CHILDREN & SOCIETY VOLUME 28, (2014) pp.

404415
DOI:10.1111/chso.12003

Child Well-Being: What Does It Mean?

Gaelle Amerijckx* and Perrine Claire Humblet
CRISS - Research Centre Social Approaches to Health, School of Public Health, Universite Libre de
Bruxelles, Bruxelles, Belgium
The notion of child well-being appears in a large number of publications nowadays. Our
review of the literature underlines both the oddly pathogenic approach to child well-being and
the scarcity of papers discussing a still poorly defined notion. Through this review, we identified the recourse to a binary language; from there, we derived five theoretical axes that heed
the multidimensional and multilevel nature of well-being, although for each one, a pole is here
predominantly developed. We argue in favour of an override of a one-dimensional, single-level,
unipolar approach to child well-being and an exploration of its otherwise underdeveloped
positive, hedonic, subjective, spiritual and collective dimensions. 2013 John Wiley & Sons
Ltd and National Childrens Bureau
Keywords: child well-being, notion, review, social ecology.

Introduction
Well-being is, without doubt, a very appealing notion. This term can now be found
throughout the scientific literature: across disciplines and in an increasingly large number of
publications. Its growing popularity could be partly explained by the breadth and positive
connotations of the term. But beyond such a broad and unscientific observation, we
believe that a more thorough analysis of the phenomenon is required. We seek here to obtain
a clearer picture of the scope of published research on well-being, but with reference exclusively to children. From there, we draw inferences with regard to the significance of what
would constitute child well-being. The questions that we ask, therefore, are: (1) What are
the main issues investigated in the child well-being literature? (2) How is the notion
presented and anchored in papers?
The first section of our article consists of a review of the scientific literature on the notion
of child well-being. The second section is devoted to a discussion of five theoretical axes that
we found emerging in our review of the literature. These axes represent a departure from a
too often one-sided approach to this very wide, complex notion of well-being. Indeed, we
identify predominant poles in the literature for each of these axes.

Materials and methodology

To answer our research questions on the conceptualisation and study of child well-being, we
conducted a literature review by researching five references databases, covering the fields of
both biomedicine and the human and social sciences, in which child well-being is specifically
discussed: PUBMED, OVID, JSTOR, Science Direct and the Web of Science. Within each database, we selected papers having both of the terms wellbeing (with and without a hyphen)
and child in their title. Let us note that our selection strategy of keeping papers holding
specific keywords within the title, aimed at depicting the literature explicitly claiming to
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405

cover the topic, as well as the exclusion of monographs and grey literature, may lead to a
limitation of our conclusions, with respect to the comprehensiveness of the child well-being
literature.
The initial query yielded 394 results. As each database has its own search characteristics, this
query led in some cases to precise, refined results, but, in others, to highly unfocused ones.
This raw figure, of 394 papers, was therefore honed according to two principles: relevancy
child well-being being the actual topic and format only articles were kept.
We then checked for replicas and limited the timeframe to the most productive years: 1991
2010. Seven papers that had been missed in the initial selection were added. In the end, 209
papers remained.

Results
On this set of 209 papers, we operated a first classification based on the three common categories of theoretical, methodological and empirical papers.
Theoretical papers constitute the smallest contribution to our review, with about 3% of the
papers mainly focusing on theoretical approaches to the notion. Methodological papers, for
their part, encompass approximately 15% of the 209 articles. Finally, empirical papers come
out at the top of the league (82%). This last category essentially focuses on determinants
(78%), with an addition of some descriptive analyses of childrens situations.

How is child well-being conceptualised?

The very small number of theoretical papers, i.e. those primarily discussing the very notion
of child well-being, raises concern. This minimal amount is surprising, as there is to date no
consensus on a definition (OECD, 2009). Moreover, most papers within this small batch also
address the issue through a discussion on its measures or indicators.

Multidimensional, did you say?

