Pets in the Family: Practical Approaches
Adapting family life cycle theory to include pets provides veterinarians with a framework for understanding and reinforcing the human–animal bond. The family genogram with pets is a practice tool that identifies all people and pets in the family, enhancing the practice of One Health at the community level.
Introduction
Pets are important members of many families.1–4 Their significance in modern society is influenced by such changes as urbanization and increased travel.3 With geographic separation of extended families, people seek alternate relationships.5 This article provides two practical approaches to integrate the care of pets within the context of their family. The first approach is a framework that defines the family life cycle, and the importance of pets at each stage of life. The second approach is a tool for veterinarians to capture details of a patient's family that are relevant to One Health, the effective control of zoonoses, and enhancement of the human–animal bond.
Companion animals foster strong communities. Contrary to stereotype, pet lovers seldom supplant humans with animals in their relationships, but rather generalize their capacity for love, empathy, and compassion to all species.6 Pet ownership enhances social interactions, civic engagement, perceptions of neighborhood friendliness, and sense of community.7
Having pets also benefits individual health by encouraging regular exercise and dietary patterns, as a source of companionship, and through improving physiologic parameters, such as ameliorating hypertension.7 “The presence of pets increases feelings of happiness, security, and self-worth and reduces feelings of loneliness and isolation on a daily basis during separations or transitions such as spousal bereavement.”1
Pets can also be a health risk as a source of infectious zoonotic disease or injury. Veterinarians may not know how significant the risk of zoonotic disease is to a client. Seventy-seven percent of veterinarians believe it is important to advise their clients about zoonotic disease. Yet only 43% actually do, unless they are aware a family member is at higher risk of infection. Significantly, a mere 3% of clients offer this information unprompted.8
Pets play an important role in the emotional well-being of families as well. Although the frequencies of pet ownership and the animal species chosen as pets vary among ethnicities, culture has little impact on the commitment to a companion animal, or the quality of the relationship.2
Veterinarians are often considered “the other family doctor.” Constructs used in primary care and family medicine can be adapted to veterinary medicine, providing a practical framework to address the roles, both positive and negative, of pets in the family. One such theory is the family life cycle. Combined with the veterinarian's own experience and insight, the family life cycle provides a structure for understanding and reinforcing the human–animal bond, a foundation of the practice of One Health in the community.
Family life cycle theory adapts principles of individual development theory and applies them to the entire family.5,9,10 The family is viewed as an organism moving through developmental stages, separated by periods of major transition or stress. Individual family members have developmental tasks to complete during each stage for healthy progression of the family's life cycle. There is no set age for moving through the stages; individuals have their own timing. “The family life cycle provides a framework for organizing data about families, for diagnosing particular problems in family adjustment, and for formulating plans to help families cope with inevitable life stressors.”5 Several health care professionals find it useful in their work: family therapists, primary care physicians, nurses, and social workers.1,4,5,10–12
It is important to recognize that the family life cycle describes a nonexistent, normative family. Family structure is highly variable, including single parent families, gay and lesbian families, marriages with or without children, blended families, or children raised by grandparents. Half of today's families have no children.5 Yet, the concepts and progressive stages can be applied and tailored to the “real world.” The defined cycle is just a framework. Each doctor must adapt the notion of what constitutes a family to more realistic visions of contemporary families.12 It is in these nontraditional families that the role of the pet may be most important. Children are more likely to live with pets than with siblings or fathers, and often consider them among the most important individuals in their lives.3,13
Pets move through the cycle with their diverse families, taking on significant roles within the family. These roles can function in two distinct fashions. First, pets can complement the family structure, fitting into the human dynamics of the family. They adjust to the developmental stages of their families. Alternatively, pets can act as replacements for human family members. As such, their presence can augment or interfere with human dynamics.
Pets in the Family Life Cycle
Different authors have defined various stages of the family life cycle, each emphasizing different areas of development. Here, the authors present a life cycle in seven stages, based on relevance to companion animals and risk of zoonotic disease to humans.
The first stage is the independent adult. The independent adult has moved into their first apartment with all the responsibilities of living on their own; has begun full-time employment; is negotiating adult relationships with parents; and is developing an independent network of friends, peers, and co-workers. Independent adults often acquire their first pet, with which they bond quite closely, establishing patterns of intimacy as an aspect of creating an independent life.
