Do Replacement Children Exist?

«Do Replacement Children Exist?»
Having a New Child After Losing a Child

I have worked in the field of grief for many years, so long that I remember the time when parents were advised to wait a long time before becoming pregnant again – up to a year was recommended. In the literature, children born shortly after a child’s death were called «replacement children» (Cain & Cain, 1964). The danger, it was argued, was that the new child would not develop its own identity but be pressured to take on the role of the deceased child. The child’s identity development could thus be harmed by having to step into their sibling’s shoes. There may be medical reasons for recommending waiting, for example, after stillbirth, where an interval between pregnancies of 15-24 months is recommended (Bigelow & Bryant, 2015). When there are no medical reasons to wait, it is problematic when waiting is recommended.

In my work at the neonatal intensive care unit at Haukeland Hospital, Bergen, Norway, I met many bereaved parents, and I saw no signs that a new child became a replacement child. On the contrary, I met parents who showed great care for their new children, and it was rare for anyone to want to give the new child the name of the deceased child. Some chose a name with the same initial, but that was the closest they came to letting the loss influence the new child’s identity.

In my doctoral thesis, I examined how parents who had a new child early after their child’s death fared, compared to those who did not, and found no negative effects. A clear majority either had or were expecting a new child within the first year after the loss (Dyregrov & Matthiesen, 1987a). The others wished they were. A more recent study that included parents from 40 countries found that 66% of parents were expecting a new child within a year after a stillbirth (Wojcieszek et al., 2018). It is common to start a new pregnancy early. Old notions of replacement children have little relevance as advice to parents who have lost a child. In a study we conducted, we also found no correlation between the birth of a new child and the grief of mothers (Dyregrov & Matthiesen, 1987b).

It should be noted that most parents I met in the early 1980s had lost small children, where there was no well-developed identity for the next child to step into. But over the years, I have followed many parents who have lost older children, where such an identity exists, without meeting many who have transferred any expectations that the new child should fill the lost child’s identity.

In conversations, parents emphasize that having a new child is important to them and gives meaning to the meaningless. That said, it is clear that the hopes and fantasies they had for the child they lost are usually present for the new child as well. It is obvious that most can feel the fear of losing this child too. An early pregnancy in a situation where the mother and/or father is struggling with anxiety or is overwhelmed by longing for the child they have lost is not the best situation for being pregnant. Joy over the pregnancy can mix with fear and grief and can be exhausting. Good medical follow-up with frequent check-ups is perhaps the best counterbalance in such a situation. Good support and understanding from family and close friends are invaluable. For most, talking to someone who has experienced loss and then had a new child can also be valuable. If the fear is so high that it strongly affects daily routines, contact with mental health professionals may be necessary.

Bigelow, C. A., & Bryant, A. S. (2015). Short Interpregnancy Intervals: An Evidence-Based Guide for Clinicians. Obstetrical & Gynecological Survey, 70(7), 458–464. https://doi.org/10.1097/OGX.0000000000000195

Cain, A. C. & Cain, B. S. (1964). On replacing a child. Journal of American Academy of Clinical Psychiatry, 3, 443.

Dyregrov, A. & Matthiesen, S.B. (1987a). Anxiety and vulnerability in parents following the death of an infant. Scandinavian Journal of Psychology, 28, 16–25.

Dyregrov, A. & Matthiesen, S.B. (1987). Stillbirth, neonatal death and sudden infant death (SIDS): parental reactions. Scandinavian Journal of Psychology, 28, 104–114.

Wojcieszek, A., Boyle, F., Belizán, J., Cassidy, J., Cassidy, P., Erwich, J., Farrales, L., Gross, M., Heazell, A., Leisher, S., Mills, T., Murphy, M., Pettersson, K., Ravaldi, C., Ruidiaz, J., Siassakos, D., Silver, R., Storey, C., Vannacci, A., … Flenady, V. (2018). Care in subsequent pregnancies following stillbirth: An international survey of parents. BJOG: An International Journal of Obstetrics & Gynaecology, 125(2), 193–201. https://doi.org/10.1111/1471-0528.14424

Norwegian text can be read here