The purpose of this review was to understand the experience of siblings living with a child with Down syndrome (DS) and to identify factors influencing siblings' adaptation. There were both positive and negative consequences associated with being the sibling of a child with DS. Various factors affected siblings' adaptation, but many of these factors were modifiable. An understanding of the modifiable factors can help healthcare providers provide better care and facilitate the development of targeted family/community level interventions. Healthcare providers can also recognize siblings at increased risk for experiencing difficulties adapting and can initiate preventive strategies by understanding nonmodifiable factors.