Jennifer Connelly's (Hollywood actress) five year old son Kai was ambivalent about the arrival of sibling in 2003. After hearing that the child was another boy (rather than the hoped for girl), he stormed out of the hospital premises in a huff. Sometime later, Connelly and her family found themselves discussing possible names for their newest member, how about jack? or James? "I have an idea"; Kai interjected. "How about punch bag?"

(Source: Late night with Connon O' Brien Sept., 2003)

Such feelings of jealousy and rivalry exist in everyone in childhood. They become a problem when they interfere with adjustment to work or sleep or are reflected in insidious behaviour. In a child such feelings if intense, can destroy his whole outlook to life.

Sibling relationships typically, last longer than other family relationships and are often characterized by higher levels of interactivity, shared experiences and support. This is especially true when there is nearness in age and when there is a good degree of involvement in each other's lives; this automatically indicates the strong influence that sibling bonds have on a child's life. So much so that traumatic events like parental divorce, or even the loss of a parent, may make sibling bonds even more crucial. For example, in the case of a divorce between the parents, the sibling bond will play an important role even when weaker relationships with other family members may suffer, and the children grow closer to each other.

The positive impact of an older sibling who takes on the mantle of a role model for the younger ones cannot be denied. If they are a little older, they automatically assume a nurturing or care-taking role which continues well into adulthood. This is especially with today's busy world where both parents are out at work, and the elder one is often given the responsibility of 'looking after' the younger sibling.

Judy Dunn (a leading expert on sibling relationship) in 2007 described three important characteristics of sibling relationships –

• Emotional quality of the relationship: Both intensive positive and negative emotions are often expressed by siblings toward each other. Many children and adolescents have mixed feelings toward their siblings.

• Familiarity and intimacy of the relationship: Siblings typically prove each other very well, and this intimacy suggests that they can either provide support or tease and undermine each other, depending on the situation.

• Variation and Sibling relationship: Some siblings describe their relationship more positively than others. Thus, there is considerable variation in sibling relationships.

Many siblings have mixed feelings about each other, but some children and adolescents mainly describe their siblings in warm, affectionate ways, whereas others primarily talk about how irritating a mean sibling is.

Speak roughly to your little boy/and beat him when he sneezes; / he only does it to annoy, / because he knows it teases. (Caroll, Lewis)

In a house with more than one kid, there are bound to be some problems, younger kids sometimes feel like the older kids get to do whatever they want. Older brother and sisters think that the baby of the family gets more attention. These are typical problems found throughout the ages everywhere in the world.

When brother and sisters don't get along, it's called sibling rivalry. A sibling is a brother or sister and rivalry means competition.

It is a type of competition or animosity among brother and sisters, blood related or not. For example there is an Arabic saying: "I against my brother, my brother and I against my cousins; I, my brother, and my cousin against the stranger."

Sibling rivalry usually starts right after or before arrival of the second child, the older child can become aggressive, "act out", or regress (act more like a baby).

Sigmund Freud saw the sibling relationship as an extension of the Oedipus complex, where brothers were in competition for their mothers' attention and sisters for their fathers'.

Sibling Rivalry is manifested in various, sometimes subtle ways. Some children are openly hostile to their new siblings, while others are more diffident about expressing their negative feelings. Some older siblings give the baby a good pinch or try to hurt the new born while your back is turned. Another child may seem to be responding favourably to the new entrant in the family until she politely queries when the baby is being taken back to the hospital. Some older siblings show no animosity to the new born at all preferring instead to turn their anger on their mothers. Some children go to another extreme attempting to suppress their jealousy. They develop a kind of obsession with the new born. The new baby becomes a point of reference for everything that they see or do. This is neither natural, nor healthy.

- Cane and Abel in Bible

- Joseph and his brother in Bible

- Goneril, Regan, and Cordelia; Edmund and Edgar in King Lear (Shakespeare)

- Elinor and Marianne Dashwood in Sense and Sensibility (Jane Austen)

- Sonny, Fredo and Michael Corleone in the film The Godfather

- May and Mox In Manga Pokemon

- In real life tennis players Venus and Serena Williams

• A child’s personality can also have an effect on how much sibling rivalry will occur in a home. Some kids seem to naturally accept changes, while others may be naturally competitive and exhibit this nature long before a sibling enters a home.

