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Pediatricians provide care for children who live in a variety of family situations. Children may live with two working parents, unmarried parents, grandparents, or another nonparental caregiver, or they may live in single-parent families where the mother may be divorced or never married, or they may live with gay parents, in foster homes, or in blended families. The traditional nuclear family, consisting of a mother and a father who are married and living with their biological children, is becoming rare; in fact, only 25% of households fit this description.1 Although it was the norm three decades ago, today only one half of American households include a married couple, and only one half of those have children.1 Only one third of preschoolers are raised in a two-parent home with a working father and a mother who stays home full-time.2 Given the diversity of family forms, it is important to identify the ideas central to the definition of family.

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The notion of family is universal in all cultures and societies, but the definition is changing, confused, and often vague. At a broad conceptual level, the family is a system of social relationships that are shaped by expectations and values and that are based on distinctions of age and sex. Each member occupies a particular position or status that governs behavior toward other family members. On a more practical level, the US Bureau of the Census defines a family as two or more persons who live together and are related by blood, marriage, or adoption.

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Given the difficulty in defining family, it may be useful to conceptualize the characteristics and functions of family units. First, many families share biology, including temperament, personality, talent, and disease vulnerability. Second, families typically have a power hierarchy that is determined in part by age, generation, culture, personality characteristics, and gender. Third, families tend to have their own “culture,” which includes a family-specific set of values, goals, and expectations. Although they are unique to each family, these “microcultures” reflect the larger societal and ethnic cultures. Fourth, every family has an “invisible boundary” that defines who is a member and who is not.

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Another set of family characteristics are developmental and arise from a family’s common history and future. Family history may extend back for generations, and it usually reflects both ethnic and religious beliefs and the dramatic life-altering events that have affected the family. A family’s future course usually follows a pattern of successive developmental phases that depend in part on both biology and social norms. The phase of expansion includes the initial parental union and continues until the youngest child becomes an adult. This period spans fertility and the physical and emotional maturation of children. The phase of dispersion occurs when the first child achieves adulthood and leaves home. The phase of independence begins when all the children have left and the parents are alone. The phase of replacement covers the ...

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