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Family history: an important part of the medical visit.

During each well child visit, your child's doctor is likely to ask about your child's family history. Family history has been shown to be a fairly quick and inexpensive method to assess part of a patient's health risk for many chronic medical conditions. A family history of certain conditions can change the schedule of recommended health maintenance and can help pediatricians know what types of diseases and conditions are more likely to develop in their patients. It also can direct conversations and anticipatory guidance at pediatric visits.

Although family history can be very helpful, it may not be fully documented in the majority of patients' charts. Our recent study explored when in the course of the development of pediatric chronic medical conditions practitioners document family history of related health problems.

We used a group of pediatric patients who developed hypertension and/or obesity between 1999 and 2007 within a large public health system in Cleveland, OH. Of the obese patients with a documented family history of obesity-related conditions, 36% had this family history information entered into their records prior to their first overweight/obese visit while 64% did not have this information entered until after they had already become obese.

Similarly, only 14% of the hypertensive patients with a documented family history of hypertension had this information documented prior to development of hypertension and this information was documented for 86% after they developed hypertension.

Family histories can lead to increased counseling and interventions for various conditions and can allow your pediatrician to address health problems of the whole family unit, which may be more effective. Despite such benefits, our study found that the majority of relevant family history was not obtained until after the development of chronic conditions.

Family history gathered after a child has already become obese or hypertensive cannot help the pediatrician counsel families on the risk of developing these diseases or the ways of preventing them. Reasons that family history may not be obtained include parents/ guardians not remembering, knowing, or reporting family history at initial visits or providers not asking for family history.

Important family history includes chronic diseases (such as high blood pressure, obesity, diabetes), mental illness (such as depression or attention deficit-hyperactivity disorder), and cancers (such as breast cancer and testicular cancer). The more immediate the relative, the more important the family history is.

For example, diseases in first-degree relatives (brother, sister and parents) are more important than disease in second-degree relatives (grandparents, aunts and uncles) or relatives that are further removed (e.g., cousins). Parents should make an effort to know the diseases in their child's firstand second-degree relatives and to discuss these with their child's pediatrician to help assess health risks.

By Lacey Benson Sweigart, MD, and David Kaelber, MD, PhD, MPH

Dr. Sweigart is a graduate of Case Western Reserve University School of Medicine and is currently in her final year of residency training in pediatrics at the Children's Hospital Colorado in Denver, CO.

Dr. Kaelber completed his medical school and PhD training at Case Western Reserve University. He is currently the Chief Medical Informatics Officer for The MetroHealth System, Director of Research and Scholarly Activity, and an assistant professor of internal medicine and pediatrics at Case Western Reserve University.
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Author:Sweigart, Lacey Benson; Kaelber, David
Publication:Pediatrics for Parents
Date:Jan 1, 2012
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