The Gold Standard of Feeding

I once worked with a mother who came to me for help after her 4-year old son began to refuse food, for days on end. She was concerned, understandably, and wanted to do whatever she could to get her son to eat again. She explained that he had always been a good eater, but had recently experienced a couple of near-choking episodes. We suspected he had started to develop some fear of eating as a result of this terrifying experience.

When he first started refusing foods, Mom tried to be encouraging during mealtimes,

“Would you please take another bite for Mommy? Yummm, you love chicken nuggets!”

But after days had passed, she began to get nervous, and more desperate. This mom explained that she begged, pleaded, yelled, and bribed her son during meal times, just hoping to get him to take a single bite. Night after night, he refused, only to take sips of juice, and the rare sample of yogurt. 

That’s where I come in. What I saw, as an objective outsider, was a child who had developed a fear of food. He needed to learn to trust food again before he felt comfortable eating. And on top of it all, his mother, terrified that her child was going to starve, was putting a lot of pressure on him to eat. It turns out that pressure to eat might have been perpetuating the problem.

The issue was not that this little boy did not want to eat. Or that this mother was putting too much pressure on him to eat. The issue was much more simple than that, and it’s something that many parents and children struggle with every day (though this was a more extreme manifestation of the problem). The problem was lack of trust during mealtimes – mom did not trust her child would eat without her persuasion, and the boy did not trust the food itself.

So how do we build back trust in a seemingly broken relationship? We slow down, create a safe environment during meal times, and re-establish expectations. The best way of doing this is by following a gold standard of feeding practices – the division of responsibilities.

The Gold Standard – Division of Responsibilities

During mealtimes, parents and children have a distinct division of responsibilities (DOR). This practice, coined by Registered Dietitian and Family Therapist, Ellyn Satter, is intended to establish expectations for both parents and children, to promote healthy relationships with food during mealtimes.

For caregivers, your responsibilities are threefold –

1. To determine when mealtime is (at a set time every day or variable on your schedule)
2. Setting the location of the meal (i.e. at the table, outside, in the playroom, etc.)
3. To determine what what the meal is (tip: variety is key – keep a few safe foods in rotation and offer variety to compliment the foods you know they will eat)

For kids, their responsibilities are as follows –

1. To determine what they eat on their plate
2. To determine how much they eat (just a few bites or asking for seconds)

The idea is to allow children some autonomy in their food-related decisions, which allows them to build trust and healthy relationships with food over time. In the case of the mother and son I began with, we had to create an environment where the child felt safe and comfortable in exploring his own relationship with food. When mom relinquished control of what and how much her son was eating, he learned to take ownership of those responsibilities. He very quickly returned to old habits, as his trust in food returned.

Common Barriers

When I suggest the DOR to help restore healthy relationships with food, I know that parents can become apprehensive when they they about relinquishing some control during mealtimes. The most common concerns I hear from caregivers sounds something like,

“But if I allow my child to eat as much or as little as they want, they’ll eat until they’re sick,” or “If I don’t ask them to eat their vegetables, they won’t touch them.”

And these concerns are completely valid. It does seem like a risk to allow full trust in your child’s decision on how much and what they eat. You may not see the outcomes you’re hoping for when you first introduce this practice during mealtimes. But trust me, the DOR is referred to as the gold standard of feeding for a reason. This practice will help your child learn how to develop a healthy, self-regulated relationship with eating as they grow up.

For parents who are just getting started using the DOR to guide mealtimes, I want to include a few tips to help ensure your success:

• Offer variety – your children may or may not eat the food, but repeated exposure is important for familiarization, encouraging curiosity, and ultimately, promoting acceptance of food.
• Keep your comments to a minimum – the point is to allow your child to interact with the food at their own pace. It may be challenging, but resist the urge to ask them to ‘take just one bite’ of their broccoli.
• Cue them into listening to hunger and fullness signs – the practice of cueing kids into their feelings of hunger and fullness is important for helping them learn to self-regulate appetite, and prevent overeating. You can ask them questions like,
  • “How do you know when you’re full and it’s time to stop eating?”
  • “Before you take another bite, how does your tummy feel?”
  • “Remember when you got too full last night? Can you tell me how that made you feel?”
• Practice patience – if this is a new practice for your and your kids, it may take some getting used to. Know that consistency over time will have the greatest impact on your family.

This feeding technique can present challenges for parents who may not be used to this style of feeding. But with time and practice, you can successfully implement the DOR into your mealtimes. You can teach your children the autonomy and skills needed to develop healthy relationships with food as they get older. And for those who may still feel uncertain, I offer free consultations to talk you through the steps you need to take to get started. Go ahead and fill out my 1:1 Coaching Application, and I will reach out to you within 24-48 hours to schedule your free consultation!