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

Step 4: Get help if you need it

You may be able to address established feeding problems on your own, once you understand Satter’s Division of Responsibility (sDOR) in feeding and set proper goals. Or you might be stuck and need help. Here is how to tell if you are stuck: 

  • Your child’s growth veers upward or downward abruptly.
  • You worry a lot about your child’s eating or growth.
  • You are making no progress toward having pleasant, harmonious meal- and snack-times. 
  • You and your child have prolonged or continuous struggles about his or her eating.
  • Feeding isn’t rewarding or pleasant for you and/or your child.

Cultivate your own feeding dynamics professional. Look for a professional who thoroughly understands sDOR or is willing to learn right along with you. Ideally, that person will have been trained in feeding dynamics education and intervention by taking Ellyn Satter’s Feeding with Love and Good Sense Visions Workshop or passing the Child of Mine CEU exam. Such professionals bring their expertise, their commitment to sDOR, and their willingness to help you understand and parent your child. That’s a lot! Identify the causes  of your child’s food refusal, make a feeding relationship plan, carry it out, and help each other to be consistent and brave. Remember, you are working toward having pleasant and harmonious meal- and snack- times and your child’s feeling good about eating, behaving well at mealtime, and eating in a relaxed fashion. See part 1. If you can’t find anyone to help you, consider coaching  from ESI faculty members. Seek therapy if your child has trouble chewing and swallowing. On the other hand, he may provide his own therapy and figure out chewing and swallowing on his own in the process of learning to eat.

Talk with your health professional. Tell her your feeding relationship plan and ask some questions:

  • Does your child chew and swallow normally? If not, consider specialized help.
  • Is your child gaining weight and growing as expected? Is he in good enough nutritional shape to carry him through the transition to learning to eat?
  • Can a dietitian help you gradually cut down on the amount and timing of tube feeding to let him be hungry but not starving at meal- and snack-time?
  • Is he physically capable of eating enough to maintain his nutritional status, or does he need tube feeding to help out when oral feeding stops being rewarding for both of you? Keep in mind that your child will show hunger and satiety cues even when s/he is tube fed. You can learn to read those cues and use them to guide tube-feeding amounts.

Do Division of Responsibility-based intervention. Follow the recommendations in step 1

Join Ellyn Satter on Facebook

Sign up for the ESI mailing list

Say thanks for this great information by making a donation to ESI!

©2016 by Ellyn Satter published at You may reproduce this article if you don't charge for it or change it in any way and if you do include the for more about and copyright statements.