The author begins his argument by confronting child murder in the real: in clinical work, in the media, in historical accounts of rituals. Studying ritual child murder within the Inca culture, together with stories of child murder throughout history, allows the author to draw some initial parallels between ritualistic child murder and its treatment in the clinic. A Winnicottian reading of the genesis of the subject, with narcissism as a central focus, provides a framework for understanding this kind of aggression in the clinic. Taking into consideration the effects of being able to psychically represent, we learn that fantasmatic, real and ritual murder of a child is embedded in the structure brought about by the entrance into language.