Intervening with Pediatric Feeding Disorders:
Extreme food selectivity, extreme picky eating, special needs

Step 2: Conventional treatment destroys the utility of the Division of Responsibility

From the conventional perspective, some children are naturally so eating-averse that they will go hungry rather than eat foods beyond their comfort level. Based on this conviction, interventions are medicalized, agenda-driven, and intended to overcome the child’s resistance to eating. Interventions that try to get children to eat certain amounts or types of food use persuasion and pressure and are inconsistent with Satter’s Division of Responsibility in feeding. Those treatment methods include any or all of the methods listed in Avoid pressure. Other, more systematic treatment methods include the following:

  • Food or energy prescriptions: Setting targets for how much the child should eat. This increases the parents’ tendency to take the child’s eating personally—the conviction that for them to be a good parent, their child must eat. In Spanish, “No me quiere comer,” means, literally, “my child doesn’t want to eat me.”
  • Positive reinforcement: Praise, compliments, rewards (preferred food, toys, or activities), distraction with video or other means, blending preferred with non-preferred foods (gradually increasing the proportion of non-preferred food).
  • Negative reinforcement (e.g., “Response Cost”): Warning, punishing, withholding preferred food until child eats non-preferred food, selective attention (looking away when s/he doesn’t eat, paying attention when s/he does), stopping a video if the child doesn’t eat.
  • Escape extinction: Nonremoval of the spoon (spoon held in front of the child’s mouth until s/he gives in and takes a bite), physical guidance (physically opening the child’s mouth and putting in the food).
  • Systematic approximation: Getting the child to do eating-related activities, such as chewing on a washcloth, sitting in the chair at the table, offering food and having the child touch, poke, squish, draw or sculpt the food; smell, kiss or lick the food or blow it into the trash. 
  • Food chaining: Getting the child to eat a wider variety of food by starting out with favorite and then offering closely related foods that are a bit more challenging.  

The Satter Feeding Dynamics perspective on conventional treatment

From the Feeding Dynamics perspective, conventional approaches to children’s food refusal and special needs interfere with good parenting with feeding and are likely to cause or worsen the very problem that such intervention is intended to address. Here are the reasons that conventional interventions are unnecessary and even counterproductive:

  • Food or energy prescriptions: Children vary greatly with respect to how much they need to eat. Calculated targets for energy intake can drastically overestimate or underestimate the child’s needs and increase the child’s resistance and/or discomfort relative to eating. In the long run, pressure to eat makes the child eat less, not more.
  • Positive reinforcement: Children eat because they want to. Praise, compliments, rewards, and other forms of outside reinforcement take away the child’s inborn desire to eat and pride in mastery. 
  • Negative reinforcement (e.g., “Response Cost”): Children eat well when they feel positive about eating and food and are comfortable at family meals. Negative parenting, such as warning, punishing, withholding attention, etc. all undermine children’s positive feelings and comfort with eating.  
  • Escape extinction: This really negative parenting really undermines children’s eating attitudes and inclination to eat.  
  • Systematic approximation: Children eat well when they feel positive about it and are comfortable at family meals. Without prompting, they do their own “systematic approximation” by watching adults eat, by asking for the bowl to be put by their plate, by allowing food on their plate, touching or holding the food, and using other means to “sneak up” on the food. Systematic approximation using eating-related requirements imposed by adults take away those positive feelings and behaviors.

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