Although the multidimensional nature of child well-being has long been noted (Pollard and
Lee, 2003), its actual modulation into specific precepts remains uneasy. A discussion on the
five notions of In need, Rights, Poverty, Quality of life and Social exclusion is initiated by
Axford (2009) to underscore the richness and breadth of the child well-being notion through
the complexity of the debates surrounding each of these five notions. Whereas this latter
encompasses all five notions, according to the author, it is, nonetheless, a more far-reaching
concept as it does not simply equate to their sum. In this same perspective, Camfield and
others (2010) plead for a bridging and integrative concept that interests different fields of
research (inter alia political science, philosophy, psychology and sociology) and covers various topics. For them, the diversity of conceptions results from three distinct perspectives in
the scientific literature: well-being as the outcome of a set of domains, a lens that determines
what is seen, or as a process in cultural time (Camfield and others, 2010). The authors
argue in favour of an integrative approach of these three perspectives.

The role of the context

Another aspect of child well-being conceptualisation relates to the role played by the context.
Indeed, this notion is, by nature, context-specific (Camfield and others, 2010). Well-being
is seen by the authors as a process located in historically and culturally specific
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Gaelle Amerijckx & Perrine Claire Humblet

contexts (Camfield and others, 2010). As an example, they underline, in the context
of developing countries, how individual well-being cannot be departed from the relation to
others. This is also underscored by Saith and Wazir (2010). Given that most international
research applies to developed countries, they discuss its relevancy in the context of developing countries, specifically India, and argue against a universalising approach towards child
well-being and an over-intense focus on its material dimensions. Finally, the inclusion of
childrens own perceptions also distances itself from this positivist approach of the conceptualisation of childrens well-being (Fattore and others, 2009).

Measuring child well-being, an ever growing stream of research

General framework
Northern American studies have long dominated this sector of research: this might explain
the two papers devoted to historical developments in child well-being research, solely in the
United States (Land and others, 2007; Lippman, 2007). In the field of psychology, interest in
the study of positive development has grown over the last decade, particularly in the United
States (Moore and Keyes, 2003). In this context, Lippman and others have tried to address
common critics against the so-called softness of indicators of positive outcomes (Lippman
and others, 2009; Moore and others, 2004). Such works are rooted in the strength-based
approach that seeks to underline childrens capabilities to enhance them (Pollard and Rosenberg, 2003).
Major issues in the study of indicators refer to (i) the necessary distinction between subjective (experience) and objective (outcome) measures; (ii) the need for a positive development
approach through the integration of positive indicators in the pool of measures; (iii) the
combination of microdata and population-based data, in a context where the latter monopolise the debate; (iv) the segmentation between contextual measures and child outcome
measures in reaction to a confusion prevailing in some papers; (v) the consideration for
ecological diversity of childrens situations; and (vi) the room for multi-method approaches
(Huebner and others, 1999; Jones and Sumner, 2009; Lippman, 2007; Moore and others,
2008).
As for the political implications of indicator selection, these are more clearly debated in
Suzanne Hoods (2007) paper on London children and in a paper devoted to the European
Union at large (Micklewright and Stewart, 1999).

Data issues
Strategies to develop national sets of child well-being indicators are still scarce and apparently resistant to this rich and positive development approach. The initial ground for the
development of such data sets was to document, at a regional or country level, childrens
situations as well as potential problematic behaviour for them, with a view to developing
appropriate preventive measures and prevention programmes (Moore and others, 2004). It
implied the collection of data on childrens difficulties (morbidity and mortality indicators)
and their causes, for the whole population of children, and on a recurrent basis. Such an
information system being expansive, this could partly explain why, given the narrowness of
available data, empirical research has been enclosed for so long in a very restrictive perimeter of analysis. Indeed, we observed a reverse logic in the discussions over appropriate indicators, in that the data appeared to directly determine the field of discussions, instead of
closing it (Bradshaw and others, 2009; Niclasen and Kohler, 2009; Sawyer and others, 2000).
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At a local level, various scales have been developed; but most focus on specific dimensions,
i.e. physical and psychological (Gaudin and others, 1992; Smith and Brun, 2006) or specific
contexts, i.e. Magura and Moses Child Well-Being Scale as an evaluation tool for a family
services agency (Lyons and others, 1999).

Childrens perspective
Finally, a handful of papers address the feasibility and added-value to research of the integration of childrens perspective on their own situation (Norrby and others, 1999). Child
well-beings subjective nature is thus here more or less given; evidence leading in that direction relates for instance to the discrepancy existing between a populations perspective on
childrens level of well-being and its valuation by official statistics (Guzman and others,
2009). Thus, the object of debates relates to the need for appropriate methods of research
(Crivello and others, 2009).

