Among the most frequent questions pediatricians must address are those related to sibling rivalry, which is important regarding both behavior and development.1 The parents' concerns often begin before the next child is born and may be the result of their own personal experience or family situation. They need guidelines for managing this situation. Parents often find it difficult to understand the concept of innate competition between siblings and to accept some conflict as common in healthy families regardless of how loving, clever, persistent, and available adults may be. The pediatrician is in a unique position to intervene because of the frequent contacts with the family.
Many potential situations should alert both parents and physicians to a potential problem, including: the sibling reaching significant milestones (eg, walking); change in status (eg, no longer being the oldest, only, or youngest child); change in health status of sibling (eg, injury, malignant illness, identification of disabilities); and change involving a significant adult (eg, illness, death, divorce, job loss, change in caregiver).
History taking is essential and can be therapeutic as well as diagnostic. It should include inquiry about who is involved (both children and adults) and their perceived roles; the reporter and most frequent observer; time, situation, and place of occurrence; significance attached to the problem by each of the parents; other occurrences in the entire household regarding relationships; why this problem is receiving attention now and not earlier; and any long-term concerns.
Family situation of primary care patients – evaluation of the psychometric properties of the Polish version of the Family Apgar Questionnaire