The “replacement child”: Early intervention for babies and their families

I recently heard Kristina Schellinski’s talk on the “replacement child” and read her book entitled “Individuation for Adult Replacement Children. Ways of Coming into Being”. I found her work fascinating and yet it struck me how neglected this topic is in psychological and psychotherapeutic literature. In my clinical work I have encountered many such individuals as children and adults. Many suffer from what Schellinski calls the “replacement child condition”. Replacement children are those who are conceived under the psychological cloud of parental trauma or grief after the death or disappearance of a child. The child born into this atmosphere can carry this burden throughout their lives as if they are living out someone else’s life. Members of the family may be too overwhelmed by their loss and not capable of working through their grief. Schellinski puts us in touch with how unconscious these experiences can be and that they can impact more than one generation.

What is it like to be in touch with these powerful and overbearing dynamics from the baby’s perspective? From the onset, the baby is met by a parent who seems preoccupied, there is no proper welcome. Instead, the baby is unconsciously asked to come into the world but only via the script of the missing ‘other’ child. Cramer (1992) reminds us that “if children are born as replacements, they will be expected to cure their parents of nostalgia. They are intended to restore in full what we feel as an empty longing” (p. 107). Babies are intrinsically relational and will make every effort to engage, and replacement babies may only to be met by an unavailable parental gaze. Of course, every baby is an individual and reacts differently. Some babies react with great force and fight parental projections, but other babies sense they have to play their designated role and end up losing their own self, before they even have a chance to develop it. If there is no room for flexibility in the parental psyche, they “give up” trying to be anything else; they can only step into the parental projection. In other words, they step into the parental imaginary longed-for-child as the only available route and forfeit development of their self.

As an infant observation tutor and clinician, it is a pleasure when one hears stories of babies who are welcomed and their individual gestures are enjoyed. However, in my role I also hear some painful stories of newborns who are described in limiting ways, attributing characteristics to them before they have had a chance to be greeted by the world. Parent-infant psychotherapy can be a powerful way of intercepting these early patterns (Eleftheriadou, 2016). By intervening early, a therapist can help to reintroduce the baby and the parent in a fresh way, noticing the minutiae of their communications, such as deciphering whether baby looks uncomfortable, fearful, happy or playful. Through this active interpersonal encounter and mirroring of the baby’s affective states, the therapist can slowly start the process of freeing the baby from the unresolved grief locked in the parental psyche. The aim is for the baby to experience someone who is interested in getting to know them. Disentangling the imaginary baby from the real baby takes time. As Schellinski says, people need therapeutic support to “reconnect with their own life force and discover the unique individual they are, so that they can come to discover, like Jung: ‘this is what I am’.” Alongside the parent-infant work, the therapist may need to work with the parents separately, in order to help them encounter their grief away from the sensitive gaze of their baby. This work plants the seed for the need of a separate space to process their loss. 

It is important to start early and challenge family dynamics before they get set. In the poignant text “The Importance of being baby”, Cramer (1992) writes about allowing the baby to write their own life script. The therapist acts as a sort of mediator, talking to both baby and parents and translating what they are saying to each other. The psychotherapist listens closely to the parental conscious and unconscious meanings held via their gestures, behaviour and words. Similarly, the baby’s communications are full of emotion and rich meaning. If babies sense (and we now know from developmental research that babies have a strong sense) that they have entered something frightening or confusing they may be afraid to look or listen too closely; or the opposite might happen where they become vigilant or shut off. Either way, it is too much for them and if this experience prolongs it is at a cost to their emotional development.

Cramer (1992) aptly summarises the task ahead: early intervention “allows parents to re-work old conflicts and anxieties that might otherwise have remained unresolved” (p. ix). Furthermore, he reminds us that:

“this period is more favourable to change than any other phase in life. We should make the most of this potential and support new parents in creative introspection. In this way the spells cast by family ghosts can often be broken so that the child’s own nature can be expressed” (p. 196).


Cramer, B. (1992). The Importance of Being Baby. Wokingham, England: Addison Wesley.

Eleftheriadou, Z. (2016). Creating a safe space: Psychotherapeutic support for refugee parents and babies. In S. Acquarone (Ed.). Surviving the Early Years: The Importance of Early Intervention with Babies at Risk (pp. 87-99). London: Karnac.

Updated photo- ZE (May 2021)

Dr Zack Eleftheriadou is a UKCP trained adult, child and parent-infant psychotherapist. She is a Chartered Counselling Psychologist and a Fellow of the British Psychological Society. She works as an infant observation tutor and a clinician in London, UK. She is Committee member of the UKCP Child Faculty & College of Child and Adolescent Psychotherapies, Parent-Infant Psychotherapy subcommittee. The group was set up by parent-infant psychotherapist, Dr Yvonne Osafo, to raise the profile of infant-parent psychotherapy in the UK and has been meeting regularly to develop formal parent-infant psychotherapy training standards.

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