Journal of Pediatric Health Care
Volume 22, Issue 3 , Pages e3-e4, May 2008

NAPNAP Position Statement on Supporting Grandparents Raising Grandchildren

Article Outline

 

The National Association of Pediatric Nurse Practitioners (NAPNAP) supports and commends the role that many grandparents have taken as primary caregivers for their grandchildren, thereby strengthening family values, developing intergenerational sensitivities, and encouraging continuance of cultural and ethnic heritage.

According to the U.S. Census Bureau (2005), more than 5.8 million children and adolescents live in households headed by grandparents. In more than 2.4 million homes, grandparents are the sole caregivers for these youth. Grandparent involvement in raising grandchildren has become increasingly prevalent in our society and may be attributed to many factors, including parental military service, educational needs, or unemployment, spiraling child care costs, divorce, poverty, death of a parent, child abuse and/or neglect, teenage pregnancy, drug or alcohol abuse, HIV/AIDS, incarceration, mental health problems, or family violence (Butler and Zakari 2005, Kinship Caregiver Support Act, Pincus et al 2005).

The ethnic diversity in these families and cultural perceptions markedly affect the adaptation to the custodial grandparent role (Goodman & Silverstein, 2002). In many cases, a two-generation gap may create cultural differences and wide disparity in social values (Goodman, 2005). Despite these potential problems, grandparents who raise grandchildren are experienced parents who provide unconditional love and afford stability in family life for these children. What's more, the role of primary caregiver can enhance the lives of elders who feel a renewed reason to live life fully.

Unfortunately, the legal status of children raised by grandparents can be tenuous. Although grandparent involvement keeps the family together and out of the formal foster care system (Kinship Caregiver Support Act, 2007), public policies often do not take these families into consideration (Copen, 2006). Grandparents raising grandchildren may experience unique challenges, including financial strain, legal custody issues, and limited access to medical care for their grandchildren (Butler & Zakari, 2005). Additionally, grandparents who raise grandchildren may be at risk for parental stress, disruption of social activities, physical ailments (Hughes, Waite, LaPierre, & Luo, 2007), and alterations in family relationships (Butler and Zakari 2005, Sands et al 2005). For these reasons, NAPNAP acknowledges the critical need for social support of custodial grandparents and of their grandchildren who also may have challenges of their own, including feelings of abandonment, behavioral issues, anxiety, depression, criminal involvement, and school difficulties (Campbell et al 2006, Goodman 2005, Hayslip and Kaminski 2005, Smith et al 2002).

To advocate for improved health care for children being raised by grandparents and for support and respect for grandparent caregivers, NAPNAP encourages pediatric health care providers and educators to:

1.Recognize the uniqueness of each family headed by grandparents and be culturally sensitive to intergenerational gaps and family values when performing assessments and providing interventions.

2.Assess grandparents and grandchildren for unique strengths, strong familial bonds, religious or cultural beliefs, and value systems that can be encouraged to further reinforce a cohesive family.

3.Support legislative efforts, such as the Kinship Caregiver Support Act, that aim to provide services and funding for programs that assist grandparent-headed households, particularly those that address health care, school enrollment, and housing policies.

4.Screen grandparents raising grandchildren for potential stressors or depression, using a culturally competent approach, and provide referrals as needed.

5.Screen children being raised by grandparents for potential mental health issues, including attention deficit disorder, post-traumatic stress disorder, anxiety, and depression, using a culturally competent approach, and provide referrals as needed.

6.Assess the psychosocial status of families headed by grandparents and make appropriate referrals for behavioral health, parenting skills, and support groups for both grandparents and grandchildren.

7.Become familiar with community resources for families headed by grandparents and provide referrals to these resources as appropriate.

8.Coordinate services with the child's school and grandparents, involving biological parents, if possible, if the parents plan to return as head of the family.

9.Include content related to families headed by grandparents in the curriculum of pediatric nurse practitioner programs.

In summary, NAPNAP, an organization that promotes optimal health for children, commends and supports the role of grandparents as primary caregivers of grandchildren. Realizing that this unique family structure may place stress on grandparents and children, NAPNAP calls on health care providers to screen for stressors and coping skills, providing culturally competent interventions as warranted, and to encourage strengths and bonds as building blocks for a stronger family unit. Furthermore, NAPNAP acknowledges the instrumental role PNPs have in incorporating family values and cultural sensitivity when assessing health and psychosocial needs, providing education and support, building family strength and cohesiveness, and offering appropriate referrals to meet these needs.

