Do children lose the ability to self-regulate?

January 2012
Family Meals Focus #65

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The two-part free webinar I presented for the Ellyn Satter Institute, Preventing Child Overweight and Obesity: Raising children to be competent eaters has been posted along with handouts and video. This question from a reader summarizes the main issue I addressed in the webinar: Is there such a thing as a toddler or preschooler who has lost the ability to self-regulate his/her eating? For a child that has lost this ability to feel fullness, and has become overweight and continually “overeats,” how do we help? How can we trust that he knows or will go back to his own internal regulation if left alone to decide how much to eat?

Children want to grow up with eating.

Children are born with many of the components of Eating Competence1-4: they want to eat, they feel good about it, they know how much to eat,5 and they are inclined to grow in the way that nature intended for them. Feeding children according to the Division of Responsibility (sDOR) throughout the growing up years retains their natural Eating Competence and lets them learn the rest:

  • To feel good about eating.
  • To take an interest in unfamiliar food and to know how to sneak up on it and learn to like it.
  • To regulate food intake based on internal cues of hunger, appetite and satiety.
  • To enjoy family meals and behave nicely there. 

Distorted feeding undermines food regulation.

Parents interfere with children’s natural regulatory ability and the hild reacts by becoming frightened, angry, or overwhelmed, loses track of internal regulators, and is at risk of growing too fast or too slowly. Parents interfere in one or both of two ways:

  1. By having an agenda that leads them to interfere with the child’s prerogative with eating (what or how much) and growth. By trying to get children to eat certain types or amounts of food and/or grow in a certain way. 
  2. By failing to do their jobs with the what, when and where of feeding.

Children do recover internal regulation.

The good news is that when parents of a growth-distorted child consistently and persistently do their jobs with feeding, the child recovers internal regulatory ability and growth stabilizes.6 For children, this process is non-verbal and intuitive. They eat because they are hungry and the food tastes good. They stop eating because they are full and the foods stops tasting so good. It doesn't help and in fact it hinders the process to talk to children about eating as much as they are hungry for or paying attention to their tummies. That puts language and cognitive processes in the way of the child's intuitive process. Worse, for a deprived child, that feels like more deprivation.

What is the child's regulatory ability does not recover?

When the child's eating attitudes and behavior fail to recover, something is wrong with the way parents and other important grownups enact sDOR. When feeding is going well, children are relaxed and positive about eating and join in happily with family meals. When feeding is going poorly, children continue to be food preoccupied, anxious, and urgent with eating.  

  • Parents are failing to provide structured meals and snacks and or letting the child graze for food or beverages between times. It takes a while for structure to fall into place. Until or unless it does, children do not get the support they need for regulating food intake. 
  • Parents are interfering with what and/or how much the child eats. Food restriction and food avoidance are pervasive and insidious. Feeding dynamics must be carefully examined to identify ongoing distortions in feeding.  

You have to trust.

You can trust that the child will recover internal regulators because you have no choice. The alternative is lifelong food restriction - a path that is unthinkable - and unworkable. At first when parents restore sDOR, the child’s eating becomes more extreme and he eats even more than before (or less, or a smaller variety of food, depending on the presenting complaint). Once parents accurately and consistently restore sDOR, an infant takes a matter of days to recover internal regulators; a toddler, weeks; a preschooler, a month or so; and the school-aged child, two or three months.The first few times you do this with a family are white knuckle times.  Parents come in for followup reporting how much (or little) the child eats, and you will fear that the child’s eating will get stuck in the extreme position. You must keep your nerve and encourage the parents to do the same. If you lose your courage, you, and they, will go back to interfering with the child’s eating. That leaves the children in an impossible position. They have briefly been parented well, kindly, and trustingly with feeding. They they have that and kindness taken away. It is a devastating loss for them, and their eating attitudes and behavior will become even more extreme.

What about adolescents? 

If they want to, adolescents, too, can recover internal regulators, as can adults. I talk about my treatment program in Secrets.7 For the adolescent, treatment is two-pronged:

  1. Individual work to address distorted eating attitudes and behaviors and recover internal regulators.
  2. Work by and with parents to restore a division of responsibility in feeding.

References

  1. Satter EM. chapter 7, Optimize Feeding: Your Adolescent. Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005.
  2. Satter EM. Chapter 6, Optimize Feeding: Your School-Age Child. Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005.
  3. Satter EM. Chapter 7, Optimize feeding: your adolescent. Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005:217-258.
  4. Satter EM. Chapter 6, Optimize Feeding: Your School-age Child. Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005:171-216.
  5. Satter EM. Appendix I, Children and food regulation: the research. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press; 2008:263-266.
  6. Satter EM. Internal regulation and the evolution of normal growth as the basis for prevention of obesity in childhood. Journal of the American Dietetic Association. 1996;96:860-864.
  7. Satter EM. Chapter 4, Eat as Much as You Want. Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook. Madison, WI: Kelcy Press; 2008:27-43.

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