The HIV and AIDS pandemic in sub-Saharan Africa has orphaned many children, leaving the extended family responsible for their care. We use findings from a longitudinal study on child welfare in South Africa to compare the economic status of households that support only orphaned children (orphan households), those that support both orphan and non-orphan children (mixed households), and households that support only children whose parents are alive (non-orphan households). We ask the question “Which household type is the worst off?” We also discuss the extent to which the social grants system is assisting in poverty reduction, with particular reference to households’ abilities to provide material care for its children. Generally, the situation is one of dire poverty; 64% of all households fell below the poverty line. While mixed households appear to be the “worst off”, this is due mainly to them being larger and, therefore, carrying a greater burden. Government social grants provide an economic safety net but our data suggests that child support grants, in particular, are not being accessed by many in need of them.