Tamara Newton gives her 3-year-old daughter, Mattie, cough medicine in the early morning. Tamara cooks a full, hearty breakfast for each of her daughters every morning before she leaves for college classes at Hocking College. Tamara, a single mom, gets some help raising her two daughters from her boyfriend, Aaron.

Akeyna Dishong carries some of her belongings into a new two-bedroom apartment she will share with her fiancée, Derrick, and her two children, Kaleb and Jherica in West Virginia. Akeyna has been living with her mother, Pam Jones, for the last few years and was eager to finally get her belongings out of storage and into her own place. The cramped living quarters at Pam’s home in Ohio meant all the children shared one bedroom as Pam and Akeyna pooled their resources to provide for seven people under one roof.

The Sims family sits down for dinner together on Tuesday, Feb. 21, 2012. With five children, two from previous relationships, patriarch Albert Sims, firmly believes in “table talk” where everyone in the household gets the opportunity to share their day. Albert and his wife, Autumn are both pastors at a new startup church in Lancaster, Ohio, and attend Hocking College working toward their degrees in addiction studies.

A dying plant adorns the top of Pam’s bedroom dresser. With her multiple health problems and two young children to care for, household chores are no longer a priority.

Athens County Magistrate Melinda Bradford listens to a child support adjustment hearing on Wednesday, Feb. 15, 2012 in Athens, Ohio. Bradford, who works with Keith Wiens, far left, of the Athens County Child Support Enforcement Agency, hears cases every Wednesday and is often booked weeks in advance. Bradford estimates at least 4,000 child support hearings take place in the county each year.

Jherica, Angel and Kaleb play in the living room of their Coolville, Ohio home on Monday, Jan. 23, 2012. The cousins are among seven people who all live in a small three-bedroom ranch home that belongs to Pam Jones. Pam has cared for her niece and nephew since they were infants and allows one of her adult daughters and her family to live with her. By pooling their resources, the family has three caregivers for the children but a limited expendable income.

Akeyna prepares dinner for her family on Monday, Jan. 23, 2012 at her mother’s home in Coolville, Ohio. Akeyna and her two children have been living with Akeyna’s mother, Pam, and children for several months. Akeyna acts as a dual caregiver, helping Pam with her multiple health issues and caring for four children under the age of 10. Pam, who has multiple sclerosis and a myriad of other health complications, receives money from the state each month to help her care for her family.

Angel, Kayleigh, Aaron and Jerhica, all cousins, play with motorized helicopters at Pam’s house in Coolville on Monday, Feb. 13, 2012. The extended family usually only gets together when one of the parents has errands to run.

Akeyna gives Angel a mini-manicure and paints her nails a bright orange. Angel, who has autism, is often overlooked in a household of four young children and wants to be a part of everything her siblings do.

Angel plays by herself in the backyard while Pam is evaluated for home health care. Pam suffers from multiple sclerosis and other degenerative illnesses that limit the extent of effective care giving for her children, according to Pam’s daughter, Akeyna.

Akeyna pulls the door shut to the bedroom where Aaron is violently kicking and screaming to get out. Aaron had started an argument with one of his cousins about watching a video that escalated into a violent tantrum where he was hitting Akeyna. “This is the only thing I can do to calm him down,” Akeyna said. Aaron’s tantrum continued for about five minutes behind the bedroom door.

Aaron helps wash Pam’s feet one afternoon after Akeyna and her children unexpectedly moved out of the house. Pam’s health issues make caring for two young children a challenge.