Family History in Pediatric Primary Care

Abstract

The family history is a critical element in pediatric medicine and represents the gateway to the molecular age of medicine for both pediatric clinicians and their patients. The pediatric clinician has several opportunities to obtain a family history and multiple clinical and educational uses for that information. Available methods include paper and digital forms, classical pedigrees, online programs, and focused family history at the time of a new diagnosis or problem. Numerous barriers impede the application of family history information to primary pediatric practice. The most common barrier is the limited amount of time the typical primary care encounter allows for its collection. The family history can be used in many facets of pediatric practice: (1) as a diagnostic tool and guide to testing and evaluation; (2) to identify patterns of inheritance; and (3) as a patient-education tool. The most exciting future use of family history is as a tool for public health and preventive medicine. More accurately identifying children at risk for common chronic conditions such as diabetes, asthma, and cardiovascular disease could change the primary care clinician's approach to pediatric medicine.www.pediatrics.org/cgi

Primary Care and Genetics and Genomics

“…Nevertheless, the multigenerational family history is sometimes an important tool. 11 It should be taken on an as-needed basis and can help inform a diagnosis and identify other at-risk family members who might benefit from genetic counseling or testing. It can also be used to identify individuals at risk for conditions that might be prevented or mitigated by lifestyle changes, increased monitoring, or genetic testing.…”

Capturing the Power of the Family History

“…Most often cited is time constraint. Many physicians report a lack of time to take a detailed family history for each patient [1,2]. One solution might be inclusion of family history questions in a patient's previsit paperwork, which could then be followed by specific questions during the patient's visit.…”

“…Online tools have been created to help the clinician and patient in gathering more thorough family histories, some of which can be updated by the patient and his or her family on a regular basis [2,6]. The Office of the Surgeon General has named Thanksgiving "Family History Day," encouraging people to collect, share, and update their medical family history when they gather for the holiday every year.…”

The Family History: Reemergence of an Established Tool

“…The pedigree is used for many clinical and research purposes including: making a diagnosis, establishing a pattern of inheritance, identifying family members at risk, calculating risk, deciding testing and surveillance strategies, and patient education [2,[13][14][15][16]. Importantly, the pedigree facilitates a patient's understanding of disease by illustrating the central observations of a medical family history and promoting conversation that clarifies misconceptions about disease and heritability.…”