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Large-scale migration has reshaped children’s living arrangements with their parents, yet evidence on how distinct childhood residential configurations influence health in adulthood remains limited. Integrating a life-course perspective with a relational spatial approach, this study examines how variations in parental co-residence and spatial stability during childhood are associated with adult self-rated health. Using retrospective life history data from a national survey of rural-origin adults in China, we distinguish four childhood experience types: only left behind (OLB), both left behind and migrated (LBM), only migrated (OM), and neither left behind nor migrated (NLBM). Regression analyses reveal a clear health gradient across these configurations. Adults who were only left behind report the poorest health, followed by those who experienced both left-behind and migration episodes, those who were only migrants, and those with no childhood mobility or left-behind experience. Parent-child relationship quality is positively associated with adult health overall. However, its protective effect is significantly weaker among individuals who experienced childhood left-behind arrangements (OLB and LBM) compared to those with continuous parental co-residence (NLBM). Moreover, this differential moderating pattern is observed only among males. Theoretically, this study advances life-course health research by explicitly linking temporal processes with geographic space. It demonstrates that sustained disruptions to everyday parental co-residence, rather than mobility itself, constitute a central pathway through which childhood environments generate long-term health inequality.