During the independent adult stage, pets may act as a social lubricant. A young man can easily meet new people at the dog park with his puppy, for example, or by participating in a more organized activity like obedience trials. A young woman and her horse can be involved in a community of showing or trail riding. Conversely, involvement with the pet can be so intense as to exclude other social activities. Other people can be nervous around the pet, as can happen with snakes, which can have a distancing effect.
How independent adults model responsibility and caring for this first pet reveals patterns of relationships with others, which may predict how they care for future children or balance relationships with partners and the outside world.1,6 In discussions with colleagues, the authors learned that the species of the pet can indicate its role for the independent adult: dogs tend to act as buddies or younger siblings, cats as children, and horses and parrots as partners. Although the independent adult's connection with the child-role pet can be particularly intense, it may be less like that of a parent with their own baby and more like that of an adult brother or sister to a younger sibling.
Much is new in the independent adult's life: home, job, social life, and responsibilities of all sorts. A new pet can be left alone too long and too often, leading to separation anxiety with its attendant problems: destructive behavior, self-inflicted trauma, inappropriate elimination, and/or excessive vocalization in the owner's absence. A significant association has been shown between separation anxiety and a dog being kept by a single adult owner.14 The independent adult's veterinarian may choose to discuss a mental wellness program with the new pet owner to forestall such problems or management techniques if they have already arisen.
Complicating veterinary care, independent adults are sometimes unable to manage the financial responsibilities of their pet.
The second stage is the marital dyad, when the independent adult settles into a stable partnership that supersedes the family of origin in importance, becomes established in a career, and furnishes a home. The partnership can be heterosexual or same-sex.
Where the pet augments the human dynamic, negotiating care for the pet may be a predictor of how care of any future children will be shared. Pets can be a source of conflict within the dyad. When people with pre-existing pets form a partnership, difficulties can arise from forcing the pets to live in one home. The challenges here parallel those of blended families: learning to give (or take) direction, struggling with divided loyalties, and concern for others' happiness and welfare in the new family.5 The veterinarian can intercede with advice on introducing pets to each other to smooth the transition. More demanding pets, such as parrots, can generate feelings of jealousy in the new human partner. Conversely, a very attached pet can resent the new person in its life, even to the point of causing harm to itself or to others.
Alternatively, the companion animal can replace a human in the dyad, creating a person–pet partnership. This can be a healthy development, with the person continuing to cultivate a social network and fully participating in the world outside the home. Pets assist in regulating exercise and dietary habits. Less often, the relationship with the pet can replace other social interactions, and limit that person's social life and personal development.
If the marital dyad acquires its first pet as a couple, it moves them into the next stage of the family life cycle.
The third stage is the infant/toddler family, which typically begins with the birth of the first child. The new parents learn to care for the child, manage the increased financial demands, share household responsibilities, and develop a mature relationship with the new grandparents.
Pets as an addition to the growing family can augment human dynamics. They are also an understood health risk that requires appropriate management. A cat may exhibit inappropriate elimination behavior by urinating and defecating around the house when a new baby is brought into its territory. This can be prevented with planned socialization of the cat. Dogs do not recognize infants as human until they can talk and walk strongly, and may exhibit prey–hunting behaviors.
Pets can be a source of infectious larva migrans, spread to children through pica or in the sandbox. A recent US study found the prevalence of Toxocara infection to be almost 14%, “more widespread and common than previously understood.”15 Children are most commonly affected. Veterinarians knowing children are in the household can recommend routine monitoring for Toxocara spp. and preventive deworming regimens, and educate the family about prompt disposal of dog and cat feces to reduce the risk of exposure.
Sometimes, pets can replace the child, particularly in “single parent” or child-free families. In these cases, the infant/toddler stage is protracted: the people retain complete responsibility for all the animal's physical needs throughout its life. Pets fulfill a need to nurture, but bring their own complications: the “baby” will develop geriatric illnesses and the family must deal with the grief of pet loss.
The fourth stage is the school age family, when career issues, the developmental and emotional needs of the children, and expanding the social network and resources must all be balanced. During this time, family members are pursuing educational achievement, creating family rituals and activities, and dealing with career ascendancy and employment change issues.
