Previous research has found that the presence of grandparents, particularly grandmothers, is often positively associated with child survival. Little research has explored the potential mechanisms driving these associations. We use data from rural Guatemala to test whether contact with and direct investment (advice and financial) from grandparents is associated with child health, proxied by height. Our results demonstrate the complexity of family relationships and their influence on child health, suggesting that both cooperative and competitive relationships exist within the family. The clearest evidence we find for grandparental influence is that having a living paternal grandmother tends to be negatively associated with child height. By contrast, contact with maternal kin appears broadly to be beneficial for child height, although these relationships are weaker. These patterns are mirrored in maternal body mass index, suggesting grandparental influence acts partly through maternal health. These findings support the hypotheses that, under conditions of limited resources, family relationships may be competitive within the family lineage which shares the same resource base, but cooperative when there are few costs to cooperation. Finally, financial assistance from maternal grandfathers is positively correlated with infant length but negatively with the height of older children, perhaps because the receipt of financial support is an indication of need. The provision of advice shows no associations with child height.