Pediatric liver transplantation is becoming increasingly common, but specific information regarding the adaptation of the families of these children, particularly of siblings, is lacking. We examined 64 siblings from 45 families of children and adolescents evaluated for liver transplantation using the Child Behavior Checklist and the Impact-on-Family Scale. As a group, the sibling subjects did not show deficits on measures of social competence or behavioral maladjustment. However, 15 siblings showed behavioral maladjustment. These children were not distinguishable from the pool of siblings based on sex, birth order, or age spacing relative to their sibling (the patient), socioeconomic status, or duration of the patient's illness. However, these behaviorally maladjusted children came from families in which the mothers reported significantly greater personal strain than did the other parents in the study. Suggestions are made for interventions to reduce stress in families facing liver transplantation.