12 - Behavioural approaches to eating and sleeping problems in young children

Summary

When working with young children who have eating or sleeping problems, there are a range of therapeutic approaches that are utilized to tailor the treatment to the particular needs of the child and parents. Cognitive behavioural therapy (CBT) is one part of the armoury and, when the child is preschool age, this therapy is often directed at the parents rather than at the child. The fact that CBT has been lifted from the adult arena of treatment techniques and applied to the complex set of relationships of children in families means that our use of CBT has to widen to include not just ‘individual’ work with children but also with their parents and carers (Barrett, 2000). The behavioural and emotional problems of young children, in particular, make us rethink who is in treatment and how those treatment goals are best implemented. Helping parents change their behaviour towards their child can have a positive impact on the child's problems. This process will often involve the parents changing their cognitions and feelings about their child and his behaviour.

CBT programmes directed at parents are valid forms of treatment for children (Bugental and Johnston, 2000; Rapee, 2001), but they do raise the question: ‘what is the goal of treatment?’ There is an assumption of a mediating role of change for parental cognitions that produces change in their behaviour, which in turn affects their child's behaviour. There may be uncertainty whether, in these circumstances, change in the child's cognitions occurs before behaviour changes.