Conflict of interest statement: No conflicts declared.
Psychological vulnerability in children next-born after stillbirth: a case–control follow-up study
Article first published online: 9 JUL 2009
© 2009 The Authors. Journal compilation © 2009 Association for Child and Adolescent Mental Health
Journal of Child Psychology and Psychiatry
Volume 50, Issue 12, pages 1451–1458, December 2009
How to Cite
Turton, P., Badenhorst, W., Pawlby, S., White, S. and Hughes, P. (2009), Psychological vulnerability in children next-born after stillbirth: a case–control follow-up study. Journal of Child Psychology and Psychiatry, 50: 1451–1458. doi: 10.1111/j.1469-7610.2009.02111.x
- Issue published online: 5 NOV 2009
- Article first published online: 9 JUL 2009
- Manuscript accepted 2 March 2009
- perinatal loss;
- psychological impact; siblings;
- ‘replacement child’;
- ‘vulnerable child’
Background: Case studies and anecdotal accounts suggest that perinatal loss may impact upon other children in the family, including those born subsequent to loss. However, there is a dearth of systematically collected quantitative data on this potentially vulnerable group.
Methods: Case-controlled follow-up of 52 mothers with history of stillbirth with their next-born children aged 6–8 years, and 51 control mother–child dyads. Previously reported baseline data included maternal antenatal and postnatal psychological assessment, and infant security of attachment at 12 months. Follow-up assessments included maternal psychiatric and socio-demographic data, mother and teacher-rated scales of the child’s strengths and difficulties, child IQ, observer-rated mother–child interaction and maternal reports of child health.
Results: There were no significant between-group differences in child cognitive or health assessments, or in teacher-rated child difficulties. However, mothers with history of stillbirth (the index group) reported increased child difficulties, in particular peer problems, and more adverse interaction was observed in respect of higher levels of maternal criticism of the child’s actions, more overall controlling behaviour by the mother, a less harmonious emotional atmosphere and a lower level of maternal engagement with the child. Some of these effects appeared to be mediated by maternal perinatal psychological symptoms and family breakdown.
Conclusions: This study provides no evidence to suggest that siblings born after stillbirth are clinically at risk but does lend empirical support to clinical reports that such children are seen by their mothers as having problems and that they are exposed to less optimal interaction with their mothers. Possible interpretations of these findings are discussed in the context of theoretical accounts of ‘replacement child’ and ‘vulnerable child’ syndromes.