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Family Meals Focus

The Ellyn Satter Institute Newsletter

Children who do not self-regulate: How do you help?

Ellyn Satter, Registered dietitian and Family Therapist

It is normal for children to know how much they need to eat based on hunger, appetite, and satiety. When parents follow the division of responsibility in feeding, children continue to regulate their food intake as toddlers, preschoolers, school-age children, and adolescents. They only lose that ability when there is something wrong with feeding: when they get too little support, interference, or both. To eat well, children need regular and reliable meals and snacks, and they must be allowed to determine what and/or how much to eat from what grownups provide. 

Children are born capable with eating

Children are born with many of the components of eating competence:14 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 in feeding (sDOR) throughout the growing up years lets them retain those natural capabilities and gain the rest:

  • To continue 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 continue to regulate their food intake based on internal cues of hunger, appetite and satiety.
  • To enjoy family meals and behave nicely there. 

Distorted feeding undermines food regulation

A child eats because he is hungry and food tastes good. He stops eating because he is full and food stops tasting so good. It doesn’t help, and in fact it hinders, to talk to him about paying attention to his tummy.

Failing to provide support for a child’s eating and/or putting pressure on feeding, interfere with children’s natural regulatory ability. An unsupported or pressured child reacts by becoming frightened, angry, or overwhelmed and loses track of internal regulators. He is then at risk of growing too fast or too slowly. Interference is the opposite of the division of responsibility in feeding: 

  • Having an agenda that leads to interference with the child’s prerogatives with eating (what or how much) and growth. This agenda leads to trying to get him to eat certain types or amounts of food and/or grow in a certain way. The child complies or resists, either one of which impairs internal regulation. 
  • Not letting the child do his jobs with the how much and the whether of eating leads to struggles around feeding. The child’s resultant conflict and anxiety undermines his ability to tune in on his internal regulators and know how much to eat.  

Children intuitively recover internal regulation

The good news is that the child recovers his internal regulators and growth stabilizes when parents follow the division of responsibility with feeding – when they consistently and persistently do their jobs with feeding and avoid doing their child’s jobs with eating.6 For children, food regulation 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 food stops tasting so good. It doesn’t help, and in fact it hinders the process, to talk to the child about eating as much as he is hungry for, slowing down his eating, or paying attention to his tummy. That puts language and cognitive processes in the way of the child’s intuitive process. Worse, for a deprived child, it feels like more deprivation.

What if 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, and uncomfortable at mealtimes.  

  • Adults 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. 
  • Adults 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 that the child will regain internal regulation

The first few times are white knuckle events. You work with parents to establish sDOR and wait for the child to show signs of internal regulation. At first when parents establish 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). Parents will report how much (or little) the child eats, and you may fear that the child’s eating will get stuck in the extreme position. Once parents accurately and consistently apply sDOR, it takes a while for the child to trust that they really mean it. He intuitively tests by becoming even more extreme in his food behaviors. If parents can hang in there, the child’s eating settles down to be like that of another child of his age and stage of development. Throughout the process, you must keep your nerve and encourage the parents to do the same. Otherwise they will go back to interfering with the child’s eating. That leaves the child in an impossible position. He has briefly been parented well, kindly, and trustingly with feeding. Then all the kindness and trust get taken away. It is a devastating loss for him, and his eating attitudes and behavior will deteriorate.

What about adolescents

If they want to, adolescents, too, can recover internal regulators, as can adults. I talk about my How to Eat treatment program in the Chapter 4, “Eat as much as you want,” in Secrets of Feeding a Healthy Family.  

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.

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