The empirics of child well-being

Child well-being, a matter of determinants?
A first observation concerns the extremely targeted nature of most of the well-being studies
in this category. In contradiction to the broad and multidimensional approach advocated by
many authors (Bradshaw and others, 2006; Camfield and others, 2010; OECD, 2009; Pollard
and Lee, 2003), the majority of papers develop only one dimension or aspect. We classified
papers on the basis of their central topic, through an inductive analysis of the material.
Among these topics, health factors (i.e. health problems, health history and various types of
health-related behaviour), family factors (i.e. family structure, family history, intra-household
relationships and parents behaviour towards children), economic factors (i.e. parents work
and socioeconomic status, and families level of affluence) and political factors (i.e. social
and welfare policies) were particularly widely discussed.
To further structure this analysis and make explicit the different levels of determinants actually considered in the literature, we used Bronfenbrenners (1979) theory of Ecology of
Human Development and its structure resting upon four distinct levels of micro, meso, exo
and macro systems. Indeed, this comprehensive and context-specific model enables us to
cover and organise all issues affecting individuals (Figure 1).
We observed a high concentration of papers on microsystems (about 65% of the category)
the environments in which children directly participate with a special focus on the

Figure 1. Levels of factors influencing childrens wellbeing.

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Gaelle Amerijckx & Perrine Claire Humblet

family/home environment. If we look more closely, it appears that most of these papers
focus on problems or harmful dynamics occurring within the family context. The analysis
of families virtuous characteristics and dynamics is overlooked: the main examples would
be couples divorces or separations (Amato and Cheadle, 2005; Amato and Keith, 1991;
Cudina and Obradovic, 2001; Morrison and Cherlin, 1995; Yongmin and Yuanzhang,
2002), parental conflicts (King and Heard, 1999; Vandewater and Lansford, 1998), fathers
absence (Bzostek, 2008; Perloff and Buckner, 1996), parents substance abuse (Lundgren
and others, 2007; Osborne and Berger, 2009), parents incarceration (Geller and others,
2009) or parents (physical or mental) health problems, impairments or disabilities
(Annunziato and others, 2007; Luoma and others, 2001; Prilleltensky, 2004). This list portrays a rather dark vision of modern families and their contributions to child well-being,
thereby bearing out the theory of family decline (Houseknecht and Sastry, 1996). If we
add to the list childrens health problems (Brandow and others, 2010; Keilmann and others,
2007), and child abuse (McPhedran, 2009; Perlman and Fantuzzo, 2010), we can see that a
good deal of attention is being devoted at the microsystems level to studying aspects,
which adversely affect children.
Attention paid to the impact of the community is quite exceptional in this regard. Indeed,
these studies also consider positive outcomes for children (Bradley and Lowe Vandell, 2007;
Ferguson, 2006; Reynolds and others, 2003).
The few references we found in relation to mesosystems (about 5%) which comprises the
inter-relations between microsystems follow a more complete pattern of analysis. A broad
set of characteristics of the community including its virtuous characteristics of the
direct environment, or of the neighbourhood in which children live, are considered. The
characteristics of the child, his/her family, the various services available, and his/her neighbourhood are examined altogether, for their part in shaping child well-being. This approach,
placing the individual at the centre of his/her environment, refers back to health promotion
(Alperstein and Raman, 2003) and socio-ecological studies (Kohrt and others, 2010), which
both share an interest in communities participation in the shaping of childrens lives (Gill,
2008).
Studies falling into the category of exosystems (about 8%) which concern environments
wherein children do not participate, but that affect them nonetheless for their part, are
centred on the analysis of economic factors that affect families with children, and the way
in which these factors influence child well-being. This group includes the study of one or
both parents work statuses and schedules on the one hand (Hsueh and Yoshikawa, 2007;
Dunifon and others, 2005; Secret and Peck-Heath, 2004; Strazdins and others, 2004), as well
as the financial position of the household, on the other. Economic inequalities between children and their impact on child well-being are reserved for rich countries (Ozawa and others,
2004; Pickett and Wilkinson, 2007). A significant number of authors adopted a longitudinal
perspective to see how the duration (or instability) of a situation, rather than solely its nature, would affect children (Pedersen and others, 2005; Vogt Yuan, 2008).
As for macrosystems (about 23%) the broad environment that cut across all systems
we mainly found research into policies addressing certain types of households with children:
single-parent families, households on low income or living in poverty, welfare recipients
(Dunifon and others, 2006; Lee, 2009; Wu, 2008). This dovetails with our observation
concerning the concentration of papers on problematic issues, but it might be merely
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circumstantial here, as most research covers countries (i.e. UK, USA) where policies target
underprivileged families or are antipoverty instead of following a universalistic approach to
social provision. Nevertheless, the main angle of investigation concerns the cost-effectiveness
of government measures, and not so much the actual assessment of populations well-being.
Many of these publications focus on the nature and effects of child support policies (Barham
and Devlin, 2003; Bartfeld, 2000; Pirog-Good, 1993; Rettig and others, 1991). In particular,
some studies focus on childcare subsidies (Brooks, 2002) or analyse the impact of a universally accessible childcare system on family well-being and in relation to mothers work
(Baker and others, 2008).
In parallel, a few papers discuss the pros and cons of social policies as regards the work/life
balance for families, a trendy issue in European countries. These policies comprise leave periods (Bergmann, 2008; Galtry and Callister, 2005) and working conditions (Gennetian and
Morris, 2003; Kalil and Dunifon, 2007; London and others, 2004). As such, child well-being
is seen as the antithesis of mother well-being, or at least authors focus on the impact of children on womens labour market participation in relation to gender issues.

