This paper examines the limited literature on narcissistic personality disorder in children, addressing the relevance of the concept of ‘personality’ or enduring and consistent traits during childhood. Children are formally viewed by most diagnostic criteria as lacking consolidated personalities. Still, some children present with consistent patterns of behavior like those defining the adult disorder. Psychodynamic and other theories that help us understand narcissistic disorders in childhood and their treatment are then examined. These theories are heavily developmental and descriptive in focus, with much less attention to treatment. A case example of a challenging, often silent child who denied most difficulties is offered to illustrate treatment challenges. Recommendations for clinicians treating children who have narcissistic disorders conclude the article.