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Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

During the first years of a baby's life, parents develop ways of caring that affect the child's health later in life. In this paper, we focus on eating and sleeping, as social practices that mediate between socioeconomic and cultural conditions and health outcomes, such as weight status. We argue for an analysis of what we call 'family health competence', meaning emerging know-hows and resources relevant to healthy living produced, embodied and shared by household members, to understand the development of health practices of first-time parents and their children. In an ethnographic panel study in the Netherlands, we follow households pre-birth until the first child turns age four. Our analysis suggests that across different families, competences develop enabling parents to balance a) attaching and b) detaching in particular ways. Parents learn how to observe and interpret their new-borns, bracket doubt, build trust, manage time pressures and mobilize support networks. These competences are partly class and gender-specific while there is also significant diversity within class and gender. The competence to balance attachment and detachment can be understood as the effect of contradictory social norms and institutional (labour market and care) provisions typical for late-modern welfare states. • Eating and sleeping practices mediate between social conditions and health outcomes. • 'Family health competences' are emerging know-hows and resources. • Families develop competences to balance attaching and detaching in particular ways. • These ways are partly class and gender-specific, but show within-group diversity. • Families deal with contradictory social norms and labour market and care provisions. [ABSTRACT FROM AUTHOR]