The Feeding with Love and Good Sense Video and Teacher’s Guide, published in 1987, is being revised! The Childhood Feeding Collaborative of the Santa Clara County Public Health Department in San Jose, CA funded the videography and recruited parent volunteers. I produced 30 hours of footage with as many families and am well on my way to turning the footage into about an 80-minute video that addresses feeding the (infant, transition, toddler, preschooler). I have lots of plans for making further use of this footage, but enough of that. Let’s talk about what I saw.
To put a positive spin on it, parents work way too hard! To put a not-so-positive spin on it, parents are interfering. They sit down to a lovely meal and spoil it right away by telling the child, “you know the rules-you have to eat your vegetables.” Often the “eat your vegetables” admonition reverberates, with one parent picking up the words of the other and the first amplifying the second and back again. Parents peer and arrange and wipe-wipe-wipe and scrape together the child’s food. They tap the child’s plate and interrupt her conversation to remind her to finish whatever-it-is. They insist on one bite of everything and reason and praise and feed children who are old enough to feed themselves and explain about nutritional superiority and make bargains about “first this and then that.” They keep up a rat-tat litany: Use your fork, use your spoon, use your napkin. For their part, children do not easily give up their rights with eating. They argue, whine, cry, resist and evade, become defiantly messy, throw anything within reach, and press their parents to make increasingly ridiculous food bargains.
As a result of all this static, children are so stressed that they lose touch with themselves: their internal cues of hunger and satiety, their enjoyment and curiosity about food, and their pride in learning to do well with eating. But parents are stressed as well. They do not enjoy making their child miserable, but they do it anyway because they think it is good parenting with food. Why all the fuss? If children get the support they need – enjoyable family meals – they push themselves along to learn to eat the food their parents eat. Eventually they even do it neatly. Where do parents get the idea that they have to micromanage children’s eating? This pattern is not confined to San Jose, CA, nor is it new. Thirty years ago, an experienced Pediatric Nurse Practitioner observed to me, “If a child eats, parents think it is all their idea.”
Given this pressure on their eating, little wonder that children who are at all cautious and limited in with respect to eating develop extreme food selectivity or bizarre food behaviors. If fed according to a division of responsibility and allowed to move along according to their own tempo, slow-to-warm-up children learn to enjoy a variety of food. Really cautious kids, such as those with sensory integration disorders and autism spectrum disorders, still push themselves ever-so-slowly along to learn to eat. To do that they need structure, opportunities to learn and no pressure. Children with neuromuscular limitations struggle to manage the nipple or the spoon and eat until they run out of energy and it stops being enjoyable. Then they need nutritional support delivered in some other way so they and they and their parents don’t have to wear themselves out satisfying their nutritional requirements.
The take-home message is that we have work to do. We must let these poor parents – and these poor children – off the hook by teaching parents the division of responsibility in feeding. Along with that, we must help parents identify when they are putting pressure on feeding, and give them the good news about how much happier they and they child will be if they stop it.
Copyright © 2010 by Ellyn Satter. Published at www.EllynSatter.com.
Abby and her speech therapist were making major gains. She had mastered feeding herself, clapping and grinning, clearly proud of her accomplishments. Problem is, it all fell apart when Abby left her therapy center. Her parents tried bribes, rewards and begging, but Abby would simply refuse to eat unless she was nestled in Mom’s lap and spoon-fed.
Six-year-old Abby had been medically fragile, overcoming heart surgery and oral motor concerns. Mom had done a great job supporting and feeding her daughter over the years, but now at age six, the feeding practices that served them well were holding Abby back.
What can you do if you suspect you are stuck with feeding?
- • Utilize the team, bring in the latest information you are working from. Perhaps the advice from two months ago is no longer appropriate.
- • Find out if your child has adequate nutritional reserves to handle changes in feeding.
- • When appropriate, optimize feeding on a schedule, work on family meals. This will be the framework that will help Abby’s parents feel secure moving forward.
- • Explore your fears. Is it hard to let go of your notion of your child as medically fragile or incapable of feeding herself? Are you worried about a feeding tube? Voice your fears to the team. Believe them if they reassure you. (This assumes you have a good working relationship.)
- • Do you believe that if you pressure or push your child to eat more that they will grow better? Has this worked? Ask your feeding team to explain why pressure with feeding often backfires. (Studies show that overall, children who are pressured to eat do less well with eating and grow more slowly.)
- • Make sure that all care-givers involved are on the same page with any upcoming feeding changes. If Dad refuses to feed Abby, but Mom caves in, things won’t change.
- • Find a behaviorist or feeding specialist to work with. Get specific about how you are feeding. Are you eating with your child? Are you minimizing distractions? What kind of chair are you using? Is there a footrest, or soft belts to help center and focus your child? Bring in your utensils and plates. Sometimes having the right fork can make a huge difference.
- • What are you getting from feeding? Perhaps Abby and her mom get special cuddle time during meals? Explore, find other ways to connect, maybe keep the rituals if there is no harm, but be honest about your motivation. (My own daughter was not cuddly, so I held on to that last nighttime bottle longer than I “should” have, but there was no harm to her eating or health, and I needed that cuddle time! Eventually it became clear that it was time to give up the bottle and we did.)
- • Use your discipline techniques that work to enforce and teach behavior at the table. Be calm. Discipline behavior and not what or how much the child is eating. Ask the team or other parents for some ideas on this.
- • Center yourself before a meal. Food, nourishment, the “threat” of a “failure to thrive diagnosis,” and behavior challenges can all combine to make mealtime a high-stress, high-anxiety experience. Your child will pick up on this. Sit down, take a few deep breaths. Try to be pleasant and calm.
- • Have a game plan for making changes. Some thoughts for Abby who has the understanding and skills to work on change:
- • Start with breakfast (you know more snacks and meals are coming.) Be calm but firm with expectations. Do not feed Abby.
- • Be very reliable about offering balanced foods, with a mix of finger foods and spoon foods every 3-4 hours.
- • Get support. Check in with your team. If intake truly is a concern and she eats well for others in the care team, consider sharing duties during the transition.
- • Watch for small victories, but celebrate them in your head. Some kids view any praise or reward as pressure and will back off. Tailor your approach to what works with your child.
- • If positive reward works well, go for it. For Abby, all the offers of stickers and cheering may have slowed things down. Having the calm expectation of mastery might help.
- • Don’t focus on who is eating what. Talk to Dad or Big Sis. Abby might just pick up that spoon when no one is looking.
- • Give the new plan at least three days and longer if Abby has the nutritional reserve! Many parents lose their nerve about twenty minutes into a meal…
- • Understand normal growth and development (See chapter 2 of Child of Mine online at www.ellynsatter.com) so that you know it’s normal to eat small amounts some meals, and larger amounts at others. Allow children the time and space to learn to tune in to hungry and full if they are able. (Children with pain, or other underlying medical issues may have a harder time with this.)