Carol D. Berkowitz, MD, FAAP
An 8-year-old boy is brought to the office for an annual checkup. During the course of the evaluation, his mother reports that her son and his 6-year-old sister are always fighting. She says her son hits his sister and pulls her hair, and nothing she does prevents them from fighting. The boy is a B student and has no behavior problems in school. The medical history and physical examination are completely normal.
1. What is sibling rivalry?
2. What is the physician’s role in counseling a family about sibling rivalry?
3. What is the role of anticipatory guidance in preparing older children for the birth of a new sister or brother?
4. How does birth order and an individual’s sex affect sibling rivalry?
5. What are some of the unique considerations related to sibling rivalry between stepsiblings?
6. What are some practical suggestions to share with parents about sibling rivalry?
Sibling relationships are important in helping children shape peer and, later, adult interactions. Moderate levels of sibling rivalry are a healthy indication that each child is assertive enough to express his or her needs or wants. Siblings educate and socialize together and mediate parental demands. Siblings often spend more time interacting with each other than with either parent. The sibling relationship is characterized by continuity and permanence, but the relationship is not without turmoil.
Sibling rivalry refers to the competitiveness between siblings based on the need for parental love and esteem. The rivalry is often characterized by jealousy, teasing, and bickering. The term was introduced in 1941 by David Levy, who described it as “a common feature of family life.” Alfred Adler, the noted psychologist, described siblings as “striving for significance” within the family and noted that birth order had a strong influence on development. Historical examples of sibling rivalry include relationships between the bibli-cal figures Cain and Abel, Joseph and his brothers, Jacob and Esau, and Leah and Rachel. Sibling rivalry is also noteworthy in pairs of celebrities, such as actresses Joan Fontaine (Academy Award winner for Suspicion) and her older sister, Olivia de Havilland (Academy Award winner for To Each His Own and The Heiress). Even after more than 40 years, the turbulence of their relationship has remained legendary, was termed one of the most dysfunctional sibling relationships in Hollywood, and may have had its roots in their simultaneous nomination for an Academy Award in 1942. By 1975, the sisters were no longer in communication with each other. Other siblings whose performances have often been compared include football players Peyton and Eli Manning, tennis stars Venus and Serena Williams, and musicians Liam and Noel Gallagher of Oasis and Ray and Dave Davies of the Kinks. Many Shakespearean plays have battling siblings. Television has included the issue of sibling rivalry in sitcoms, sometimes trivializing the challenges for parents. However, some shows portray unrealistic compatibility between children. Shows such as Good Luck Charlie and Jessie have shown large families in which conflicts are easily and humorously resolved. This may perpetuate unrealistic expectations in families. The 2019 comedy Fighting With My Family relates the true story of a former wrestler and the deterioration and subsequent competition that develops between a sister and brother and their careers as wrestlers.
Sibling rivalry is a universal phenomenon occurring even in the animal kingdom. For instance, the firstborn eaglet pushes the other eaglets out of the nest as soon as they are hatched as a way of ensuring an adequate food supply. Studies in animals show variation depending on brood or litter dominance and sex dominance (male or female) within the species. Aggressive interactions are more likely when there are multiple offspring in a single brood. Among wolves, however, older siblings help to feed and guard younger ones. In humans, the fear of displacement, dethronement, and loss of love occurs with the birth of a new brother or sister, leading to sibling rivalry. Older children fear they are not good enough and that their parents need to replace them with a new offspring. Such feelings lead to a fear of abandonment. Jealousy also plays a role, and older children may be angry with younger siblings for displacing them within the family.
Sibling rivalry frequently has a negative effect on parents because it is hard for them to see 1 of their children hurt, even if it is by a sister or a brother. The challenge for parents is to know when, and when not, to intervene and what strategies to use to minimize conflicts. Physicians can help by offering anticipatory guidance to all parents and specific recommendations to parents who are experiencing such individual problems.
Sibling abuse is a relatively recent concept that recognizes the occurrence of physical, emotional, or sexual abuse of 1 sibling by another. The aggression may range from very mild to severe. Parents may not recognize the intensity of the aggression and may attribute negative interactions to sibling rivalry. Physicians should be knowledgeable about sibling abuse and be able to help parents to differentiate between rivalry and abuse.
Sibling rivalry is a universal phenomenon, and a number of factors influence its development. Time interval between children affects the degree of rivalry, as does the age of the older children. Toddlers who are entering the “terrible 2s” may have a particularly hard time mastering independence and tolerating the presence of their younger sibling. Close spacing results in more problems, particularly when children are fewer than 2 years apart. In such situations, older children still have dependency needs, often feel less secure, and experience a need for maternal attention. They stay closer to mothers, are less playful, and are tenser. Closely spaced children engage in less spontaneous play, seem angrier, and issue sterner commands to their playmates. Sex of a new sibling also influences the relationship. There tends to be greater rivalry between same-sex siblings. Additionally, a child’s temperament affects sibling relationships. The 3 components of temperament include emotional intensity, activity level, and sociability. It is also important to remember that children are egocentric, which, according to Erich Fromm, lasts through 8 years of age. This contributes to a child’s willingness to share (including toys and parental attention) and to act unselfishly.
