THE INFLUENCE OF THE FAMILY
before birth and is shaped in the “limbic nexus” of family life.
ON HEALTH AND DISEASE
Family has 6 main effects on the health of its members
GENETIC
- Every individual is a product of the interaction between his
genotype and the environment.
- Recent advances in describing and understanding the human
genome makes it more important that family physicians be
conversant with and able to communicate the significance of the
results of genetic counseling to patients and their families.
FAMILY CRUCIAL IN CHILD DEVELOPMENT
- Although children have a remarkable capacity for overcoming
early difficulties, there is a large body of evidence supporting
the relationship between family dysfunction and childhood
disorders—both physical and behavioral.
- Parental deprivation for prolonged periods is associated with
psychological problems, including suicide, depression, and
personality disorder.
- The relationship is by no means constant, and the outcome
depends on individual factors such as the previous parent–child
relationship and the availability of parent substitutes.
- Advise parents to avoid separation from the child whenever
possible in the crucial stage between 3 months and 4 years.
When separation is unavoidable, as in the serious illness of
mother or child, care should be taken to minimize the trauma by
providing a good mother-substitute or by keeping the child’s
time in the hospital to a minimum.
- Respiratory disease was the most common health problem. In
the first 5 years it accounted for half of all the illness and two-
thirds of all infections. The frequency and severity declined
during the school years, but the ratio of respiratory to total
illness remained. At all ages the incidence and severity of lower
respiratory infection was strongly related to adverse family
factors.
- Intestinal infections were strongly related to inadequate housing
(large families), overcrowding, and poor maternal care
- Nonfebrile convulsions were significantly associated with low
social class, a family history of seizures, mental illness, parental
deprivation, and defective child care.
- Accidents during the school years more commonly occurred
away from home. At all ages there was a significant association
with poor maternal care and low intelligence in the child.
- Enuresis was associated with low social class, overcrowding,
poor maternal care, and absence or ineffectiveness of the father.
- Parental neglect, both physical and emotional, is considered
to be the most common cause of failure to thrive. In
emotionally deprived children, the secretion of growth
hormone is reduced. Inadequate parenting has a range of
effects on child development, from physical trauma at one
end of the scale to mild behavior disorders at the other.
What makes this doubly important is that children deprived
of adequate parenting are likely to repeat the same pattern
when they themselves become parents.
- Life course research has begun to emphasize that many of the
chronic diseases of adult life have their roots in early childhood.
- Environment influences  first few years of life represent a
window of opportunity that if missed because of poor nutrition,
physical, psychological stress  impact!!
- In this early time period, as neural connections are made and
nurtured, the groundwork for functions such as binocular vision,
emotional competence, habitual ways of responding, and
language are laid down. After age 6 it becomes much more
difficult to make changes in these areas.  inadequate? Later in
life more prone to learning difficulities, behavioral and
emotional problems
- Poor nutrition  hypertension, diabetes, obese
- women who experience family disruption and conflict during
their early years were more prone to depression and other
mental health problems in adult life
- Emotional learning in early life happens implic- itly, begins
The concept of “limbic attractors” has been borrowed from
systems theory to explain the tendency of repeating certain
emotional behavioral responses, even when we desire a different
outcome. This has been used to explain the observation that
some individuals repeatedly enter into damaging relationships,
for example.
SOME FAMILIES ARE MORE VULNERABLE TO ILLNESS
THAN OTHERS
- Illness rates were higher in families where one or both parents
were emotionally unstable and where there was marital discord
- Children had more illnesses when
o their parents tended to avoid conflicts
o their mother was little involved in social networks outside
the family
o their parents were prone to somatic complaints
o their parents had less than average sense of well-bein
o 
their mother was strongly inclined to accept the sick
role
o there was a discrepancy in their parents’ knowledge of the
complaints of the spouse.
- abnormal family functioning was a strong predictor of low birth
weight. The abnormalities of function included disengagement,
enmeshment, and both rigid and chaotic families.
INFECTIOUS DISEASE SPREADS IN FAMILIES
- streptococcal infection related to family stress
- virus infections strong tendency to spread from the index cases
to other family members
- infections were introduced into the home, in descending order of
frequency, by schoolchildren under6, preschool children,
schoolchildren over6, mothers, and father
- Preschool children are the most susceptible to infections
because they have not yet acquired immunity. Children starting
school are more likely to bring infections home because they are
exposed to other children at a time when their immunity is
incomplete. The number of infections falls rapidly as immunity
is acquired during the early school years.
FAMILY FACTORS AFFECT MORBIDITY AND MORTALITY
IN ADULTS
- widows in the first year  mortality
- Mortality for most causes of death is much higher among
widowed, divorced, and single people than among the married.
- males with severe family problems were three times more likely
to develop angina than those with a low score for family
problems. In males with high anxiety levels, the risk of
developing angina was significantly lower in those who
received much support and love from their wives than in those
who did not.
FAMILY IMPORTANT IN RECOVERY FROM ILLNESS
- especially chronic illness and disability
- When we confront an adult with a new diagnosis, we need to
understand the entire history of the patient, not only current and
recent life style choices. The physician who has attended a
patient for a long period of their life time, perhaps including the
prenatal period, delivery, and childhood, has an obvious
advantage in coming to an insightful understanding and helping
their patient cope realistically with the implications of a new
diagnosis, illness, or life event. Indeed, such a physician has
become an integral part of the patient’s life history and vice
versa.