How fathers’ positive engagement and caregiving can support child mental health

Approximately 20% of Australia’s population is made up of fathers (McCrindle, 2023); that is, male-identifying people who care for and are committed to the wellbeing of a child, regardless of their biological relation, living situation or marital status (Tully, 2019). Most children in Australia will have a relationship with their father or a father figure (e.g. a stepfather, uncle, grandfather, adoptive father), which will shape their lifelong health and wellbeing. Fathers play a vital role in their child’s health and development (Cabrera, Fitzgerald, Bradley, & Roggman, 2014). However, much of what is known about parent–child relationships has been based on mother–child relationships, which may differ from how fathers and their children interact (Cabrera, Volling, & Barr, 2018). As fathers continue to be more involved in the lives of their children, there is an increased need to understand how fathers can positively support their children’s mental health.

In this resource, we summarise the evidence on how fathers can positively affect their child’s mental health through engagement and caregiving activities. We also provide some suggestions as to how professionals working with children and families can encourage and support positive engagement from fathers. This resource largely discusses the experiences of cisgender, heterosexual fathers, as the vast majority of available research literature focuses on this type of father. However, we acknowledge that practitioners may also work with fathers and non-birthing parents who may be gender diverse or don’t identify as a ‘father’.

Men’s role as fathers has changed over time. In recent decades, Australian men have become increasingly involved in providing childcare when compared to previous generations; this has come at the same time as women’s participation in the workforce has grown. Australian fathers spend more time with their young children compared to their generational counterparts in the 1970s–80s (Craig & Mullan, 2010; Rubiano Matulevich & Viollaz, 2019). Fathers are often no longer solely perceived as ‘breadwinners’, but as actively contributing to ‘hands on’ parenting duties, such as nurturing, feeding and bathing their children. These shifts offer new opportunities for fathers to directly support their children’s health and wellbeing.

Fathers can influence children’s health and wellbeing by being directly involved with them through activities such as reading, caregiving and playing (Cabrera et al., 2014; Pleck, 2010). Fathers can also influence children’s health and wellbeing indirectly through behaviours and interactions that can transform the environment around the child, such as supporting mothers, completing household duties, booking appointments for their children, and purchasing goods and services that can help meet a child’s needs (Cabrera et al., 2014). Both direct and indirect involvement are critical to children’s development and wellbeing, and there is no single way that fathers should support their children’s health and wellbeing.

This resource specifically explores research evidence on the influence of fathers’:

• positive engagement activities
• indirect care; and
• process responsibility on child mental health.

Positive engagement activities are direct behaviours and are defined as interactive or enriching activities that likely promote development in children (Pleck, 2010). Indirect care and process responsibility are indirect behaviours. Indirect caregiving includes caregiving activities done for the child that don’t involve direct interaction with the child (Pleck, 2010). Process responsibility (referred to going forward as responsibility for planning and organising) involves monitoring the child’s needs and taking initiative to ensure that those needs are being met (Pleck, 2010).

Other elements of father’s involvement with their children (i.e. warmth and responsiveness; monitoring and discipline) are outlined in separate, complementary resources later under Further reading and related resources.

Overall, the evidence suggests that fathers’ participation in positive engagement activities supports child mental health and in particular it has been associated with decreasing child behavioural difficulties.

There are a variety of positive engagement activities that fathers can engage in with their children, such as:

• direct caregiving of children
• playing with children
• reading and telling stories to children
• doing arts and crafts together
• taking the child on an outing
• talking with the child; and
• helping with homework.

There is strong evidence from the United States (US) and the United Kingdom (UK) that fathers’ positive engagement supports child mental health. Research studies in these contexts have found that the children of fathers who participate in more positive engagement activities (compared to fathers who engage in fewer or no positive engagement activities), experience lower levels of:

• behavioural difficulties (Emmott & Mace, 2021; Lee & Schoppe-Sullivan, 2017; Slaughter & Nagoshi, 2020; Twamley, Brunton, Sutcliffe, Hinds, & Thomas, 2013)
• externalising mental health challenges (e.g. aggression, rule-breaking, antisocial behaviour) (Gold, Edin, & Nelson, 2020); and
• internalising mental health challenges (e.g. anxiety, depression, withdrawal) (Gold et al., 2020).

The research is not entirely clear as to how and why fathers’ engagement impacts child mental health, but there are likely multiple reasons. One possible explanation is that fathers’ positive engagement helps to form a secure attachment between the child and father, which in turn can reduce the risk of internalising mental health challenges (Cabrera, 2020; Lee & Schoppe-Sullivan, 2017). ‘Attachment’ in this sense is an emotional bond between a caregiver and child, and can influence a child’s social, emotional and cognitive development (McLean, 2016). Fathers’ positive engagement may also encourage children to be curious and to safely explore their environment (Lee & Schoppe-Sullivan, 2017). This may help children develop strong emotional and behavioural regulation skills, which could reduce their risk of externalising mental health challenges (Lee & Schoppe-Sullivan, 2017).