• Positioning in the family – for example, the oldest child may be burdened with responsibility for younger cildren. The younger child spends his life trying to catch up with an older sibling.

• When one sibling is handicapped – Quite different considerations must come into play when there is a handicapped child in the family, especially if it is a youngster who requires a lot of extra services both in and out of the home. In this case non-handicapped siblings can be resentful of the time spent on their brother or sister. They sense the parents’ preoccupation. They feel that often they are receiving only surface attention, that the parents are not really alert to their needs.

• Sex, for instance a son may hate his sister because his father seems gentle with her. On the other hand, a daughter may wish she could go on to hunting trip with her father and brothers.

• Age – a five and an eight year old child can play the same game together but when they become ten and thirteen, they will probably be poles apart.

• When one sibling is gifted – different people, gifted children, have abilities and talents in different areas.

• Stress in the parents and childrens' lives can create more conflict and Sibling Rivalry.

• Encouraging competition, especially where winning is the object, can provoke severe sibling rivalry.

• The most important factor, is parental attitude. Parents have been taught that they may be impartial but this can be extremely difficult.

• Avoid labeling and comparing - Don't make comparisons. Instead of comparisons, each child in the family should be given his own goals and levels of expectations that relate only to him.

• Shield younger children (siblings) from no win situations. Younger children often want to compare with older siblings, which can be very disappointing when they keep losing.

• Don't dismiss or suppress your children's resentment and angry feelings. The resentment is the time to sit down, acknowledge the changes and talk it out thoroughly.

• Use humor – Just as in any conflict, humor can dispel tension that builds with disputes.

• Try to avoid situations that promote guilt in siblings. The guilt that follows doing something mean is a lot worse than the guilt of merely feeling mean. So parental intervention must be quick and decisive.

• When possible, let brothers and sisters settle their own differences. Sounds good but it can be terribly unfair in practice. Parents have to judge when it is time to step in and mediate, especially in a contest of unequals in terms of strength and eloquence.

• Remove the source of the conflict and distraction - If a particular item seems to be cause of the conflict, remove it for a period of time.

• Help children understand that their actions bring consequences – consequences are an alternative to punishment but don't confuse consequences with bribing.

• Set a good example in your children - Your children are watching how you handle disagreements and arguments with your spouse and your friends and extended family. They look to your example for how to work out their own problems.

Siblings can create certain stresses but if they are overcome successfully, that will serve them well later in life.

Best of all as they watch you handle sibling rivalry with equanimity and fairness, they will be gaining knowledge; that will be valuable when they, too, become parents.

[Dr. Vivek Sharma is a Consultant Paediatrician in Rungta Hospital, Jaipur. His works can be seen on his website SlowLearner.co.in. He can be contacted at drvivek_sharma@rediffmail.com or on 09829062347, 0141-2752347]

Being young is greatly overestimated ...

Any failure seems so total. Later on you realize you can have another go.

(Mary Quant 1934 - Interview in Observer 5th May 1996)

Adolescence originates from "Adolescere" the Latin word, meaning to grow to maturity, which is a dreaded age for others as they are difficult to be managed.

Adolescents of today are living in the modern era in 6 major zones

• School Education

• Violence

• Sexual

• Home Atmosphere

• Materialism

• Computer, T.V. & Media

All of which have an impact on adolescent development and behaviour. Since there is a high emphasis on educational achievement, in a highly literate and achievement-oriented society, anything that affects this causes serious concern to parents. Poor academic performance is a symptom, which has many underlying causes. The reasons for poor performance have been given below:

1. In adolescent

• Sensory deficits & visual problems

• Long term illnesses

• Mental retardation, learning disability and attention deficit disorder

• Emotional disorders like anxiety, depression, disobedience and school phobia

• Poor motivation

• Certain medications like anti allergic, anti epileptic, anti asthmatics and recreational drugs

2. Environmental Factors

• Home, school, peers, teachers

• Deprived/discordant home atmosphere (poorly disciplined, broken homes, fighting parents)

• Lack of encouragement, problem with siblings, educational back ground of parents, over expectation of parents

• Adolescent pre-occupation with their own body and other problems

• More interest in co-curricular activities, ignoring studies

• Medium of instruction different from the mother tongue, high student-teacher ratio, teacher-student relationship

• Overcrowded ill-equipped class rooms, faulty learning techniques, faulty teaching strategies, not acquired basic skill/knowledge for higher classes

How Companions and Care Givers can help?

