On the song, J. Cole explores "his place between the old and new generations of hip hop, making him the 'middle child' of rap.

They read: I'm Counting My Bullets, I'm Loading My Clips, I'm Writing Down Names, and I'm Making A List, J Cole later deleted the posts.

[5] Then, later that same day, Cole announced on social media that he was releasing "Middle Child" on January 23, 2019, at 9:00 PM EST, and uploaded the cover art which featured the song's title capitalized over a static grey background.

The song includes an exclusive multi-track sample of the horns section from "Wake Up to Me" by '70s Philadelphia trio First Choice, which was found and cleared through music licensing site Tracklib.

[9] Next was the addition of drums to the song, which T-Minus said was reminiscent of KOD "'cause a lot of it's very like stuttery kind of hats, very short but rhythmic".

The drums added a variety of sounds, but J. Cole wanted to add an 808 pattern to the song, with the beat going from high to low.

An accompanying music video for the track was uploaded to Cole's official YouTube channel on February 25, 2019.

[13] The video was shot in Georgia, and was directed by fellow North Carolina rapper Mez, and features cameos from Dreamville artists Lute, Omen, and Cozz.

In an interview with Complex, Mez spoke about the creation of the video, he said: I came up with everything from scratch, but [J. Cole's go-to director] Scott [Lazer] had an idea for the Bentley.

[15]Reviewing the music video, Laura Dzubay of The Michigan Daily said, "The visuals used in the "MIDDLE CHILD" video are very evocative: Between the lit-up marching band, the covered dead bodies, the stuffed rappers' heads on the mantle and the woman at the end picking a Saran-wrapped head out of a sale freezer at the grocery store, it's almost hard to land on which theme (if any) might be the most significant.

"[17] J. Cole performed "Middle Child" at the 2019 NBA All-Star Game halftime show on February 17, 2019, in Charlotte, North Carolina.