Position in the family also influences sibling rivalry. Middle children experience what is referred to as middle-child syndrome; they lack the prestige of older children and the privileges of younger ones. These children are often the least secure and strive hardest to gain affection. Special difficulties may develop if middle children are the same sex as older ones. Middle children grow up to be flexible, adaptable, and good negotiators. In myths and folklore, youngest children are “favorites.” They are often the ones defended by parents when there are bouts of fighting.
Twins rarely present a problem of sibling rivalry; instead, they have a problem maintaining their individuality. However, sets of twins create problems for older siblings because the older siblings are not as unique as the pair of twins.
Stepsiblings also present a unique problem in sibling rivalry. Children of divorce frequently feel abandoned by 1 parent and in competition for the time and love of the custodial parent (see Chapter 149). Competition with stepsiblings is especially difficult if the stepsiblings are in the same home.
There are also unique considerations when 1 child has a chronic or potentially terminal illness or long-term disability. Similarly, being the sibling of a gifted child (see Chapter 35) places unique challenges on sibling relationships. The unique strengths of each child need to be acknowledged.
Issues of sibling conflict change over time. Toddlers are protective of their toys and belongings and are particularly upset when a younger sibling touches their possessions. Sharing is a challenging theme of the toddler years. During their school-age years children are concerned about equity and fairness. They may be upset by what they construe as preferential treatment (eg, when a 1-year-old sibling is not expected to put his or her toys away). Sibling competitiveness is said to peak between the ages of 10 and 15 years. Adolescents, with their additional responsibilities, including minding younger siblings, may resent the siblings for imposing on their time. Sibling rivalry can persist into adulthood, and one-third of adults describe their relationship with a sibling as distant or rivalrous. After age 60 years, 80% of siblings report being close.
Significant sibling abuse is said to affect 3 in 100 children. Less violent abuse is reported to occur in as many as 35 per 100 children. These figures are reported to cross all socioeconomic levels.
Parental concerns related to sibling rivalry consist of fighting between siblings, including physical violence and verbal abuse, bickering, and regression to immature behavioral patterns. Although such immature behavior occurs most often following the birth of a new baby, it may also be apparent if 1 sibling is receiving more attention, such as during an illness or after a major accomplishment. Regressive behavior includes bed-wetting, drinking from a bottle, and wanting to be carried to bed. Substitution behavior, such as nail-biting in place of biting the new sibling, may occur after the birth of a new baby.
Before the birth of a new baby, parents may report that their children exhibit temper tantrums, irritability, and solemnness. They may mimic the pregnancy by eating a lot and putting a pillow under their clothes. In addition, children may have psychosomatic symptoms such as stomachaches or headaches. Risk factors for malad-justment following the addition of a sibling include family discord, physical or emotional exhaustion in parents, and housing insecurity. Conversely, a good marital relationship and family support facilitates the adjustment to new siblings.
Dilemmas concerning the correct diagnosis of sibling rivalry most often relate to the appearance of behavioral changes, such as regressive or aggressive patterns after the birth of a new sibling. For example, a child who was previously toilet trained may become incontinent of urine. Although urinary tract infection may be considered in the diagnosis, a careful history concerning the birth of the sibling reveals the correct etiology.
The other issue to consider is whether the sibling rivalry has moved into the arena of sibling abuse. Risk factors for sibling abuse include the absence of parents from the home, domestic or community violence, and children having inappropriate family roles (eg, having to care for younger siblings).
The evaluation of children with suspected sibling rivalry involves a history of the problem and parental strategies for addressing the difficulties. The parent should be particularly queried about 1-to-1 opportunities between parents and individual children. Physical examination and laboratory assessment are noncontributory.
If there is concern for sibling abuse, appropriate additional questions include the following: Is one child always avoiding another sibling? Has there been a significant change in a child’s behavior? Does one sibling always seem to be the aggressor and the other the target?
The focus of management is to allow parents to recognize the normalcy of sibling rivalry while helping them define the behaviors that are acceptable or unacceptable within the family context and to recognize when the rivalry has progressed to sibling abuse. Children fight more often in families when parents condone fighting and aggression between siblings as normal behavior. Likewise, children of parents who are angry may interact with their siblings through anger. Parents should be counseled about this. Parents may not appreciate their child’s fear of loss of parental love as the basis of sibling conflicts. They should be reminded that many children think, “If I am so good, why do I have to be replaced?” Parents should be prompted to empathize by imagining how they would feel if their spouse brought home another mate, even if they were reassured about being loved. Physicians can also help parents address sibling rivalry by having them consider their treatment of children in terms of uniqueness versus uniformity and quality versus inequality. In general, parents should be advised to set the ground rules for acceptable behavior. Such rules include no hitting, punching, hairpulling, name-calling, cursing, or door slamming. There may be a neutral area in the home that can be set aside for arbitration should disagreements arise. Moving to a neutral area also allows for some time to cool off. Parents should be reminded that children who are hungry, tired, or bored are more easily frustrated and may start fights more readily.