• Selecting the time

• Keeping away all distractions inclusive of TV & Computer

• Ways of learning using Survey, Questioning, Reading, Recall and Reviewing

• Try to identify the style of learning suitable to the individual

• Start learning with the easiest: do not put off the most difficult till the end. In between there should be a short time for rest

• Parents should appreciate and reinforce the effort made by the individual and not the outcome alone

• Encourage the individual the exploit his fullest potential rather than making comparisons with other children in the family or outside

• Let not learning be forced, help the individual learn at his pace and style

• Do not keep on nagging, criticizing, humiliating or making negative statements in the presence of others

• Talking to the teacher and requesting for a different approach. Change of place or class and at times even the school

• Help the child develop more defensive strategies through outdoor games

• Teach the individual to be assertive by using assertive training

• Many a time the therapist may have to call the family members to ensure their help and co-operation so that the disturbed adolescent outlive the problem

• If there are problems between the parents, family counseling may be necessary

• At times even the help/support of a classmate or teacher would be necessary

There is no single or simple way of achieving success. Using some of the strategies in your particular situation should help to create a learning environment that will promote success and a positive attitude toward academic performance.

[Dr. Vivek Sharma is a Consultant Paediatrician based in Jaipur. He can be contacted at drvivek_sharma@rediffmail.com]

When I diagnose attention deficit hyperactivity disorder, I often ask my patients whether they know anybody else with this problem.

These days, children are likely to reply with a household name: Michael Phelps, the Olympic superstar, who is emerging as an inspirational role model among parents and children whose lives are affected by attention problem.

Attention deficit / hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood.

ADHD is characterized by:

(a) In attention, including increased distractibility and difficulty sustaining attention.

(b) Poor impulse control and decreased self inhibitory capacity.

(c) Motor activity and motor restlessness.

Affected children commonly experience academic under achievement, problems with interpersonal relationship with family members and peers, and low self-esteem. ADHD frequently occurs with other emotional behavioral, language and learning disorders.

(a) Mothers of ADHD children are more likely to experience birth complications, such as toxemia, lengthy labour and complicated delivery.

(b) Maternal drug use, smoking and alcohol use during pregnancy are commonly linked to attention difficulties associated with the development of ADHD.

(c) There is strong genetic component to ADHD.

(d) Abnormal brain structures are linked to increased risk of ADHD.

(e) Child's exposure to lead (metal) has also been associated with ADHD.

(a) Inattention:

Fails to give close attention, careless mistakes at school and home, difficulty in sustaining attention in tasks and play activities, does not seem to listen when spoken to directly, fails to finish duties at home and school (not due to oppositional behavior or failure of comprehension), often avoids to engage in tasks that require sustained mental effort (such as school work and homework), often looses things school or at home (e.g. toys, pencils, books, assignments), is often easily destructed by extraneous stimuli, is often forgetful in daily activities.

(b) Hyperactivity:

Often fidgets with hands or feet or squirms in seat, leaves seat in classroom or in other situations where remaining seated is expected, runs about or climb excessively in situations where it is inappropriate, difficulty playing or engaging in leisure activities, talks excessively, is often "on the go" or acts as if "driven by a motor".

(c) Impulsivity:

Difficulty awaiting turn in games and group situations, blurts out answers to questions before they have been completed, interrupts or includes on other, for example, butts into other children's games.

The goal of managing the ADHD child is to improve the child's functions at home, in school and with peers through modification of his or her inattention, impulsivity and hyperactivity. Mode of management are education of parents and ADHD child, medications, training of parents, classroom management of child, cognitive behavior training, group social skills training and academic intervention.

The symptoms of ADHD persist throughout childhood. 70% of affected children continue to have disorder in adolescence and is more likely to persist in those who exhibit aggression and conduct problem in childhood.

Untreated adults show an increase incidence of aggressive behavior, antisocial personality disorder, conduct disorder, depression and bipolar disorder, divorce, early school leaving and alcohol and drug abuse.

