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Pediatric Genogram Template
A genogram template with the child as the primary person for pediatric health assessments, child welfare documentation, and developmental care planning.
Pediatric Genogram Template
What This Template Shows
Three generations with the child as the primary person.
The paternal grandfather is deceased with a heart disease marker. The maternal grandmother carries a diabetes marker. The father carries an asthma marker. The mother carries anxiety and depression markers. The child (the primary person) carries an asthma marker that connects directly to the father's.
The hereditary thread between father and child is visible in the diagram. So is the parental mental health picture sitting in the generation above, i.e., what the child is growing up around.
The child has a close relationship with the mother and the paternal grandmother, and a distant one with the father.
A newborn baby brother sits alongside the primary person in the third generation.
This is the family picture a pediatric clinician maps to understand what surrounds the child, not just what is inside them.
The symbol legend is displayed below the diagram. For full definitions and clinical usage, see Genogram Symbols Explained.
When to Use This Template
- Pediatric primary care intake and well-child assessment: map the child's household composition, parental health history, and hereditary conditions as part of a routine or developmental assessment.
- Child psychology and developmental evaluation: document the family context surrounding a child presenting with developmental, behavioral, or emotional concerns.
- Child welfare and safeguarding documentation: establish household composition, caregiver health, and key relationships for child protection assessment and planning.
- Pediatric nursing and occupational therapy coursework: use as a reference diagram for child and family health assessment across pediatric clinical training programs.
How to Use This Template
1. Download as-is
Click the PDF or PNG button under the embed to download immediately. Use as a clinical reference, intake supplement, or teaching example.
2. Customize before downloading
Click "Use this genogram" to open the template in EasyGenogram. Replace the generic labels with real or fictional names, adjust the household composition, and update the health markers and relationship lines to reflect the actual child and family.
Export as PDF or PNG when done, or share via link with a clinical supervisor or colleague.
Pediatric Genogram Template
Explore this genogram and adapt it to your needs.
FAQ
What is a pediatric genogram template?
A pediatric genogram template is a family diagram built with the child as the primary person. It maps the child's household, the health and relational context of the parents and grandparents, and any hereditary conditions relevant to the child's health and development. It is used in pediatric clinical settings to understand what surrounds the child as part of a holistic assessment.
How is a pediatric genogram different from a standard family genogram?
The structure and notation are the same, but the orientation differs. A standard family genogram typically places an adult at the center as the primary person. A pediatric genogram centers the child, which shifts what gets mapped and what gets annotated; parental mental health, household composition, caregiver capacity, and hereditary conditions affecting children become the clinical focus rather than the adult's relational history.
What does a pediatric genogram include?
A pediatric genogram typically covers three generations: grandparents, parents, and the child alongside any siblings. It includes structural relationship lines, health markers on parents and grandparents relevant to the child's health, household composition, and key emotional relationships; particularly between the child and their primary caregivers.
Is this template free?
Yes. Open and customize it in EasyGenogram at no cost. Export requires a subscription for most users; students with a valid school email can export free.
Can I use this for a child welfare or pediatric nursing assignment?
Yes. The template follows McGoldrick-Gerson-Petry standard notation and includes the markers relevant to pediatric and child welfare contexts. Open it in EasyGenogram, adjust the family structure and health markers to match your assignment, and export as PDF for submission.