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The death of a child invariably affects the family, who in effect become survivors. Adaptations are made in order to secure a new family equilibrium attendant upon such a loss. Surviving siblings not infrequently become the focus of maneuvers unconsciously designed to alleviate guilt and control fate through silence and efforts to maintain silence, through substitution for the lost child, and through endowing the survivor-child with qualities of the deceased. Three types of clinically identifiable types of survivor-children are described. Families that emphasize silence and focus on guilt, families in which the child becomes incomparably precious, and families in which substitution and replacement provide the major theme lead respectively to the “haunted,”“bound,” and “resurrected” child.

These children share many features, as do their families, but there appears to be a connection between the family defensive maneuver and the specific consequences for a child of the bereaved family.