Lois' estranged parents, Ida and Victor, pay the family a visit. Right away, trouble starts brewing. Victor bonds with Reese, Ida gets Malcolm into a fight, and Dewey is haunted by childhood memories of his inattentive grandparents.

When Malcolm and his brothers destroy their Christmas tree ornaments, Lois punishes them by canceling Christmas and moves all the presents into the garage. The only way she will reinstate the holiday is if the boys behave impeccably up to Christmas morning. Her plan works better than expected, and Lois is touched that her family responded so well to her challenge. Meanwhile, the boys decide that Lois could use this tactic for future holidays and retaliate by breaking into the garage and opening up all the presents. Elsewhere, Francis is forced to visit his Grandma Ida for Christmas.

Grandma Ida is even nastier than usual (if that's possible) because of a tumble down the front steps that resulted in a broken collarbone, prompting her to sue her daughter and son-in-law for pain and suffering. And there's more momentous news on the home front: Lois is pregnant.

Lois goes into labor while Hal and the boys are at a bridal exposition. Ida moves in after her apartment burns down and she refuses to stay with Susan.Dewey reveals the date his parents chose for the baby's planned delivery is his birthday in an announcement at the exposition to humiliate Hal.

While Lois is in labor, the house is hectic, and Hal, desperate to get home, has crashed the car on the way out of the expo.

Malcolm gets his tongue pierced and needs to hide it for a month. While Lois' mother, Ida, comes and annouces that she will marry a rich Chinese Man that she met on a cruise. Malcolm gets complications when his tongue ring gets infected, rendering him unable to say "S's" and he discovers that Ida has been drugging her fiancé with opiates and mood enhancers. When Lois and Hal confront Ida, she drugs them with free food. But luckily, the fiancé misses a drug treatment, and realizes that Ida is a terrible woman and he leaves her at the altar. Malcolm is punished for his tongue piercing. Meanwhile at the ranch, Otto decides to hire a murder mystery acting troup, but it all turns out badly.

When Lois tracks down her father's "other family," she meets Victor's "other wife" Sylvia, and learns something shocking about her dad.

During Grandma's unwelcome visit with the family, she loses her leg while saving Dewey from a moving truck. Consumed with guilt, Dewey is determined to find his Grandmother's leg and give it the proper burial. Francis, on the other hand, begrudgingly becomes the caretaker for his stubborn, cranky grandmother. Meanwhile, Malcolm and Reese are given a new idea for a prank that forces them to stay awake days at a time to avoid the embarrassment of having their faces glued to the floor.

Lois goes over to visit Ida, but gets unpleasantly surprised by the St. Grotus Day festival. Malcolm fails a music appreciation course, and reluctantly goes to Dewey for help. Reese and Hal secretly watch scary movies while Lois is not around, but it ends up revealing some unexpected secrets about both Reese and Hal.

Lois, Hal, and Dewey go out of town for a piano competition, so they get Ida to watch over Malcolm and Reese while they're gone. Since Ida thinks Reese needs to become a man, she comes up with a competition for Malcolm and Reese, and if Reese wins, he can take Raduca as his bride. Now, when Lois and Hal return, they're surprised to find out that Reese has run away to Las Vegas to get married.

Malcolm struggles with his speech when he's elected valedictorian of his graduating class at school. However, Lois refuses to listen to any of his complaints and reveals that she wants him to become President of the United States. Meanwhile, Reese does everything he can to get a permanent job as a high school janitor, which includes creating the most disgusting mess ever. In the meantime, Hal has problems with Malcolm's Harvard tuition, while Francis finally gets a real 9-5 job that he actually enjoys. Also returning for the family celebrations is Grandma Ida, as they all say goodbye to Malcolm when he leaves for college.