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This paper focuses on children whose first recourse is to use the body, who seem unable to pause, think or reflect. The roots in early parenting and failures of early infant-object relationships are explored, as are the developmental routes available to the growing infant/child. Thoughts on the role of the ego ideal and ideal ego are offered - continuing adherence to an ideal ego with its preoccupation with omnipotent fantasy prevents the establishment of an ego ideal, an aspirational self with possibilities and ambition. The emergence of an ego ideal indicates the child is back on a developmental track, engaged with growth. The cases of two children are used to show the processes involved and to help us think about therapeutic technique and theoretical understanding: George who, aged 9, told his parents that he wished to be a girl, and Martin, a violent adolescent.