Families with children often obtain pets to help teach values of caring and responsibility. Pets may become an important part of family rituals. Preventive health concerns continue to dominate. Young children are most often bitten by dogs known to them, and the injury is preventable. Dog bites during this stage of the family life cycle tend to be fearful and/or aggressive bites (often in response to the child's testing behavior), as distinct from the prey behavior usually implicit in dog bites of infants.16 Veterinarians can mitigate this risk through anticipatory guidance.17 Implementing important management and behavioral modifications can prevent costly dog bite injuries and fatalities.
The fifth stage is the adolescent/launching family, when the parents are negotiating greater freedoms and responsibilities for teenagers, and maintaining couple time while always being available in crisis. During this stage, the family provides the emotional and financial resources to launch young adults into college, a job, or marriage. The parents are managing increased responsibilities in their careers while preparing for the “empty nest.”
Pets can be emotionally significant companions and social lubricants for teenagers. However, they can also be a flashpoint for family arguments, particularly as their care needs increase with age. Abuse of a pet can indicate violence in the home or emerging sociopathic behaviors in an adolescent.18–20 Recent evidence suggested that “children may not just ‘graduate up’ from animal abuse to interpersonal violence, but instead, human and animal directed violence may be linked through the lifespan.”18 The veterinarian is more likely to get honest answers about domestic violence than a police officer or emergency room physician and may be the first health care professional alerted to this potential disaster.21
Pets obtained when the children were young are now elderly and frequently ailing. Chronic illness has an enmeshing effect on families. Adolescents may be strongly affected by the death of a pet, which may trigger serious depression.
The sixth stage is the empty nest /retired family. The couple is now advancing and making significant contributions at work and then transitioning into retirement. Intermittently, they provide emotional support to the newly launched young adults who have moved from the home. In this stage, they may obtain pets once the human children have moved away. This is a mechanism to help prevent the “involutional melancholia” of the empty nest syndrome.10 Pets are a source of attachment and provide the empty nester with the opportunity to nurture.1 Preventive health issues come into focus for aging family members, and pets (particularly dogs) encourage regular exercise.
Obesity of both pets and people is of increasing concern. Walking is the preferred exercise of obese individuals, and an exercise partner is known to be a strong motivator. Dogs provide “a buddy along with three uniquely identifiable positive influences: consistent initiator and enjoyment (both exercise-related) and parental pride.”22 Walking together provides consistent exercise, leading to weight loss in both species, as well as enhancing the human–animal bond, and enriching the owner's community life.
The empty nest/retired couple may be cultivating new hobbies or enjoying travel. Pets, unsocialized to children, are often sent to the adult children for care during extended travel vacations, posing a potential risk to any grandchildren.
The final stage is the elderly family. During this time, health problems, medical costs, the death of friends and even a spouse, and challenges to an independent life are all important. Older pets, which have increased incidence of health problems at the same time as their humans, have greater health concerns and more stresses over caring for themselves. However, pets are often an important source of support to the elderly, particularly as a social lubricant. Having a pet necessitates the regular exercise and dietary patterns that assist in maintaining health.6 For those who are more housebound and less able to socialize in the community, pets are an important source of support and can take on the role of partner. Pets reduce the feelings of loneliness that come with the loss of friends in advancing age.1
The death of a pet can be devastating to elderly pet owners. The veterinarian is usually the first health care provider who learns of this loss. In seminars on pets in the family life cycle, primary care physicians frequently remark on their need to know of the pet's death in such circumstances (personal communication). The owners' grief can disrupt their activities of daily living and further distance them from their social support system.4
The family life cycle as described is an idealized theoretical framework and not intended to be fully descriptive (or prescriptive) of family life. Yet its stages and transitions are readily recognizable and adaptable to the wide variety of functioning family structures. Family life cycle theory becomes clinically relevant only when the doctor “moves from the excessively generic to the accurately specific” by carefully learning about the entire family surrounding the pet.12
Pets in the Family Genogram
Practical application of family life cycle theory is possible only when the clinician is aware of all the members of the family. In family medicine, the family genogram, a graphic representation of the family tree captured in the medical record, is a simple tool to collect information about all the family in a clinical situation. It identifies family members over three generations, including significant events such as marriage, divorce, pregnancy, and death in the medical record.23 “Visualizing the family history in pictorial form may clarify the risks to a patient that had not been appreciated previously.”24
The family genogram can help identify patients at greater risk of zoonotic disease: young, old, pregnant, and immuno-compromised patients. Factors affecting immune status are varied and plentiful: HIV and other infections, chronic disease, chemotherapy, radiation, splenectomy, depression, etc. It is reasonable to anticipate that any given extended family will include at least one individual at increased risk of zoonotic infection. Preventive measures are appropriate.
