One question that improves your family history-taking

Howard King, MD’s article “How to help adult children of alcoholic parents” prompts us to ask about important information that most likely is not a part of our routine family history questions, and thus not a part of our child’s treatment plan. Although we all include family history, and often a genogram, as part of our comprehensive and interval history encounters, the question raised for us from Dr. King’s work is: Do NPs specifically ask parents about their childhood parenting experiences?

Questions that go unasked

A quick review of advanced practice history and physical examination textbooks reveals that a specific question on the adult’s personal childhood parenting experiences is not included in the family history of our pediatric patients. Questions are asked of parents about domestic violence (in their present home) and this may encourage the parent to reveal their childhood experiences, but no research studies have investigated whether parents reveal information about their personal childhood experiences during routine history-taking of the pediatric/adolescent patient. However, there is a growing body of literature on theoretical frameworks about adult children of alcoholics (ACOAs) and investigations involving personality subtypes, as well as intervention studies to identify and treat ACOAs.

Probing their own pasts

Because the majority of pediatric nurse practitioners practice within a “family-centered” framework, Dr. King’s insights and recommendations are very meaningful for our practices. We know with certainty that parenting is often influenced by parents’ personal childhood experiences; thus, we must consider asking parents during our initial encounter with them and later, after we have established a comfort level, about their personal exposure to alcoholic parents, or for that matter, about exposure to any dysfunctional family experiences. We should not wait to ask the parents until a situation arises in our office, similar to the case study that Dr. King presented at the beginning of his article.

Sensitive advocacy

As NPs, let’s advocate for adding a routine, sensitively worded question about the parent’s personal childhood experiences related to possible parental alcoholic exposure to all family histories that we obtain in our pediatric practices. This question may better inform us on the anticipatory guidance that is needed to help ACOAs improve their self-efficacy while parenting their own children.