Traditional families (also called nuclear families) are headed by two parents who view parenting as the major priority in their lives and whose energies may not be depleted by stressful conditions such as poverty, illness, and substance abuse. Traditional families can be single-income or dual-income families. Generally, traditional families are motivated to learn all they can about pregnancy, childbirth, and parenting (Figure 3-1). Today a family structure composed of two married parents and their children represents 66% of families with children, down 4% from the last report. Twenty-six percent of children live with one parent and 44% with no parents. The remaining percentage of children live with two parents who are not married (Forum on Child and Family Statistics, 2011).

Single-income families in which one parent, usually the father, is the sole provider are a minority among households in the United States. Most two-parent families depend on two incomes, either to make ends meet or to provide nonessentials that they could not afford on one income. One or both parents may travel as a work responsibility. Dependence on two incomes has created a great deal of stress on parents, subjecting them to many of the same problems that single-parent families face. For example, reliable, competent child care is a major issue that has increased the stress traditional families experience. A high consumer debt load gives them less cushion for financial setbacks such as job loss. Having the time and flexibility to attend to the requirements of both their careers and their children may be difficult for parents in these families.

The growing number of nontraditional families, designated as “complex households” by the U.S. Census Bureau, includes single-parent families, blended families, adoptive families, unmarried couples with children, multigenerational families, and homosexual parent families (Figure 3-2).

Although divorce is traumatic to children, research has shown that living in a home filled with conflict can also be detrimental both physically and emotionally (Kelly & El-Sheikh, 2011; Lindahl & Malik, 2011). Divorce can be the outcome of many years of unresolved family conflict. It can result in continuing conflict over child custody, visitation, and child support; changes in housing, lifestyle, cultural expectations, friends, and extended family relationships; diminished self-esteem; and changes in the physical, emotional, or spiritual health of children and other family members.

Divorce is loss that needs to be grieved. The conflict and divorce may affect children, and young children may be unable to verbalize their distress. Nurses can help children through the grieving process with age-appropriate activities such as therapeutic play (see Chapter 35). Principles of active listening (see Chapter 4) are valuable for adults as well as children to help them express their feelings. Nurses can also help newly divorced or separated parents through listening, encouragement, and referrals to support groups or counselors.

The teenage birth rate in the United States decreased by more than one-third from 1991 through 2005 but increased by 5% over the next 2 years. Current data show another downward trend, reaching a historic low of 39.1 per 1000 teen births. Adolescent birth rates vary by race; however, there has been a steady decline in teen birth rates for all racial and ethnic groups. The birth rate for Hispanic teenagers showed the largest decline of all race and ethnicity groups. From 2008 to 2009, the rate declined by 11% (National Center for Health Statistics, 2011).

Teenage parenting often has a negative effect on the health and social outcomes of the entire family. Adolescent girls are at increased risk for a number of pregnancy complications, such as preterm birth, low birth weight, and death during infancy (Ventura & Hamilton, 2011). Those who become parents during adolescence are unlikely to attain a high level of education and, as a result, are more likely to be poor and often homeless. An adolescent father often does not contribute to the economic or psychological support of his child. Moreover, the cycle of teen parenting and economic hardship is more likely to be continued because children of adolescent parents are themselves more likely to become teenage parents.

Violence is a constant stressor in some families. Violence can occur in any family of any socioeconomic or educational status. Children endure the psychological pain of seeing their mother victimized by the man who is supposed to love and care for her (see Chapter 24). In addition, because of the role models they see in the adults, children in violent families may repeat the cycle of violence when they are adults and become abusers or victims of violence themselves.

Abuse of the child may be physical, sexual, or emotional or may take the form of neglect (see Chapter 53). Often one child in the family is the target of abuse or neglect, whereas others are given proper care. As in adult abuse, children who witness abuse are more likely to repeat that behavior when they are parents themselves, because they have not learned constructive ways to deal with stress or to discipline children.

Parents who abuse drugs or alcohol may neglect their children because obtaining and using the substance(s) may have a stronger pull on the parents than does care of their children. Parental substance abuse interrupts a child’s normal growth and development. The parent’s ability to meet the needs of the child are severely compromised, increasing the child’s risk for emotional and health problems (Children of Alcoholics Foundation, 2011).

The child may be the substance abuser in the home. The drug habit can lead a child into unhealthy friendships and may result in criminal activity to maintain the habit. School achievement is likely to plummet, and the older adolescent may drop out of school. Children, as well as adults, can die as a result of their drug activity, either directly from the drugs or from associated criminal activity or risk-taking behaviors.

When a child is born with a birth defect or has an illness that requires special care, the family is under additional stress (see Chapters 36 and 54). In most cases their initial reactions of shock and disbelief gradually resolve into acceptance of the child’s limitations. However, the parents’ grieving may be long term as they repeatedly see other children doing things that their child cannot and perhaps will not ever do.

These families often suffer financial hardship. Health insurance benefits may quickly reach their maximum. Even if the child has public assistance for health care costs, the family often experiences a decrease in income because one parent must remain home with the sick child rather than work outside the home.

Strains on the marriage and the parents’ relationships with their other children are inevitable under these circumstances. Parents have little time or energy left to nurture their relationship with each other, and divorce may add yet another strain to the family. Siblings may resent the parental time and attention required for care of the ill child yet feel guilty if they express their resentment.

The outlook is not always pessimistic in these families, however. If the family learns skills to cope with the added demands imposed on it by this situation, the potential exists for growth in maturity, compassion, and strength of character.