Struggling with feeding
September 2, 2010 in Ask the Feeding Specialist, Insider Insight by Katja Rowell MD
As a behavioral childhood feeding specialist, I work with lots of families struggling with feeding. From picky eating to weight and nutrition concerns, parents are working hard, frustrated and scared. While I have worked mostly with typically developing children, Ellyn Satter’s Division of Responsibility in feeding is appropriate for almost all children, including those with special needs, from Type I Diabetes, to autism. Families with children who are extremely selective have called in despair- months of therapy and the problems seem to be getting worse. I’ve had families say they “tried” family meals for a few weeks and they “didn’t work.” I am pleased that Satter’s latest newsletter specifically addresses children with ASD and SI issues and look forward to more of her work addressing the concerns of special needs families.From: July 2010 • Family Meals Focus #47 • Pressured on All Sides
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.
