For a variety of reasons, occupational therapists are beginning to explore the use of cognitive, or “top-down” approaches during intervention. While these approaches have a long history within education and psychology, the steps involved in problem-solving and the techniques that are used to mediate a child's occupational performance are unfamiliar to most therapists. In this paper, the historical underpinnings of cognitive approaches and mediational techniques are reviewed and the steps involved in teaching a child to problem solve are outlined. As each is described from the literature, it is interpreted and applied to paediatric occupational therapy practice. Finally, the problem-solving steps and techniques are combined to demonstrate usage of a cognitive approach in order to address a common occupational performance issue in childhood.