Birth of New Siblings
Parents may notice behavioral changes in their children before the birth of a new sibling. These changes depend on the age of the children and presence of other siblings. Children should be told about the upcoming birth. The timing depends on the children’s age; younger children do not need much lead time. Some studies have evaluated the inclusion of older children in the birthing process. The results of these studies vary, but they suggest that children younger than 4 years need their mother for emotional support and are concerned about her physical exertion during the birthing process. Some older children may also want to distance themselves from the actual events.
Physicians should suggest that older children be involved in planning for the arrival of the new baby as a means of minimizing their feelings of exclusion. For example, they can help purchase clothes or prepare the baby’s room. Physicians should also suggest that parents purchase a gift for older children that represents a present from the new baby, such as T-shirts that announce the older sibling’s new status, such as “big sister” or “big brother.” In addition, older siblings may be given a doll to serve as a baby they can care for. Parents should point out the advantages of being older with comments such as, “You can stay up later,” or “You can walk and play with all these toys.” Frequently, the birth of a new baby is met with regressive behavior in older siblings. Regressive behavior should be addressed with tolerance and a realization that symptoms resolve with time.
Once the birth mother goes to the hospital, she should be advised to maintain contact with older children by telephoning or video chatting. Video chatting will also allow the older siblings to see the new addition to their family. Many hospitals now allow for visitation by siblings. Currently, hospital stays are so brief (often just 24 hours) that this period of separation is much shorter than it was previously. Household changes that may be necessitated by the birth of the new baby, such as room changes, the substitution of a bed for a crib, and entrance into nursery school, should be made before the arrival of the new baby.
Rivalry Between Older Children
Physicians need to consider individual parenting techniques when counseling parents of older children. Parents who compare 1 child with the other may foster contentious behavior, and those who strive to treat all children equally may inadvertently perpetuate rivalry. Children need to feel that they are unique rather than ordinary. For example, parents who buy both children the same presents may think they are preventing rivalry from developing, but they are actually depriving each child of a sense of uniqueness. The harder parents try to be uniform, the more vigilantly children may look for inequality. Each child needs a parent’s undivided attention and time alone together. Siblings also need time apart from each other, and they should be encouraged to hold separate playdates and individual activities. Not all children in a family need piano lessons and soccer practice. Individuality and uniqueness are important. The more agreeable a parent-child relationship is, the more agreeable a sibling-sibling relationship is because each child has good self-esteem. Practitioners should recommend uniqueness and quality in each parent-child relationship.
Parents sometimes have to contend with sibling rivalry between older children. Physicians should reassure parents that these older children should be allowed to vent their negative feelings toward each other. For example, if a girl refers to her brother by saying, “I hate him,” the parents should respond by validating these emotions and saying something like, “It sounds as if he’s done something to really annoy you.” Parents should also be advised not to take sides. They should examine how they usually respond to squabbling between siblings. Is one child’s name always called first during a fight? Do they perpetuate sibling rivalry by using certain nicknames (eg, “turkey brain”) or other derogatory terms? Parents should assume that both parties are at least partially guilty and should not allow themselves to be drawn into the fight as referees. Parents can respond to a request for arbitration with a statement such as, “I wasn’t here when things started, so I don’t know who is right or wrong.” The parents should also advise siblings that they do not have to be friends with one another, but they should not hurt each other’s feelings. Positive, authoritative parenting should be encouraged (see Chapter 50).
Anticipatory guidance helps parents anticipate conflictual situations, such as who sits where during long car rides and who holds the remote control. Family meetings can be held to determine the ground rules that may avoid such battles. If conflicts arise, children should be allowed to work out a solution by themselves, with the stipulation that the parents will solve the problem if the children do not reach an agreement. If fights between siblings have recurrent themes (eg, which television shows to watch [who controls the remote] or video games to play), parents can devise a weekly schedule. Failure to abide by the schedule means both children forfeit the activity. If borrowing is the source of disputes, children who borrow from their siblings should leave collateral, which gets given back when the borrowed item is returned. Box 47.1 lists suggestions for parents who are seeking advice about fighting between children.
Siblings of Children With Special Health Care Needs
Nearly 1 in 5 children in the United States is a child with special health care needs (see Chapter 44). Caring for such children places increased demands on parents and their resources, and there is less parental attention or time available for unaffected siblings. Integrating the unaffected sibling into the families’ care plan and activities can be empowering for children and positively influence their self-esteem. As with all children, time alone between unaffected children and parents should be strongly encouraged. Support groups for siblings of children with special health care needs have been demonstrated to help youngsters cope and deal with their often-conflicted feelings of anger at the special attention their brother or sister receives and their guilt about being healthy.
Box 47.1. Coping With Rivalry Between Siblings: Physicians’ Advice to Parents
•Allow children to vent negative feelings.
•Encourage children to develop solutions.
•Anticipate problem situations.
•Foster individuality in each child.
•Spend time with children individually.
•Compliment children when they are playing together.
•Tell children about the conflicts you had with your siblings when you were children.
•Define acceptable and unacceptable behavior.
•Serve as a referee.
•Use derogatory names.
•Permit physical or verbal abuse between siblings.