Reviewed empirical literature published since 1975 on the effects of pediatric traumatic brain injury (TBI) on the family. Few systematic, hypothesis-driven investigations of the impact of TBI on family functioning have been conducted. However, existing findings indicate that severe TBI can adversely affect families and individual family members. Certain factors, such as poor preinjury functioning and parental psychological disorder, appear to place families at greater risk for long-term disruption. Issues associated with the conceptualization of the impact of TBI on various aspects of family functioning are discussed and methodological considerations are outlined. Special attention is given to novel strategies for studying these complex, multifaceted issues. Finally, a framework is proposed for examining the processes of family adaptation after pediatric TBI to guide future research directions.