The phenomenon of the Replacement Child---a child born after another child has died---presents a complex and fascinating picture of an individual caught in a dilemma of identity.  Although much has been written about the replacement child, most of it remains within the realm of research and a few clinical studies. (Albert and Barbara Cain first studied the phenomenon of the replacement child. Their 1964 paper reports on six families in psychiatric treatment after the death of a child. The subsequent children of these families developed psychiatric problems.)

Although the classic definition of a replacement child is a child who is conceived to replace a deceased child, many researchers have sought to expand the definition to include any child born to replace a child who has died, a child who is born immediately after the death of another child, or even a child who “takes over” for a sibling who dies at an older age, literally “replacing” the deceased. In this latter case, the RC may take over the role (and often the interests) of the deceased sibling on their own, or this shift may be pushed by parents who can’t let the deceased child go.

Many parents suffer the loss of a child but this alone does not imply that a subsequent child is a replacement child. After mourning and accepting the loss of a child, parents may decide to welcome another child, and this is often a healing thing for everyone. This child is loved and accepted for who he/she is in their own right and their emerging identity is nurtured and respected. Clearly, the world of the classic RC represents a very unique situation and the factors surrounding it are very specific to the clinical presentation.

Several identifiers of the RC have emerged as a result of Cain &Cain’s initial study, as well as the work of other researchers on this specific issue and those studying the impact of perinatal loss on subsequent pregnancy and parenting:

Unresolved parental grief seems pathognomonic. And parents who cannot accept the death of a child carry over their expectations, fears, and guilt to subsequent children.

These parents are often overprotective and restrictive. The world is viewed as an unsafe place and subsequent children are kept close by so that nothing will happen to them.

Because of this heightened overprotective stance, many subsequent or “substitute” children are anxious and fearful, lacking self-esteem and confidence. The Cain study observed “infantile, immature, home-bound children, with strong passive-dependent elements and widespread ego restrictions.” In other words, many of these children have great difficulty with separation and individuation moving into the future.

An even more difficult case scenario for some replacement children is that in being required to assume the identity of the deceased (and often a designated family role), they may experience difficulty in developing their own identity; in essence, their identity is described as a pseudo or non-identity.

Guilt plays a large part in the dynamic of replacement children who may suffer “survivor’s guilt.” As irrational as it may seem, in some families the substitute child is made to feel responsible for the other child’s death. For some parents the subsequent child is a constant reminder that the beloved deceased child would be here if not for the subsequent child.

Hyper-idealization of the deceased child is common. The dilemma for some replacement children is that they may never meet the unrealistic expectations of the parents in filling the image of the deceased. They may suffer guilt about anger that cannot be acknowledged, let alone expressed, at the constant comparisons to the deceased and to the notion that they (the replacement child) will never measure up, will never be as good as the deceased child would have been.

In the extreme case scenario, the replacement child is a constant cruel reminder to one or both of the parents of the loss of the much loved child, the “angel”, the perfect one. In its extreme, the replacement child is not only criticized, judged and found lacking, but may even be ignored and made to feel worthless and unloved.

Having said all of this, no research is complete without a balanced perspective. The research thus far seems to paint a pretty bleak picture for the RC. The problem with some of the clinical studies is the emphasis on those families and children who presented on the extreme end of the spectrum. While it’s true that most replacement children have many challenges to learn to cope with, little seems to be available in the literature about those replacement children who are able to rise to the occasion, or above it, overcoming many of the inherent difficulties of being a replacement child.

From the perspective of some adult replacement children there is a place on the spectrum that describes them, but there’s not much about that in the literature. Many of them feel that a more balanced perspective needs to be explored and included in the discussion. Are there “positives” about being a replacement child? What factors explain the resilience and strength of those who have endured an assault on their identity and yet have emerged as a whole, unique self from the conflict?

 From a clinical perspective, the constellation of symptoms presented by the RC deserves more intensive focus and examination in mainstream therapeutic thought, especially for its implications for intervention in individual treatment. The patient’s history, specific clinical issues and symptoms, and unique coping skills must be considered as a totality, in order to avoid missing the proper diagnosis and intervention. For example, specific symptoms may easily fall within the broader spectrum of more general symptoms such as anxiety and depression, but in the case of many RC, these are often just the tip of the iceberg.

I’m interested in learning about your experiences with replacement children. I invite your comments, suggestions, and professional insights.

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