In the Kassena-Nankana District of Ghana, researchers and health interventionists describe a phenomenon wherein some children are subject to infanticide because they are regarded as spirit children sent " from the bush" to cause misfortune and destroy the family. This phenomenon remains largely misunderstood and misrepresented. Based upon both ethnographic research and verbal autopsy data from 2006 to 2007 and 2009, this paper clarifies the characteristics of and circumstances surrounding the spirit child phenomenon, the role it plays within community understandings of childhood illness and mortality, and the variations present within the discourse and practice. The spirit child is a complex explanatory model closely connected to the Nankani sociocultural world and understandings surrounding causes of illness, disability, and misfortune, and is best understood within the context of the larger economic, social, and health concerns within the region. The identification of a child as a spirit child does not necessarily indicate that the child was a victim of infanticide. The spirit child best describes why a child died, rather than how the death occurred. In addition to shaping maternal and child health interventions, these findings have implications for verbal autopsy assessments and the accuracy of demographic data concerning the causes of child mortality.