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Family Meals Focus

The Ellyn Satter Institute Newsletter

Does following the division of responsibility mean you have to starve children to make them eat?

Repeating the division of responsibility in feeding (sDOR) 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 sDOR properly and ethically, health professionals have to understand it thoroughly. Those who don’t truly understand sDOR often combine it with pressure: advice about getting the child to eat – or eat less. 

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 an approach that testifies to misunderstanding about feeding dynamics. sDOR does not exist in a vacuum. Googling the division of responsibility in feeding leads to lots of resources. The ones that come up first lead you 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. But as they say, when you are up to [here] in alligators, it is hard to think about draining the swamp! You need to be able to depend on your advisers to do that for you, and they simply aren’t doing their homework.  

Many professionals misuse the division of responsibility

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 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?

The division of responsibility in feeding as it is intended to be understood and applied, is 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 grow up with eating. At first, trusting children’s drive to eat 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, a child needs to be hungry in order to eat. That’s the point of having structured meals and snacks and not letting the child eat between times. However, the child with extreme food selectivity generally has so much conflict and anxiety about eating that those negative feelings obliterate his awareness of his hunger and need for food. At the same time, parents are so upset that it is difficult for them to hold steady with feeding. To help the child recover from this internal deadlock, the child needs to be reassured that he doesn’t have to eat. To help parents recover, they need to be reassured that they can offer the child familiar, approachable food without limiting the menu to foods s/he readily accepts. In short, parents can get the pressure out of feeding by following sDOR and being considerate without catering with meal planning.

Consider the child’s point of view with eating

For the encouragement we all need, let’s put ourselves in the child’s place with eating. Children are inexperienced eaters. They are continually being offered food that they haven’t seen before, and pressuring the child to eat that unfamiliar food overwhelms him. 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. As Skye demonstrated, once the pressure is off, children push themselves along to learn and grow with food acceptance. Keep in mind that the child’s having positive food acceptance behaviors does not mean he eats everything. It means that he 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, he is being provided with repeated, neutral exposure to a variety of food and will, ever-so-gradually, broaden out his food repertory.

The child will not do, not do, not do, then do

Establish and maintain a stage-appropriate division of responsibility in feeding, provide the child with opportunities to learn; then wait, wait, and wait some more. As feeding therapist Pam Estes observes, the child will 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 the child’s eating and not-eating. Avoid pressure. Be prepared for the long haul. Like other children, a child may be a teenager before some of his eating issues are resolved. Do problem solving when the child’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 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. I actually enjoy family meals now. I can’t remember ever looking forward to them. I never thought I would, and yet, here we are.”

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