Child well-being factsheets

The interest for international comparisons has grown strong these last few years, in the line
of UNICEF reports (Dijkstra, 2009). Although few in number, the papers considered here
matter as they more broadly participate in the advocacy of childrens rights around the
world. Unfortunately, these works rest mainly on the combination of population indicators
(Richardson and others, 2008).1 As such, the analyses have limitations in their capacity to
offer a refined description of childrens diversity of situations, at a local level and on an
individual basis. Furthermore, they usually rely on existing data. As a result, we find many
studies perpetuate an analysis of child well-beings negative aspects. A related perverse effect
is the emergence within the public opinion of a pessimistic vision about the youth and its
future prospects (Moore and others, 2004).

Five structural theoretical axes

After reviewing this CWB literature, we revert to our second research question: the notion
of CWB itself. As previously discussed, little literature is devoted to it and no consensus
prevails around it. In keeping with a rich and complex approach to child well-being, where
it cannot be narrowed down to the study of a single aspect of a single dimension, we
attempted to gather and make explicit a structure taking account of its multidimensional
and multilevel nature. Our starting observation of this literature was the binary language
commonly used throughout the papers. Our purpose was then to identify the main binary
axes covered in our literature and try to make sense and order of it. We have unfolded
five axes.

Axis 1: positive versus negative

Although the term well-being has a rather positive connotation, it is, nonetheless, doublesided, in that there is a duality between the positive and negative manifestations of wellbeing. As has become plain, most studies investigate mainly the negative manifestations of
well-being; some even study it exclusively, following the pathogenesis model. Nonetheless,
interest in the study of positive development has grown over the last decade, as we have seen
(Moore and Keyes, 2003).
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Gaelle Amerijckx & Perrine Claire Humblet

Axis 2: objective versus subjective

The notion of well-being contains another duality, most obvious in relation to its measurement: a distinction between subjective and objective measures of well-being (Axford, 2009;
Camfield and others, 2010; Lippman, 2007; Pollard and Lee, 2003). Although most research
projects present a panel of objective measures, this objectification does not take account of
the inner subjectivity of well-being. Indeed, its subjective nature has been demonstrated
through the discrepancies existing between peoples perception of childrens circumstances
and childrens perception of their own circumstances, thereby defending the integration of
childrens own perspective (Ben-Arieh and others, 2009; Fox and others, 2008; Guzman and
others, 2009).

Axis 3: state versus process

Whereas some consider well-being as a current state, others see it more as a process. This
dichotomy has been described in the literature (Carlisle and others, 2009; Jones and Sumner, 2009; Ryan and Deci, 2001) as a hedonic vision, in the former case, where the here
and now is what matters, in the same line as the Convention on the Rights of the Child
(UN, 1989). In the latter case, the eudemonic vision considers a larger timeframe, which
can encompass a lifetime. The dichotomy is particularly meaningful when considering a
child population, as many discourses on childhood revolve around the notion of investment in childhood.

