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Case Study: 3 Year Old Sleep and Behaviour Issues

Harry's mum, Andrea, got in touch with me when she was at the end of her tether. She was exhausted because he was waking up 1 to 3 times a night, and would sometimes be awake for up to 2 hours. Other nights he would sleep soundly through the night. But what she was finding even more difficult was his behaviour during the day. He was being incredibly clingy to her and demanding of her, often lashing out when she wouldn't immediately give him exactly what he wanted. He only wanted her to do things for him, like getting him dressed, and would have huge tantrums if anyone else tried to help. In addition to this, he wouldn't eat much at mealtimes, was very jealous of his little sister, who he would be aggressive towards, and often hurt her. Harry has many food allergies and they were in the process of reintroducing dairy using the milk ladder.

Andrea and I spent about 3 hours talking online as she was too far away for me to see in person. While we were chatting, Harry was pottering around in the background, playing with toys with the TV on. The first thing I asked Andrea to do was to turn off the TV as I didn't want it to be a distraction for Harry, and I wanted to see how he was when he got bored. Initially he was quite happy playing near his mum. She engaged well with him, answered his questions and took direction from him so she could join in his game. However, once we started to get more involved in our conversation, and she couldn't reply to him immediately, he started to whine, then shout, and then hit Andrea with a car. She gently said, "Harry, that's not okay, please don't do that and I'll play with you again." He stopped and she started to play again.

Tantrums

Once he was settled down again, we talked about how she had pacified him when he had become cross, but how she was actually rewarding his aggressive behaviour, and therefor encouraging it, by her choice of word, tone of voice, and reaction. I suggested that next time he behaves in a similar way, she try being firmer and clearer as what he is doing is aggressive and has to stop immediately.


Within minutes, he was demanding that she stop talking with me and join him on the floor. When she said that she needed to carry on talking, he started screaming and hitting her again. This time, she crouched down beside him, took a deep breath and said, "Harry! You must not hit me. It hurts. I don't like it! Do not do it again. I will not play with you when you hurt me." She then moved to the other side of the room. Harry started crying and rolling around on the floor.


We had also discussed what she needed to say to him when he had tantrums, so she moved closer to him, crouched down again and said, "Yes, I can see you're cross because I'm not playing with you. You look very cross and upset. It's okay to feel cross."


Again he tried to hit her, and this time I directed her to say, "Feeling cross is okay, but hitting is not allowed." And she moved away from him again. He continued to roll around on the floor, shouting and wailing but didn't try to hit her again. She was able to stay close to him and I told her to make eye contact with him every few minutes and say, "Yes, I hear you, you're still very cross."


After about 8 minutes of the tantrum, she picked him up and said, "Come on, take some deep breaths and calm down, you're okay. That's enough." I could see that she wasn't comfortable with letting Harry have such a big tantrum so I explained that as long as she was close to him, it was fine for him to display his emotions in this way. It is totally natural early childhood behaviour, wasn't extreme or anything to worry about, but it was very important NOT to try to control his emotions by telling him he's fine or distracting him. What I wanted her to do was to let him work through his big emotions so that he could calm down when he was ready. She put him down again and let him carry on shouting and feeling cross, and every few minutes she said, "Yes, I hear you, you're still very cross." And eventually he calmed down after about 40 minutes.

Eating

In the early part of the conversation, we had touched on Harry's eating habits and how he preferred to eat snacks that came pre-packed, rather than his lunch and dinner, because "he is a very fussy eater". I had explained that the snacks will usually trump proper food, because they are fun, sweet and usually lack nutrition, even if they look healthy.


When Harry asked for a snack, Andrea told him that he couldn't have one, and that lunch was in half an hour. Again, he threw himself to the floor and had another tantrum. Andrea quickly responded in the same way as I had told her to earlier, and she waited patiently for him to calm down. This time it took about 10 minutes before he was happy. I suggested that she ask him to help prepare the lunch. He helped to get the food out the fridge, put plates on the table, and cut up the cucumber. He seemed to really enjoy being helpful!


She served a plate of food that he would normally push away and refuse to eat, which he did initially do, so I told her to get him down from the table, send him off to play, and tell him that the food was there when he was hungry and ready to eat it.


After about 5 minutes, he came back to the table, looked at the food and reached out for a piece of chicken. I told her to tell him that he would need to sit in his booster chair if he wanted to eat. Again, he initially fought this, but Andrea used a firm tone and repeated the instruction. He climbed into his booster and picked at the food on his plate. Some bits he ate well, and other bits he left, but Andrea was ecstatic as it was the most he had eaten at lunchtime in months!


We also decided that they would pause the milk ladder until Harry's eating and sleeping had settled down, as the milk could be aggravating his gut, making his more angry and demanding, disturbing his sleep, and possibly affecting what he ate.

Sleep

After lunch we discussed his sleep. Harry had dropped his nap when he was two and a half, but because he wasn't quite ready to get through 12 hours awake time, they had started putting him to bed at 6pm. To start with, this seemed to be working as he would fall asleep quickly if they stayed with him and would usually sleep most of the night. However, over the last few months, he had started waking up during the night and staying awake for up to a couple of hours on a bad night.


We decided that the 6pm bedtime was now far too early for him and that he needed to learn to fall asleep on his own as this would help him to stay asleep during the night. I made a gradual retreat sleep plan for Andrea to follow as she worked on Harry's behaviour. I explained that as he started to feel more secure, which she would see with a reduction in tantrums and lashing out, he would cope with her gradually moving away from sitting right beside him at bedtime.

Sibling Rivalry

We also discussed putting in very clear boundaries about aggression towards Harry's little sister, and decided that Harry would be put in a travel cot in the open plan living area if he hurt her. We decided to try this as he needed a safe place to calm down when he was cross, where his little sister couldn't then annoy him, and also where he couldn't get to her if he wanted to hurt her. The space needed to be close to Andrea so that she could talk to him and sit beside him if he needed her to. We had discussed sitting him on the sofa but Andrea felt that she couldn't safely keep an eye on him there if she was occupied with cooking or other chores, and he probably wouldn't stay on it anyway.


We talked at length about how the travel cot was not to used as punishment, and that Harry's little sister could also be put in it to be kept safe for short periods while Andrea did chores, as she had recently started emptying kitchen cupboards and climbing into them. Neither child was never to be left alone in the travel cot or ignored. The aim was for safety and to give them a space to calm down without their sibling attacking them, which would ultimately help them to feel more secure, which would have a positive impact on Harry's sleep and behaviour as well as his relationship with his little sister.


We also worked out a schedule so that Andrea would get some one-to-one time with each of the children a couple of times each week.

Results

Andrea worked hard over the following 5 weeks. We spoke regularly about her progress and discussed her questions. She needed a bit of reassurance as she didn't feel like she "was getting it right some of the time" but her confidence grew as Harry chilled out and his behaviour changed.


When we last spoke, she had completed his sleep plan and he was going to bed at 7.00pm and waking at 6.30am most days. He would occasionally go in the travel cot, but it was mostly used as a playpen for his little sister while Andrea cooked dinner, and Harry would sometimes play in it with her too. He would still make some unreasonable demands of mum, but she said that he didn't lash out any more and accepted her firm tone when she used it. The children still squabble but she's no longer worried about Harry intentionally hurting his little sister!

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