The scale economies effect is strong and the resource dilution effect is weak when sibling size is small.

How Does Family Intergenerational Relationships Affect the Life Satisfaction of Middle-Aged and Elderly Parents in Urban Only-Child Families in Chengdu, China.

Over the past 40 years, the implementation of the family planning policy in China has led to the creation of many only-child families. In the process of modernization and urbanization, it is critical to focus on the intergenerational relationships in only-child families and their associational mechanism on the life satisfaction of middle-aged and elderly parents, which has crucial implications for them staying active and healthy aging. Using the survey data from Chengdu, China, this study analyzed the characteristics of only-child parents' life satisfaction and family intergenerational relationships, and explored the associational mechanism of family intergenerational relationships on only-child parents' life satisfaction in urban families, as well as the possible moderating role of gender. The results indicate that there are gender differences in the life satisfaction of only-child parents in urban families, and men are more satisfied than women. Moreover, parents of sons and daughters differ in life satisfaction from the dual-gender perspective. Parents of daughters are likely to have higher life satisfaction, especially mothers. The only-child families have not moved toward nucleation in urban families, and intergenerational members maintain close contact and provide frequent mutual support to achieve individual and family development. There are significant gender differences in structural, associational, affectual, and functional solidarity among only-child. This study confirms that there are differences in the associational mechanism of family intergenerational relationships on life satisfaction in different dimensions. Affectual solidarity is the most influential factor of life satisfaction. In terms of normative and consensual solidarity, gender plays a moderating role. For men, normative and consensual solidarity is beneficial for improving life satisfaction, but it has an insignificant effect on women. The effects of structural solidarity, association solidarity, and functional solidarity are not significant.

Having siblings promotes a more healthy weight status-Whereas only children are at greater risk for higher BMI in later childhood.

BACKGROUND: Birth order and having at least one sibling are known to be associated with an increased risk for development of overweight. However, there are no studies assessing pre- and postnatal factors for developing overweight within families. Therefore, the present study aimed to analyse the association of the mother's weight gain during pregnancy, prepregnancy BMI, mother's age at birth, breastfeeding, age gap between siblings, and physical activity together with sibling-related characteristics on the development of overweight in children and adolescents. METHODS: Data were obtained from the longitudinal LIFE Child cohort. The study sample included n = 1932 children, stratified into first-born (n = 578), second-born (n = 608), third-or-later-born single-born siblings (n = 162), only children (n = 526), and twin children (n = 58). Children with chronic or syndromic diseases, born prematurely or from mothers with gestational diabetes were excluded. Data were adjusted for multiple children per family using mixed models. Pregnancy weight gain, prepregnancy BMI and mother's age were considered prenatal co-variates. Postnatal factors included the duration of breastfeeding and the children's physical activity level. RESULTS: Particularly until the onset of puberty, the BMI-SDS differed between single-born siblings, only children and twins, and increased with birth order. Compared to children with siblings, only children exhibited a strong increase in BMI-SDS starting at age nine. A higher age gap between siblings was associated with a higher BMI-SDS in second- and third-or-later-born children. Single-born siblings had the highest rate and duration of breastfeeding. Physical activity was highest in twins and third-or-later-born children and lowest in only children. In a multivariate model, being an only child showed a highly significant association with BMI-SDS. CONCLUSION: The present study demonstrated that siblings had a lower BMI-SDS than only children did. For single-born siblings, the association between birth order and increased BMI-SDS seemed to persist only up to 11 years of age.