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Grandparents: Raising their children's children, they get the job done

November 02, 2018

ORLANDO, Fla. - Millions of children are being raised solely by their grandparents, with numbers continuing to climb as the opioid crisis and other factors disrupt families. New research being presented at the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition shows that caregivers who step up to raise their grandchildren are overcoming unique challenges to manage just as well as biological and adoptive parent caregivers.

The study abstract, "Grandparents Raising Grandchildren: Are They Up to the Job?" will be presented on Monday, Nov. 5, at the Orange County Convention Center in Orlando, Fla. The study is the first to examine a nationally representative sample of children and directly compare households where children are being raised by their grandparents with those being raised by their parents.

"A large and increasing number of mothers and fathers aren't able to meet the responsibilities of parenthood, prompting their own parents to take on the primary caregiver role for their grandchildren," said senior author Andrew Adesman, MD, FAAP, Chief of Developmental and Behavioral Pediatrics for Cohen Children's Medical Center of New York. "Although these children are more likely to have endured one or more adverse childhood experiences and the grandparents themselves often face extra health and socioeconomic hurdles, our findings suggest they appear to be coping well."

The researchers analyzed and compared 2016 National Survey of Children's Health data from 44,807 parent-led households and 1,250 grandparent households. They determined that caregivers raising their grandchildren were more likely to have a greater number of physical and mental health problems, have household incomes at or below the federal poverty line, have lower levels of education, and be single.

In addition, the grandchildren they were raising were more likely to become angry/anxious with transitions, lose their temper and have other behavioral issues.

"This was not surprising, since we know that children in non-parental care are likely to have experienced more adverse childhood experiences and have an increased risk of behavioral problems as a result," said abstract co-author Sarah Keim, PhD, Principal Investigator at Nationwide Children's Hospital.

However, Keim said, grandparents and parents showed no difference when asked if the child "does things that really bother" them, is "harder to care for" than peers, or if they "felt angry with this child." In fact, grandparents and parents did not differ on most measures of parent coping, parenting stress, or caregiver-child interactions when stratified by child health and child age.

The study also found that a substantial proportion of both grandparent caregivers (31 percent) and parent caregivers (24 percent), reported that they did not have anyone "to turn to for day-to-day emotional support with parenting."

"Given that children being raised by their grandparents may pose greater behavioral challenges, and that nearly a third of the parenting grandparents reported they had no one to turn to for day-to-day emotional support with parenting, pediatricians and other health professionals caring for 'grandfamilies' must be mindful of these issues and be ready to refer families to counseling when needed, as well as refer them to supports groups locally and online," Dr. Adesman said.

Abstract co-author Nallammai Muthiah will present the study abstract, available below, from 2:50 p.m. to 3:10 p.m. ET in the Barrel Spring room at the Orange County Convention Center.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

In addition, Dr. Adesman will be among highlighted abstract authors available during an informal Media Meet-and-Greet session Saturday, November 3, after a brief presentation at 12:55 p.m. EST in room W208AB of the Orange County Convention Center (Press Office).
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at


Grandparents Raising Grandchildren: Are They Up to the Job?

Nallammai Muthiah, B.S., Sarah Keim, Ph.D., and Andrew Adesman, M.D.

Introduction: According to the CDC's National Survey of Non-Parental Care (NSNPC), more than 3% of children live apart from their parents. Approximately two-thirds of children in non-parental care are being raised by one or more grandparents. Children in non-parental care have a greater incidence of developmental and behavioral disorders. At the same time, parenting grandparents may feel isolated from peers and may not take advantage of local/online supports. Although the NSNPC provides important insights into the health, parenting, and social support issues of the grandparent-child dyad, it did not include a contemporaneous cohort of children living with parents. The 2016 National Survey of Children's Health (NSCH) provides the opportunity to compare children in households being raised by one/both grandparents (GP-HH) with children being raised by one/both parents (P-HH).

Objective: To assess the extent of differences between grandparent caregivers (GP-Cs) and parent caregivers (P-Cs) in managing day-to-day parenting demands and to examine several discrete child characteristics and parenting behaviors in a large, nationally representative sample of US children.

Methods: Data from the 2016 NSCH reflects 50,212 completed interviews, and survey results are adjusted and weighted to reflect the demographic composition of non-institutionalized children/adolescents ages 0-17. Rao-Scott chi square tests were done to assess between-group differences, and adjusted odds ratios were then calculated for NSCH items regarding: child temperament, child behavior, caregiver health status, caregiver support, and quality of caregiver-child interaction.

Results: The NSCH data set consisted of 1,250 GP-HH (276 single GP-C; 974 2GP-CG) and 44,807 P-HH (4,812 single P-C; 39,995 2P-C). There were no differences in child sex or age, or respondent sex between GP-HH and P-HH. GP-HH had a greater proportion of non-Hispanic black children, household income at or below the federal poverty line, lower level of education, and were more likely to be single-parent households (all p < 0.0001). GP-Cs reported worse physical health and mental health. Children in GP-HH were somewhat more argumentative, more likely to become angry/anxious with transitions, and to lose their temper. GP-C and P-C did not differ when asked if the child "does things that really bother" them, is "harder to care for" than peers, or if they "felt angry with this child". Grandparents and parents did not differ on most measures of parent coping, parenting stress, or caregiver-child interactions when stratified by child health and child age. (Figure 1a-c). A substantial proportion of GP-C (31%) and P-C (24%) noted they did not have anyone "to turn to for day-to-day emotional support with parenting".

Conclusion: In spite of raising seemingly more difficult children and despite having greater physical and mental health issues, grandparents raising their grandchildren appear to be coping with the stresses of parenting just as well as biological/adoptive parent caregivers.

American Academy of Pediatrics

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