Does following the Satter Division of Responsibility in Feeding mean you have to starve children to make them eat?

By Ellyn Satter, MS, MSSW, Dietitian and Family Therapist

Repeating the “division of responsibility in feeding” and saying “your child won’t starve” and “when he’s hungry, he’ll eat.” is no help at all and, in fact, is harmful. To use the proper and ethical Satter Division of Responsibility in Feeding sDOR, health professionals have to understand it thoroughly. Those who don’t truly understand sDOR often combine it with pressure: trying to get the child to eat certain amounts and/or types of food or grow in certain ways.

Saying “your child won’t starve” is no help at all

Skye, a parent: “The division of responsibility has caused me a great deal of stress over the past few years. I can’t tell you how many times it has been used as expert-sanctioned advice to starve my son. Dietitians, daycare agencies, children’s services, doctors, therapists . . . they all explain it the same. ‘You cook the food, and if your child doesn’t eat, don’t worry, he won’t starve.’ ‘Give him what you eat, if he doesn’t eat it, he doesn’t eat anything at all till the next meal. No meal, no snacks.’  ‘He won’t starve. When he’s hungry, he’ll eat.’ Um . . . it doesn’t work that way in my house. Maybe we won’t call it starve, but he certainly isn’t eating. Let me go boldly out on a limb to state that this is very likely not what you meant.”

Skye, you are so right. As you have discovered, just saying “he won’t starve” is no help at all and is downright cruel to children and parents. Your advisors simply are not doing their homework. Googling Satter Division of Responsibility in Feeding leads to the Ellyn Satter Institute website, which opens up a world of free and accessible materials that explain sDOR in enough kind and helpful detail so it can be effective. That information negates the trauma around feeding that you have experienced. You could, of course, do this yourself but you are entitled to depend on your advisors to help you.

Many professionals misuse the Satter Division of Responsibility in Feeding

As health professionals, we have to contain our own anxiety and be careful not to pass it on to already-anxious parents, either subjectively or concretely in the form of unrealistic admonitions about feeding.

The Satter Division of Responsibility in Feeding seems simple, but to use it in an ethical fashion, you have to understand it thoroughly. Too often, sDOR advice comes packed with pressure: it is accompanied by advice about what and how much a child should eat and how the child should grow. How can parents possibly do a good job with feeding when they are given an agenda for getting food into their child? How can a child possibly do a good job with eating when s/he is expected to consume certain types and amounts of foods? To be truly helpful, advisers need to think through the implications of their advice to follow sDOR and help parents through the process of application. Parents of vulnerable children do the best they can, but they are so stressed that it is pretty hard for them to decipher and apply this on their own.

Why do professionals give such rigid advice?

sDOR is theoretically sound, clinically tested, and predicated on trust in children to do their part with eating. Children who seemingly don’t eat scare everyone, even health professionals with lots of experience, and scared people tend to put pressure on feeding. Putting pressure on feeding takes away trust in the child to eat and takes away the child’s desire to eat and grow up with eating. sDOR absolutely requires trusting children’s drive to eat while giving appropriate nutritional support. That is an anxiety-provoking challenge for both professionals and parents. As health professionals, we have to contain our own anxiety and be careful not to pass it on to already-anxious parents, either subjectively or concretely in the form of unrealistic admonitions about feeding. As Skye’s story illustrates, pressure is a like a hot potato that gets tossed around until it ends up in the lap of the person least able to cope with it. In too many cases, that is the child. Pressure on the health professional (to keep the child alive and well) gets tossed to parents, who toss it to the child in the form of feeding pressure.

Make productive use of hunger; don’t starve the child into submission

Certainly, children need to be hungry in order to eat. That’s the point of the sDOR principle of parents’ providing structured meals and snacks and not letting children eat between times. Children who show extreme food selectivity want to eat and also experience a great deal of conflict and anxiety about eating. To help children recover from this internal deadlock, they need to be hungry but not famished at mealtime and also need to be reassured that they don’t have to eat. Parents have their own troubles. They are upset and concerned about their child and find it difficult to trust their child with eating. To help parents recover, they need to be reassured that they can offer children familiar, approachable food without limiting the menu to foods they readily accept. In short, parents can get the pressure out of feeding by following sDOR and being considerate without catering with meal planning. That is, they can offer menus with a variety of food they, themselves, enjoy and include one or two foods that the child generally eats.

Consider children’s point of view with eating

Children are inexperienced eaters. They are continually being offered food that they haven’t seen before, and being pressured to eat that unfamiliar food overwhelms them. At the same time, children want to learn and grow with food acceptance and mealtime behavior, the same as they do with other issues in their lives. Children want to please their parents, and they want to learn to eat the food their parents eat. Once the pressure is off, children push themselves along to learn and grow with food acceptance. Keep in mind that children’s having positive food acceptance behaviors does not mean they eat everything. It means that they can participate happily in family meals, remain calm in the presence of unfamiliar food, and pick and choose from what is available. In the process, they are being provided with repeated, neutral exposure to a variety of food and will, ever-so-gradually, broaden out their food repertory.

Children will not do, not do, not do, then do

Establish and maintain a stage-appropriate sDOR, provide children with opportunities to learn; then wait, wait, and wait some more. As feeding therapist Pam Estes observes, children not do, not do, not do, then do. Help parents be neutral, both in the way they present food and in the way they react to children’s eating and not-eating. Avoid pressure, and help parents detect when they are putting pressure on feeding.  Be prepared for the long haul. Children may be teenagers before they broaden out the variety of food they eat. Do problem solving when the children’s eating relapses. Chances are, structure is eroding or pressure is creeping in. If you get stuck (or scared), ask for help. Consider ESI coaching.

Doing sDOR properly brings big rewards

Skye’s and her son’s trauma has turned into a success story “Like I said earlier – what I was told for years was the sDOR was nothing of the sort. It’s been only a few days – maybe a week – and I already see a HUGE improvement. My son is relaxed and happy at family meals and I actually enjoy them, as well. I can’t remember ever looking forward to them. I never thought I would, and yet, here we are.”