When pets are included in the family genogram, this practice tool provides a quick reference for identifying those pets at most risk of spreading zoonotic disease, recording pets that are not under regular veterinary care, and documenting the quality of the human–animal bond relevant to a specific patient and family.
The family genogram identifies individuals in an extended family, as defined by the patient/client, indicated as the “index person” (Figure 1). Circles represent female members of the family. Males are represented by squares. Simple lines connecting individuals depict how they are related (Figure 2). Horizontal lines connect partners. A solid line is a married relationship and a dotted line represents unmarried partners. A single or double slash indicates separated or divorced couples, respectively. Offspring are connected to their parents by vertical lines: solid for biologic and dotted for adopted children. Each generation is on a different vertical level. When an individual is deceased, an X is drawn through the symbol. Ages may be noted. Family members who live in the same household are enclosed in a circle.
Citation: Journal of the American Animal Hospital Association 47, 5; 10.5326/JAAHA-MS-5695
Citation: Journal of the American Animal Hospital Association 47, 5; 10.5326/JAAHA-MS-5695
In the example given in Figure 3, the client's household, within the sketched circle, includes her husband, three young children, and her mother. Her brother does not live with them. Her parents are divorced, and her father is deceased.
Citation: Journal of the American Animal Hospital Association 47, 5; 10.5326/JAAHA-MS-5695
In human medicine, the presence of a pet may be noted in the family genogram with a simple diamond shape. This does not provide the clinically relevant, species-specific information necessary to prevent zoonotic disease.25 The authors have developed symbols for pets (Figure 4) based on species. Breed, gender, and age can be noted.
Citation: Journal of the American Animal Hospital Association 47, 5; 10.5326/JAAHA-MS-5695
Pets can take on different roles with their families. Whether the pet has a role like a child or a partner may be correlated to species: dogs and cats are more often “children”; birds and horses often act as partners. The quality of the relationship can be indicated in the family genogram (Figure 5) by changing the style of the connecting line: strong, over-close, conflicted, or cut off.
Citation: Journal of the American Animal Hospital Association 47, 5; 10.5326/JAAHA-MS-5695
Including pets in clients' family genograms can reveal a wealth of pertinent information. Clients usually do not volunteer information about pets not presented to the veterinarian.26 Including information about all pets and humans who make up the family in the clinical record can help in planning preventive health care and controlling the spread of zoonotic disease. Using a practice tool to collect information about all the pets and humans in a family communicates interest and concern for the whole family. The veterinarian clearly demonstrates that ensuring the health of all family members necessitates an integrated approach to health care.
Maintaining a written record of family information facilitates collaboration in a team practice. Relevant details are available to all veterinarians and technicians on subsequent visits.
In the case study illustrated in Figure 6, the client brings her husband's Great Dane to the clinic for veterinary care. In developing the family genogram, the veterinarian learns that the household consists of the client, her husband, fraternal twins, and the dog. The client's parents are divorced; her mother has an aging corgi. Her father has a menagerie of exotic pets: 20 birds, 10 turtles, and 6 snakes. Her husband's parents have no family pet; his sister is extremely attached to her horse.
Citation: Journal of the American Animal Hospital Association 47, 5; 10.5326/JAAHA-MS-5695
In this family, the people most at risk for zoonotic disease are the youngsters. The children are only 2 yr old. Prevention of intestinal parasites in the family Great Dane is extremely important, both to protect the dog and children directly, and as a buffer for parasites with a wildlife reservoir, such as Baylisascaris. The veterinarian may recommend year-round preventive care.
