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Freud asserted that birth order should be considered in every life history assessment, yet birth order has been underinvestigated in the field of child psychotherapy and allied fields such as educational and developmental psychology. An overview of birth order research and accounts of birth order perspectives in child psychotherapy and psychoanalytic literature are considered. Data from consecutive referrals (n = 174, 60% males and 40% females) to two UK primary school counselling services (children aged 5–11) were collected with a view to understanding more about possible patterns in birth order among referrals. The data analysis revealed that the number of siblings in the families ranged from one to nine, with a mean of 4.4 siblings. Males were over-represented across all birth order categories (eldest, middle, only child and youngest). Youngest siblings (39%) and children from larger families (three to six children) were over-represented (78%). Singletons (only children) were under-represented (6%). The data points to the increased vulnerability of younger siblings from larger families, and the protective factors for females and only children. The findings have implications for counsellors and psychotherapists working in primary schools, and more generally practitioners working with children and young people who should become more accustomed to considering birth order when assessing risk and vulnerability. Understanding birth order might also be of value to professions allied to psychotherapy such as teachers who have the purview of the children in their class, who can assess risk factors and plan accordingly.