When Grandparents Are the Parents

In Georgia, more than 115,000 grandparents are the primary caregivers for grandchildren who live with them. And:

  • 36.1% don’t have parents present.
  • 35.4% are older than 60.
  • 57.6% are working.
  • 23.7% are in poverty.
  • 26.5% have a disability.
  • 31.3% aren’t married.

They’re called “multigenerational families,” and they’ve been on a slow and steady rise over the past 40 years, starting with the crack cocaine epidemic in the ‘80s and continuing with the most recent recession in 2007 to 2009.

Children may be with non-parental caregivers for a variety of reasons. Generally, kinship care is better for kids than the foster care system—“when you look at studies, kids do better at being placed with relatives when it comes to stability in their in environment and mental health issues like depression and anxiety or acting out,” said Dr. Kelly Watson, a pediatrician at the Children’s Hospital of Georgia—but the age gap can come with challenges.

Are grandparents up to date with new safety guidelines when it comes to car seats and other infant care? Do they need a refresher on what’s normal when it comes to how their child grows and develops? Have they childproofed their home, including putting medications and other toxic substances up and behind a locked cabinet? Are they savvy enough on new technology so they can manage how kids use TVs, computers or phones? How are they set up financially, physically and more to raise another generation of children?

“Every situation is unique, every family is unique,” said Watson. “And there are a lot of benefits for children to be cared for by grandparents. Our job as pediatricians is to make sure everyone is on the same page as far as questions like these.”

Grandparent or Guardian?

An important question though, for a variety of reasons, is whether or not the grandparent (or other family member as the case may be) is a child’s legal guardian or not.

There are situations where the arrangements in families is informal. But when it comes to health care, that question is important since without other signed consents, only the legal guardian can approve medical care and treatments, have access to medical records and get medications for the child. “And that’s just the medical side,” said Watson.

Enrolling in school is another case where the question of legal guardianship will come up. If parents are still involved, there also can be questions about who pays for what, which could include school, clothing, food, extras and more.

Depending on the situation, Watson said that pediatricians can often provide guidance on legal resources that grandparents can turn to. “For example, the Georgia Department of Health and Human Services offers a kinship navigator program that can help with some of these legal and financial issues,” she said.

The juvenile court system for the county in which grandparents reside can also be a wealth of information, including the importance of documentation. “Especially in cases where grandparents might be looking into the process of formally adopting these kids, it may be important to start documenting not just concerns of parental behavior but also what grandparents have done as caregivers, to start to build a history to give the court system of what’s been going on in the care they’ve been providing for children,” said Watson.

Generation Gap

The age difference between grandparents and young children doesn’t actually make that much difference, said Watson. “Just like any other caring parent, grandparents tend to ask appropriate questions when it comes to how their child is growing and developing and any issues.”

However, adding a child to the home can present difficulties. Some grandparents may struggle with financial challenges, having to work longer than they expected or to go back to work after retirement to supplement their income. On the flip side, other grandparents may have more flexibility in their schedules because they aren’t working full-time or at all, which means they can spend time volunteering for school events or helping with homework—“which can have a stabilizing effect on a child,” said Watson.

In general, Watson said, grandparents today have become tech savvy. “But some struggle with trying to set limits on screen time or putting parental controls in place. Others might struggle with learning text messaging,” she said. “But they can and do learn.”

Best Interest

While it may seem odd for a pediatrician to have to know this kind of detail about a child’s home environment, it’s actually not. “When it comes to health and child development and behavior, so much of that is affected by the child’s environment,” said Watson. “Who’s living with who, work, brothers, sisters, pets, smoking, any instability in the home environment—it’s all interconnected and helps us get a better picture of the child and helps us target advice.”

The grandparent who suddenly has a 4-month-old could probably use some reminders on when to start on solid food and the importance of placing infants on their backs to sleep. The family member who’s struggling with having another mouth to feed could benefit from advice on which direction to go for help.

Pediatricians may be there to care for the child, but they can also make sure caregivers are doing OK. “I often find myself asking how they’re doing and about stressors in general, trying to make sure mental health is good and physical health is good,” said Watson.

“We try to be supportive…we may not be able to fix every problem, but we can offer advice, support and resources, not just for grandparents but for every family.”

The Children’s Hospital of Georgia has the largest team of general pediatricians, adolescent medicine physicians and pediatric specialists in the Augusta area. For more information, visit our website at or call 706-721-KIDS (5437).

About the author

Children's Hospital of Georgia

Children’s Hospital of Georgia is the only facility in the area dedicated exclusively to children. It staffs the largest team of pediatric specialists in the region who deliver out- and in- patient care for everything from common childhood illnesses to life-threatening conditions like heart disorders, cancer and neurological diseases.