This study examines how intergenerational exchanges affect elders' choice of preferred care-givers in the case of sickness among adult children in rural China. The sample derived from a four-wave longitudinal study in Anhui Province, China, based on which we constructed three time intervals (i.e. 2001–2003, 2003–2006 and 2006–2009) and stacked them. Our working sample included 10,181 observations from these three stacked intervals, representing 4,927 children with 1,170 elder parents. We used fixed-effects logistic regression to predict elders' favouritism among their children. Results show that those children who received more help with grandchild care from parents, who provided instrumental support to parents and whose spouses provided instrumental support to parents were more likely to be named the preferred care-givers. On average, parents favoured sons. For mothers, this favouritism was completely explained by proximity and intergenerational exchanges, and even reversed under certain circumstances. For fathers, this favouritism of sons was partially explained by proximity and intergenerational exchanges. Migrant children were less likely to be preferred care-givers. This effect was moderated by elder parents' help with caring for grandchildren. Particularly, mothers favoured daughters over sons if the above moderation effect was considered. We discuss these findings in the context of social changes including increased importance of daughters in elder parents' support networks and the large-scale rural to urban migration.