Evidence of the impact of fathers’ positive engagement on child mental health is robust, as many relevant studies have used data from large population studies that observe children and families over time (Emmott & Mace, 2021; Gold et al., 2020; Lee & Schoppe-Sullivan, 2017; Slaughter & Nagoshi, 2020; Twamley et al., 2013). These study designs help to produce high-quality evidence and create greater confidence that the observed factors are related. They allow us to monitor whether one of the examined factors (i.e. fathers’ behaviour) happened and was measured before the other factor (i.e. changes in child mental health) occurred (Australian Institute of Family Studies, n.d.).

The impact of fathers’ positive engagement on child mental health may differ by family and child factors, such as socioeconomic status (SES) and a child’s sex. There is some evidence that fathers’ positive engagement may help protect children against the impact of a lower SES on child mental health. Lee and Schoppe-Sullivan (2017) conducted a study of 762 families in the US. They found that children from families experiencing a lower SES were more likely to have externalising mental health challenges than children from higher SES families. However, when fathers participated in positive engagement activities, this protected children in lower SES families from experiencing externalising mental health challenges to some extent.

There is also mixed research evidence for whether the effects of fathers’ engagement on externalising behaviours is different for boys as opposed to girls. There is some research that suggests that there are differences in the way fathers engage with boys and girls. For example, fathers are more likely to engage in physical play and activities with boys, whereas they’re more likely to read stories and sing songs with girls (Leavell, Tamis-LeMonda, Ruble, Zosuls, & Cabrera, 2012). In their analysis of 2,236 families in the US, Slaughter and Nagoshi (2020) found that fathers’ positive engagement was associated with lower externalising behaviours in girls and lower delinquency (i.e. antisocial or illegal behaviour) in boys (which was examined separately from externalising behaviours in the study). However, Emmott and Mace (2021) did not find any difference in the impact of fathers’ positive engagement on child behavioural difficulties for boys compared to girls.

An absence of fathers’ positive engagement may be associated with child mental health challenges. Ramchandani et al. (2013) found that children of fathers who were distant (e.g. uncommunicative) or disengaged were more likely to have externalising mental health challenges. As this study had a small sample of fathers, all of whom were experiencing some kind of distress, more evidence is needed to confirm this finding. However, taken with the evidence previously outlined, this may suggest that child mental health is influenced by both the presence and absence of positive engagement activities.

Although the vast majority of evidence indicates that there are benefits to fathers’ positive engagement, a small number of studies found no connection between positive engagement and child mental health (Flouri, Midouhas, & Narayanan, 2016; Green, Rubio, Rothblum, Bergman, & Katuzny, 2019; Kroll, Carson, Redshaw, & Quigley, 2016). It’s expected in research for some studies to have contradictory findings. These differences occur for many reasons including: how, when and where the studies were conducted; and by chance. Because of this, it’s important to consider what a body of evidence says overall, rather than relying on one study.

Indirect caregiving, and responsibility for planning and organising, describe physical and mental activities done to care for a child.

• Indirect caregiving includes activities done for the child such as purchasing and arranging goods and services or booking doctor appointments (Pleck, 2010).
• Responsibility for planning and organising (also known as process responsibility) is the mental work done to manage the child’s life and wellbeing, such as planning, organising and keeping track of the child’s needs to ensure that they’re being met (Pleck, 2010).

We know less about how fathers’ indirect caregiving or taking responsibility for planning and organising can influence child mental health, as less research has been conducted on these types of father involvement compared to positive engagement. The studies that have examined these elements of fathers’ involvement have produced mixed results. One study found that fathers’ indirect care, such as shopping, cleaning and cooking, was associated with decreased child depressive symptoms (Opondo, Redshaw, & Quigley, 2017). In contrast, other studies have failed to find an association between father’s indirect caregiving or taking responsibility for planning and organising on either child problem behaviours (Kroll et al., 2016; Opondo, Redshaw, Savage-McGlynn, & Quigley, 2016) or prosocial behaviours (Kroll et al., 2016).

However, there is some evidence from the US that suggests that when fathers participate in both positive engagement activities and indirect care their children experience:

• fewer behavioural difficulties (Choi, Kim, & Kunz, 2018; Leon, Jhe Bai, & Fuller, 2016); and
• more prosocial behaviour (i.e. doing things to benefit someone else, such as sharing with others) (Gryczkowski, Jordan, & Mercer, 2018).