Axis 4: material versus spiritual

Well-being can also be characterised by its material aspects as opposed to its more spiritual
ones. The former are discussed here extensively as concerns access to financial, health,
educational and family resources, or the lack thereof. And this has a good deal to do with
the underlying societal model surrounding these studies. Thus, Well-being is now a highly
valuable and valued commodity in Western consumer culture and is heavily and cleverly
marketed (Carlisle and Hanlon, 2008). In a discussion based on appropriate indicators in
the context of India, the predominance of the developed countries model has been highlighted and the need for a new model adapted to the developing countries argued for (Saith
and Wazir, 2010): the call for a rethink of the content of the notion of well-being is based
on macroeconomic factors. Nevertheless, in a context of high migration flows and growing
socioeconomic inequality, peoples perspectives on this matter may differ more than are presumed. Whether as a form of dissidence or as an alternative to the main model, more people
are keen to consider non-material aspects as an integral part of their balance (Carlisle and
others, 2009; Mark and Lyons, 2010).

Axis 5: individual versus community

Well-being can finally be defined by the amount of individualisation of a community, which
emphasises more or less strongly the role played by a collective group in individuals lives.
This issue has been discussed in the following terms by Izquierdo (2005), with regard to the
Matsigenka people of the Peruvian Amazon: To what extent is well-being thought of in
individual terms, and to what extent is it conceived of as a matter of belonging to entities
beyond the self? The results of her investigation showed that Matsigenka people link wellbeing with positive and nurturing interpersonal social relations; providing for the family;
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sharing; controlling anger, disputes and jealousy; being free of illness; and () traditional
ways and values as symbols of goodness and happiness (Izquierdo, 2005). Although the
characteristics of this fieldwork are unique, and one cannot expect similar results in all
contexts, we can, nevertheless, speculate that they might apply, to some degree, to other less
unique contexts. As has been shown in some research on health and well-being concepts
seen by stakeholders in a Health Inequalities Programme in the UK, similar concerns for the
collective dimension of well-being do exist (Cameron and others, 2006). The predominance
of psychology and economics in the field of research on well-being may partly explain why
this collective dimension has scarcely been investigated as yet. As we have seen, there are
few papers on the exo- and macrosystems of childrens environments, and most attention has
been devoted to individual processes, mainly in the family context. But another explanation
lies in the much more individualistic nature of western societies, with less attention being
devoted to broader social and community relationships (Carlisle and others, 2009).
In conclusion to this section, one of our main findings regarding the literature reviewed is
the salience of one pole for each axis. The negative, eudemonic, objective, material and individual approaches to child well-being predominate over its positive, hedonic, subjective,
spiritual and collective dimensions.

Conclusion
The debate on this very complex notion is still a developing field of research. A step towards
a global perspective on the study of child well-being would reside, in our view, at the
junction of our five theoretical axes. As such, this proposition of theoretical framework
implies that, for each research, a specific combination of positioning on each one of the five
axes could and should apply. We thus argue in favour of overriding a one-dimensional,
single-level, unipolar approach to child well-being, and for further development of its
positive, hedonic, subjective, spiritual and collective dimensions.

Acknowledgements
This work was supported by the Institut dencouragement de la Recherche Scientifique et de
lInnovation de Bruxelles, en Belgique [PRFB 2011-126]. We thank Tullia Musatti of the Istituto di Scienze e Tecnologie of the Consiglio Nazionale delle Ricerche (Rome, Italy) for her
precious comments on various earlier versions of this text.

Note
1 Let us underline the evolving perspective of the UNICEF in this area, one that has been
developed through various reports, but which does not appertain to this review.

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*Correspondence to: Gaelle Amerijckx, CRISS - Research Centre Social Approaches to Health, School of Public
Health, Universite Libre de Bruxelles, Route de Lennik 808 CP596, B-1070 Bruxelles, Belgium, Tel.:
+32 2 555 40 91; Fax: +32 2 555 40 49. E-mail: gaelle.amerijckx@ulb.ac.be

Accepted for publication 11 August 2012

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CHILDREN & SOCIETY Vol. 28, 404415 (2014)