Another risk is dog bites, and a Great Dane can inflict a great deal of damage. Over 82% of bites are from dogs known to the victim.27 The children are in an exploratory phase, and the dog is a likely subject. “Children's normal expressions of affection can be loud, shrill and quite physical, and their movements are often rapid and chaotic.”17 Normal behavior such as teasing the dog with a toy or food, suddenly hugging the sleeping pet, or forcing the dog to act a role in a game (such as pretending they are their aunt riding her horse, now played by the dog) can provoke the pet, and the children may not understand or appreciate the early warning signs of aggression in the dog. The veterinarian can evaluate the dog's character and provide behavioral counsel and preventive management techniques to the client. The risk of dog bite is also present on visits to the maternal grandmother, whose older dog may not be socialized to children.
The paternal grandfather's menagerie has other risks, most notably Salmonella infection from the turtles and snakes. The veterinarian can recommend scrupulous attention to hand washing when the children visit.
The hazards of the aunt's horse primarily come from its size and reactive nature. The aunt may not appreciate the need to instruct the children about how to behave around her precious horse. Moving quietly, speaking calmly, and not approaching the horse from behind are simple safety measures. On-line tools may be helpful in this regard.28
Interprofessional Collaboration
There have been many calls for interprofessional collaboration in family care including pets.1,2,6,21,29–31 Approaching the veterinary patient's family with the same framework as the primary care physician can facilitate the collaboration needed for a One Health approach at the community level.
The roles and responsibilities of health professionals in preventing zoonotic disease are not clearly understood. Veterinarians generally believe that the primary responsibility for communicating with patients about zoonotic disease rests with physicians; pediatricians indicate that they believe public health officials and veterinarians have first line responsibility to prevent zoonotic disease.32
Communication with colleagues is lacking, and integrated preventive health care plans are less effective as a result. This creates a significant gap in the health care of pet owners, who have brought animals into their families.
One way to initiate communication and collaboration with primary care physicians is to exchange business cards. Veterinarians can offer clients a copy of the genogram and a business card, and ask them to give it to their primary care physician. Clients would then be concretely notifying their own doctor that they have pets in their family, and that their pets are important to them. It may help remind the family doctor to inquire about pets if there is a concern about a zoonotic disease. It also acts as a signal of the veterinarian's availability as a resource to consult about zoonotic disease prevention and management. In a recent survey of roughly 100 primary care physicians, 16% had conferred with a veterinarian about a zoonotic risk, and only 4% had been consulted themselves by a veterinarian (personal communication).
Veterinarians might also ask clients to bring their physician's business card for their own records.
Veterinarians have the professional responsibility to request and document the client's permission before speaking with their physician. The authors understand that permission must be written in specific terms to comply with the Privacy Rule of the US Department of Health and Human Services. “All authorizations must be in plain language, and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data.”33
Interprofessional collaboration and communication can be enhanced by identifying and approaching at least one physician colleague who is interested in consulting with a veterinarian. A cooperative relationship is most beneficial if established before a problem arises.
Conclusion
Including information about pets and humans who make up the family in the medical record helps plan preventive health care and control the spread of zoonotic disease. Veterinarians can use family life cycle theory to integrate the care of the pet within the context of the family. It provides “a profoundly supportive framework within which to understand the key stages, stresses, and passages of family life.”12
Using a genogram including pets and family members enables veterinarians to adapt principles of family medicine and apply family life cycle theory including pets. By superimposing the pet's expected life on the family life cycle, there is an opportunity to practice appropriate preventive health care, maintain and strengthen the human–animal bond, and practice One Health in the community.
Basic genogram symbols.
Relationship connections.
A sample family genogram. The index figure is married with three daughters. Her parents were divorced. Her father is deceased and her mother lives with her. She has one brother who is not part of the household.
Symbols for pets in the family genogram.
Quality of relationship connections. The character of relationships can be indicated in the style of lines connecting individuals.
A case study of pets in the family genogram. The index female is married with twins. The family shares the home with her husband's Great Dane. Her parents are divorced. Her mother has an 11 yr old corgi; her father has 20 birds, 6 snakes, and 10 turtles. Her husband's parents have no pets; his sister is strongly bonded with her horse.
Contributor Notes
