Aim Many child-onset mental health diseases have strong epigenetic links, but no genetic tests are yet available for them. Family history (FH) information in paediatric primary care should be promoted to assist decision-making. This study aims to explore the extent of the real-life use of the FH for mental health issues by paediatric physicians. MethodsThe medical records of 474 children (31.5% female), referred to the specialised mental health care services in the Netherlands, were used. Data were retrospectively extracted from the medical files, according to a list of 15 criteria regarding the use of FH information. ResultsThe FH was explored in the form of a diagnosis and was presented at birth in 88.3% of cases and in half of the files at 5years. Negative FH and the age of relatives at the time of diagnosis were virtually not mentioned. FH was present in more reports from the specialists, than in referral letters. ConclusionDespite the high importance of FH for primary paediatric care, this study shows that FH is underreported in practice. We should promote structural FH taking to increase how often it is used to treat children who do not meet criteria for definitive diagnosis.