These mixed findings highlight the need for further studies that can provide detailed insights into how children’s health and wellbeing may be shaped by a father’s indirect caregiving or taking responsibility for planning and organising.

Making sense of the evidence

There are still many gaps in the evidence for the impact of fathers’ indirect caregiving and taking responsibility for planning and organising on child mental health. However, this lack of evidence doesn’t mean that fathers’ involvement in their children’s care isn’t important or beneficial for child health and wellbeing – just that the evidence is still emerging.

As with many studies of behaviour, it can be very difficult to pinpoint the specific contribution of individual behaviours to child mental health. It’s also not always possible for researchers examining parenting behaviour to account for all possible influences on a child’s mental health. For example, the evidence described in this resource often examined the connection between one type of fathering behaviour and one child mental health outcome at a time. Although this makes sense when trying to research an association between a particular behaviour and an outcome, fathers’ positive engagement or indirect caregiving does not happen in isolation from other parenting behaviours. The family and community environment that a child grows up in can also impact their mental health and wellbeing (Cabrera et al., 2014). As such, parenting behaviours such as positive engagement or indirect caregiving are likely to contribute to positive child outcomes when they are undertaken in an environment where the child is safe and their basic needs are also being met.

Although this resource explored the relationship between fathering behaviours and child mental health outcomes, there is also evidence of other positive outcomes that arise from fathers’ being involved in their children’s care that go beyond direct benefits to child mental health but can still affect child wellbeing. These can include improvements in maternal health and the marital relationship (Diniz, Brandao, Monteiro, & Verissimo, 2021). For example, mothers whose male partners are involved in parenting and caregiving are also more likely to have better relationships with their children (Allen & Daly, 2007). As such, it’s likely beneficial for the wellbeing of children and their families to include both mothers and fathers in practice and programs for parents (Cabrera et al., 2018).

Given that there is strong evidence for the benefits of fathers’ positive engagement for child mental health, there’s also likely to be value in professionals who work with families facilitating such father–child relationships. Evidence suggests that the following considerations and approaches may help practitioners to be more aware of, and support fathers to have, positive engagements with their children.

Consider how services and programs can be more inclusive of fathers

• Reflect on how inclusive your services or programs are for parents of all genders and for diverse families. Mothers are still often viewed (in practice and research) as the default primary caregivers. Fathers are often viewed as secondary caregivers who are less engaged in day-to-day parenting (Cabrera et al., 2018). Consider whether there are practices or policies in your organisation that assume that mothers are the default primary caregiver and consider whether there are changes that can be made to challenge this default (e.g. not automatically assuming that the mother is the best person to be the primary contact for a child).
• Intentionally engage with fathers in your practice and programs. There is evidence that fathers are less likely than mothers to be engaged in child services (Maxwell, Scourfield, Featherstone, Holland, & Tolman, 2012), and only constitute approximately 20% of parents who attend parent intervention training (Fletcher, Freeman, & Matthey, 2011). Practitioners who want to engage with fathers in their services may need to include a targeted call for fathers to attend. Guidelines and tips for father-inclusive practice are provided in the Further reading and related resources section of this resource.

When speaking with fathers about their families and children, practice curiosity and explore who’s responsible for caregiving tasks with families

• Talk to families about who undertakes different parenting and caregiving tasks, and where they could be supported. Although fathers are more involved in the care of their children than previous generations, women generally remain disproportionately responsible for caregiving and other household duties, particularly responsibility for planning and organising (Carroll & Baxter, 2022; Dean, Churchill, & Ruppanner, 2022).
• Speak with fathers about their parenting behaviour. Practice curiosity with fathers and ask about what direct and indirect things they do for or with their children. Fathers can sometimes undervalue the indirect things they do for their children, so reinforcing the importance of these types of behaviours can promote good rapport between service providers and the parents who access their service.
• You can take a strengths-based approach (King, 2005) by highlighting things fathers are already doing to support their children’s mental health and wellbeing. Adopting a deficit-based approach may inadvertently lead to feelings of parental guilt or shame and may lead to disengagement from the service.

Support fathers to positively engage with their children and continue increasing your own and families’ knowledge about the benefits of fathers’ involvement

• Speak with families about the benefits of fathers actively engaging with and caring for their children on their children’s mental health. Encourage fathers to engage in behaviours that are likely to support child mental health.
  • You can highlight that when fathers engage in positive, quality time with their children, it may protect children from mental health challenges. This can include fathers engaging in activities such as play, caregiving, reading and telling stories, doing arts and crafts together, talking with children, helping with homework, and taking their children on an outing.
  • You can also talk about how there is evidence that when fathers engage in higher levels of both positive activities and indirect care (e.g. organising appointments for their children) it can also improve their children’s mental health.
• Share evidence-based resources with fathers and refer fathers to relevant support programs where needed. Resources and programs for fathers are provided in the Further reading and related resources section of this resource.
• Continue learning about best practices to engage with fathers and how father involvement can impact child mental health. Practitioners can also share these learnings and practice experiences with other practitioners and colleagues to increase their knowledge and awareness.

