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In the last fifteen years, there have been three major developments in child and adolescent psychoanalysis and psychoanalytically informed psychotherapy. After briefly reviewing what is clear and unclear about the nature of child psychoanalysis, the author describes and critiques three recent trends: (1) a greater differentiation of aetiological factors that involves an enhanced understanding about developmental influences and how they may be utilised therapeutically; (2) a shift in child analytic theory to a more equitable balance between internal and external factors, with more attention being paid to the external; and (3) a significant increase in the psychoanalytically informed, empirical study of development as well as the process and outcome of treatment. Changes in these three overlapping domains are examined and their relevance to clinical practice discussed. It is suggested that the increase in the systematic and empirical study of the child psychoanalytic process has been the most significant recent development in the field; it is this that has the greatest potential to minimise rhetoric, to support discovery and to clarify what is unique about psychoanalytically informed work with children and adolescents.