In order to capture the dynamic nature of teaching reading and writing in primary grades in Macao, China, an interview-based qualitative approach was used in this study. Fifteen grades 1–3 Macao Chinese language teachers from nine private schools which included Chinese, English, and international schools were interviewed. The study revealed that the participants adopted a balanced approach to teaching Chinese reading and writing, although what they focused on varied; PIRLS affected reading instruction; limited word recognition reduced reading and writing performance; limited time was arranged for teaching writing compositions; and reading and writing were influenced by institutions, society, culture, and policies. Because school regulations shape instructional practices, it is urgent to do research on how to balance reading and writing instruction through school-based curriculum development.