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To provide clinicians with a review of key considerations relating to the physical and behavioral well-being of children raised by their grandparents.As the number of children being raised by their grandparents in the United States steadily increases, the needs of these families require greater attention. These children and their custodial grandparents face unique health, social, legal, and financial challenges. Children being raised by their grandparents are at higher risk for developmental and behavioral problems because of prior or current adverse family environments. Moreover, there is evidence that custodial grandparents may experience negative health, social, and financial outcomes that may constrain their ability to provide the best care for their grandchildren.Pediatricians should not only be aware of the medical and developmental status of children who are being reared by their grandparents, but also assess the needs, abilities, and potential limitations of these custodial grandparents. In addition to providing useful parenting advice and direct support to custodial grandparents, pediatricians should refer these families as needed to local grandparenting groups, social service agencies, experienced legal counsel, and relevant national organizations for support and guidance.