Fathers play an important role in supporting the mental health of their children. When fathers participate in positive and interactive activities with their children, it can be protective against mental health challenges. We currently know much less about the impact on child mental health of the indirect activities that fathers do to care for their children, but there is some evidence that when fathers participate in both positive engagement activities and indirect care, their children may experience fewer mental health challenges and be more likely to engage in prosocial behaviours.

Child and family practitioners and services can intentionally engage with fathers and families to help them support their children’s mental health. They can support families by making their services inclusive of all parents and explore with families who is usually responsible for different parenting and caregiving tasks. Practitioners and services can also speak with fathers about their fathering and encourage fathers to engage in behaviours that are likely to support child mental health.

Emerging Minds resources

The following Emerging Minds resources are suitable for practitioners working with and supporting fathers.

• How fathers’ warm and responsive parenting can support child mental health
• How fathers can positively influence children’s mental health through play
• How fathers can support child mental health through setting limits and managing behaviour
• Supporting fathers’ mental health in the perinatal period
• The impact of paternal positivity on child mental health is a short article summarising the findings of a meta-analysis on paternal positivity and child mental health.
• Enhancing father engagement in parenting programs: A challenge for practitioners and policymakers is a short article examining how to improve father engagement in parenting programs.
• The webinar Supporting fathers’ mental health during the perinatal period, provides insights from research, practice and lived experience on fathers’ mental health in the perinatal period.
• The webinar Engaging fathers and their children explores practices that make it possible for fathers to discuss their children’s social and emotional wellbeing with health professionals.
• In focus: Parent–child relationships summarises the importance of positive parent–child relationships for child wellbeing and child-aware and parent-sensitive practice, and suggests related resources.
• Engaging fathers in early childhood services discusses how practitioners can engage fathers in early childhood services.
• The podcast episode Supporting dads in their role as fathers explores practical ways in which services and practitioners can make fathers feel more included.
• Inclusive practice with rainbow families is a podcast episode that explores how to make your practice and organisation more inclusive of rainbow families.
• The Rebuilding our shields: Sharing the stories of deadly dads online course is for non-Indigenous practitioners to develop their understanding and connection points when supporting Aboriginal and Torres Strait Islander fathers, children and families.
• The Supporting children’s mental health when working with separating parents online course is designed for practitioners to support them in making children’s wellbeing a central aspect of the conversations they have with parents who are going through separation or divorce.

Other resources

Practitioners can also consider sharing the following external resources with fathers.

• The Raising Children Network has plain language resources for fathers on getting involved with their children and fathers’ health and wellbeing.
• Dads Group is a not-for-profit organisation that runs local fathers groups.
• The Fathering Project is a charity that runs programs to help support fathers.
• DadSpace is a service developed by the Parent-Infant Research Institute to provide support for the emotional wellbeing of new or expectant fathers.
• SMS4dads is a free text messaging service to support new or expectant fathers in their role as fathers and increase awareness of their influence on their child’s brain development. There is also Deadly Dads, a free SMS service for new and or expectant Aboriginal or Torres Strait Islander fathers.

This resource was developed as part of a series of resources based on a rapid literature review of research articles on fathering and child mental health. As part of this review, the authors searched for terms relating to fathering, child mental health, and prevention/association in databases Medline, PsycInfo and Web of Science from 1 January 2012 to 30 May 2022. The included relevant peer reviewed literature:

• examined the association between fathering behaviours when the child was aged <12 years and child mental health
• was published in English; and
• was conducted in high-income, English-speaking countries.

The scope and resources from the review were informed by a consultation process involving 14 practitioners, service leaders and researchers who are experts in parenting, fathering, and men’s and children’s health. Insights from the consultations were used to guide the scope and resources from the review.

The rapid literature review and related resources are informed by Pleck’s (2010) father involvement framework which contains the following:

• positive engagement (e.g. direct caregiving, play, educational activities)
• indirect care (e.g. making a medical appointment for the child)
• process responsibility (referred to as responsibility for planning and organising; e.g. being the primary caregiver for the child)
• warmth and responsiveness (e.g. hugging and showing affection); and
• control (e.g. setting limits on amount of screen time).

The authors would like to thank Dr Mandy Truong for her help with screening and data extraction for the rapid literature review that informed this resource, and Hilary Miller for their review and feedback on the development of this resource.

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