Have you ever heard of the Rule of Two?
No, this isn’t about Star Wars…
What is the Rule of Two/Too?
If you didn’t know about the Rule of Two/Too, you will likely be very surprised to know that there are more than one of these rules!

The Rules of Two is a quick and easy way to figure our if your child’s asthma is out of control.
Remember that one now?
What about this other one?
The rule of Two/Too.

The Rule of Too/Two can help you figure out if you might have a genetic condition in your family!
After all, filling out your family medical history is pretty easy for most people. Knowing what to do with all of that information, especially how it might translate into a risk for a genetic condition is the tricky part…
“Family health history questions that result in answers using the descriptors “too” or “two”may indicate a genetic condition.”
A Toolkit to Improve Care for Pediatric Patients with Genetic Conditions in Primary Care
And that’s where the Rule of Too/Two comes in!
It reviews many of the red flags for genetic conditions and can help you figure out if you or your kids should undergo any kind of genetic screening.
The Rule of Too/Two includes:
- being TOO tall as compared to their genetic potential for height
- being TOO short as compared to their genetic potential for height
- getting sick at TOO early/TOO young an age – extreme early onset cardiovascular disease, cancer, or renal failure, etc., and developing adult disorders in childhood can be a sign of a genetic cause
- TOO many people in a family having the same condition
- having an unusual or extreme presentation of a common condition that is TOO different than usual, like breast cancer in a male family member
- a family member having TWO different types of tumors
- a condition in TWO generations of family members
- a condition that affects TWO people in the family
- a family member with TWO or more birth defects or congenital anomalies
When you fill out your family health history, if you are using the terms ‘too’ and ‘two’ very often, then you might talk to your health care provider to take a closer look.
“Everyone is eligible for one tumor, one birth defect (ASD, cleft lip, birth mark, etc.).”
Arthur Grix, MD
The Rule of Too/Two is an easy way to discover possible risks of genetic conditions in your family medical history.

Which ever method you use, if you find genetic risks in your family tree, you might want to see a genetic counselor for further evaluation.
More on the Rule of Two/Too
- Validation of Rules of Two™ as a paradigm for assessing asthma control
- A Toolkit to Improve Care for Pediatric Patients with Genetic Conditions in Primary Care
- Family Health History Form
- Family history: a comprehensive genetic risk assessment method for the chronic conditions of adulthood.
- CDC – Family Health History: The Basics
- CDC – Knowing is Not Enough—Act on Your Family Health History
- CDC – Breast and Ovarian Cancer and Family History Risk Categories
- Family History of Breast, Ovarian or Prostate Cancer
- CDC – Family Health History and Cancer
- Family Health History Toolkit
- Collecting Your Family’s Cancer History
- NORD’s Rare Disease Database
- Diagnosis of a Genetic Disease
- Your Family Health History & Genetics
- Why Family History is Important for Your Health
- Documenting the Family History: An Overview of Available Tools
- Family History: a Disease Prevention Tool for Public Health Practice
- How Your Family Health History Can Help You Determine Your Risk of Disease
- Collecting a family history
- Family History as a Risk Assessment Tool
- Family Therapy for Genetic Disorders
- Genetic red flags: clues to thinking genetically in primary care practice
- Why is it important to know my family medical history?
- NNLM Reading Club: Family Health History
- Relative risk for Alzheimer disease based on complete family history
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