NAPNAP is an organization whose mission is to promote optimal health for children through leadership, practice, advocacy, education and research.

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The National Association of Pediatric Nurse Practitioners would like to acknowledge the contribution of the following members for their contribution to this statement: Libby Brogmus, MA, RN, CPNP; Patricia Dyer, MS, NPP; Mary Patrice Hildebrand, RN, CPNP; Barbara S. Kiernan, PhD, PNP, APRN, BC; Sharon Page, RN, BC, CPNP; Alissa Parker, MSN, RN, CPNP; Connie Parr, BSN, CPNP; Linda Pietrzak, MSN, RN, CPNP; Maura Porricolo, MSN, CPNP; Judith S. Salzer, PhD, MBA, CPNP; and Dolores C. Jones, EdD, RN, CPNP (Staff).

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References 

  1. Butler FR, Zakari N. Grandparents parenting grandchildren: assessing health status, parental stress, and social supports. Journal of Gerontological Nursing. 2005;31:43–54
  2. Campbell LR, Hu J, Oberle S. Factors associated with future offending: comparing youth in grandparent-headed homes with those in parent-headed homes. Archives of Psychiatric Nursing. 2006;20:258–267
  3. Copen CE. Welfare reform: Challenges for grandparents raising grandchildren. J Aging Soc Policy. 2006;18:193–209
  4. Goodman CC. Intergenerational triads in grandparent-headed families. The Journals of Gerontology (Series B, Psychological Sciences and Social Sciences). 2005;58:S281–S289
  5. Goodman C, Silverstein M. Grandmothers raising grandchildren: Family structure and well-being in culturally diverse families. Gerontologist. 2002;42:676–689
  6. Hayslip B, Kaminski PL. Grandparents raising their grandchildren: A review of the literature and suggestions for practice. Gerontologist. 2005;45:262–269
  7. Hughes ME, Waite LJ, LaPierre TA, Luo Y. All in the family: The impact of caring for grandchildren on grandparents' health. The Journals of Gerontology (Series B, Psychological Sciences and Social Sciences). 2007;62:S108–S119
  8. Kinship Caregiver Support Act, H.R. 2188 (introduced May 7, 2007; referred to the Subcommittee on Healthy Families and Communities September 19, 2007).
  9. Pincus HA, Thomas SB, Keyser DJ, Castel N, Dembosky JW, Firth R, et al. Improving maternal and child health care: A blueprint for community action in the Pittsburgh region. Rand Corporation; 2005;Retrieved July 9, 2007, from: http://www.rand.org/pubs/monographs/2005/RAND_MG225.pdf
  10. Sands RG, Goldberg-Glen R, Thornton PL. Factors associated with the positive well-being of grandparents caring for their grandchildren. J Gerontol Soc Work. 2005;45:65–82
  11. Smith GC, Savage-Stevens SE, Fabian ES. How caregiving grandparents view support groups for grandchildren in their care. Family Relations. 2002;51:274
  12. U.S. Census Bureau. 2005 American Community Survey. 2005;S1002. Grandparents. Retrieved June 29, 2007, from http://factfinder.census.gov/servlet/STTable?_bm=y&-qr_name=ACS_2005_EST_G00_S1002&-geo_id=01000US&-ds_name=ACS_2005_EST_G00_.

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Resources 

  1. American Association of Retired People: Grandparenting Information Center. Web site: http://www.aarp.org/families/grandparents/raising_grandchild/

 Adopted by the National Association of Pediatric Nurse Practitioners' Executive Board on January 24, 2008.© 2008 National Association of Pediatric Nurse Practitioners. Cherry Hill, NJ. All rights reserved.All regular position statements from the National Association of Pediatric Nurse Practitioners automatically expire 5 years after publication unless reaffirmed, revised or retired at or before that time.Correspondence: Suzette Harper, NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633.

PII: S0891-5245(08)00056-4

doi:10.1016/j.pedhc.2008.02.008

Journal of Pediatric Health Care
Volume 22, Issue 3 , Pages e3-e4, May 2008

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