Ochre is one of the earliest forms of symbolism known in the archaeological record and has been associated with some of the earliest human burials. At Khok Phanom Di, a Neolithic cemetery site in central Thailand, red ochre was found in 82% of burials spanning the site’s ~500 years of use. The widespread burial practice and the length of occupation enabled investigation of the changes in ochre use over time; and whether these developments coincided with osteobiographies, environmental shift, or material culture. The site, first excavated in 1985, has been subject to extensive investigation, which enabled a holistic approach encompassing a wealth of secondary data. The relationship between ochre and site chronology, osteology, palaeopathology, mobility, funerary behaviour, and spatial organisation was explored using statistical methods and bone surface mapping. The results show that burials without ochre are almost exclusively those of perinates, however ~ 38% of perinate burials did contain ochre. Further exploration of perinatal burials from the site demonstrated that those without ochre were typically smaller skeletally and therefore interpreted to be younger in perinatal age - this also corresponded with smaller, simpler graves. The possibility of whether they were stillborn or neonatal deaths was explored through a cross-cultural discussion of perinatal death and personhood. The inclusion within the conventional burial place but distinctly simple mortuary practices, particularly in contrast to some of the more elaborate funerary practices at the site, suggests that the infants without ochre sat on the fringes of social acknowledgement. Whether they were stillborn or neonatal deaths, it demonstrates that for this society there was a grey area between inclusion and exclusion. It would also appear for this culture, that beyond burial, ochre was an essential part of marking a person’s life.