Individual and family based psychological intervention for the effective management of ADHD yield significant clinical improvements in many domains of functioning. A multi-model treatment approach, however is more likely to maximize successful therapeutic outcome

with perseverance, they made it

Galileo, Mozart, Wright Brothers, Leonardo Da Vinci, Actress and Singer Cher, Louis Pasteur, George Bush's children, Prince Charles, George Bernard Shaw, Beethoven, Carl Lewis and Sylvester Stallone

[Dr. Vivek Sharma is a Consultant Paediatrician in Rungta Hospital, Jaipur. He can be contacted at drvivek_sharma@rediffmail.com or on 9829062347. His works can be seen on his website http://www.slowlearner.co.in]

Many people will still remember the speech that R.K. Narayan, the famous novelist, had made in the parliament. He said that his heart bled whenever he saw young boys and girls going to school laden with books which they could hardly carry. This burden did not improve their minds; it only made them hunch backs.

Heavy back packs are one of the most distressing and unpleasant aspects of school life for many children. The heavy weights of books make school going drudgery and irksome. This goes contrary to the current trend, which insists that the learning process should be fun. Children who do not have to carry heavy loads, such as the resident borders, are more relaxed and at ease than those who have to carry heavy backpacks to school. Similarly one of the appealing aspects of college life for kids is that they do not have to shoulder the burden of heavy books.

Heavy bags cause stress on the spine, back and shoulders, resulting in muscular pain, fatigue and strain. The excessive weight in bags may cause a child to develop poor posture or slouch excessively.

Look for the following warning symptoms that a school bag is too heavy

• Tingling and numbness in arm

• Pain while wearing the backpack

• Struggling when putting on or taking off the backpack

• Change in posture when wearing the backpack

Problems caused by heavy school bags

1. Lifting heavy burden for a long time or distance is not good for children. Half of the school children develop pain in the back or shoulder.

2. Carrying a heavy bag on the back causes forward leaning and bad posture, which can lead to improper weight bearing on the spine, and pains and aches in the shoulder and back.

3. Carrying a backpack weighing > 15% of body weight makes a child or adolescent unable to maintain proper standing posture. Children could get into bad habits like poor posture and slouching.

4. Forward bending at the back (also called kyphotic posture) makes the work of breathing harder. Children carrying heavy bags have been found to have poor lung function.

5. Children who use one-strap bags (which put weight on one shoulder only) have a particular problem. These bags cause side ways deviation of the spine (scoliosis) because of the asymetric weight distribution and this can cause long lasting backaches and damage. Slinging the bag over one shoulder causes spine damage.

How to buy the right Backpack

• Don't buy big backpack it should be appropriate to your child's size.

• Choose a backpack with moulded frame and adjustable hip strap, so that the weight of the filled backpack will rest on your child's pelvis instead of their shoulder and spine.

• The shoulder straps should be adjustable, and the rear of the backpack padded for comfort.

• To help with packing, the backpack should have a few separate compartments.

• Canvas bags are lighter than leather varieties.

• Consider buying a backpack with built in wheels.

Packing the backpack correctly

I. The backpack should weigh less than 10% of your child's body weight. For example, a child of 20 kg should carry less than 4 kg in their backpack. Ideally the child in this example should carry around 2-3 kg of books.

II. Pack the heaviest items so they are closest to the child's back. If the heaviest items are packed further away, this throws out the child's center of gravity and causes unnecessary back strain.

III. Make sure that items can't move around during transit as this could upset your child's centre of gravity. Use the backpacks with compartments.

Data shows that more than 75% of school children carry more than the recommended safe weight in the school bag.

Some solutions for this back breaking burden

1. Loose sheets for homework.

2. Individual lockers for students in school.

3. Class work notebooks kept in school.

4. Consecutive periods for one subject.

5. To follow NCERT homework guidelines.

(a) Standard I & II - No Homework

(b) Standard III to IV - 2 hrs. a week

(c) Standard VI to VIII - 5 to 6 hrs. a week

(d) Standard IX to XII - 10 to 12 hrs. a week

The Central Board of Secondary Education (CBSE) has directed the affiliated schools that they have to maintain the school bags of the students up to Class-II. School bags of students up to Class-II should be kept in school itself. Student of this age group should come with a lunch box and the pencil box only.

The CBSE has also recommended a class library system so that students get used to habit of reading books in school.

[Dr. Vivek Sharma is a consultant paediatrician in Rungta Hospital, Jaipur. He can be contacted at drvivek_sharma@rediffmail.com]