Pediatricians need expertise in assessing family needs, strengths, and situations, along with counseling skills to offer strategies and resources to families. The structure of families and patterns of family life in the United States have changed profoundly in the past quarter century. Although remarriage rates are high, more than a third of remarried couples are divorced again. A decline in the purchasing power of family income, the lack of comparable wages for women, and significant rates of homelessness have all added to the stress on families. Social disparities have also contributed to the growing percentage of children who live in poverty.
Adolescents present the pediatrician with particular challenges for assessment and counseling.
Finally, residential mobility has separated many families from the natural support systems provided by their extended families. This may leave parents feeling socially isolated and prevents the intergenerational transmission of cultural and community-specific advice and support. These social changes have strained the ability of families to provide for their children's needs. Economic and social inequalities have led to increasingly impoverished neighborhoods, more working families living in or near poverty, and weakening of community ties. As a result, the health, development, and well-being of children have been jeopardized.