Nuclear families (consisting of a married man and woman and their children) have long been regarded as the default domestic arrangement. Nonetheless, there are many other family structures that are becoming increasingly more common and complex. Single-parent families can result from divorce or the death of one parent, or may be intentionally planned before conception. Multigenerational families typically include children, parents, and grandparents living together, although sometimes parents are absent and grandparents are the caregivers. Blended families result from a union between divorced or widowed parents, with unrelated children from their prior relationships brought together. Caregivers in these various family structures should be aware of the stigma that they or their children may face. Although children in these modern families may experience higher rates of obesity, substance use, unsafe sex, and mental illness, confounding factors for these disparities often are neglected, and it is unclear whether there are truly worse long-term health outcomes for these children compared with those in nuclear families. When working with families with diverse structures, physicians should avoid assumptions about the roles of different family members, and provide screening and guidance as needed to support them.

Case 3. LA is a 41-year-old single mother of two young boys. She is in a relationship with NC, a widower with a teenage daughter. NC also is the primary caretaker of his aging mother. LA and NC are considering merging their families, but LA is worried about how disruptive the change in family structure might be for their children.