esi-logo-062416

 

Family Meals Focus

The Ellyn Satter Institute Newsletter

Does the division of responsibility with feeding work in clinical care?

by Patty Nell Morse, RD, LDN, CDE, ESI emeritus faculty member.

I liked the division of responsibility in feeding from the first, and applied it in my well-child appointments. But when I worked with critically-ill pediatric patients, such as those who had diabetes, cystic fibrosis, spina bifida, and other chronic diseases, I got scared, and I went back to control. Eventually, I learned to trust sDOR. 

Critical ill patients scared me into being controlling

When I worked with critically-ill pediatric patients, such as those who had diabetes, cystic fibrosis, spina bifida, and other chronic diseases, I got scared, and I went back to control. I gave meal plans. I dictated calories. In the case I am telling you about, I even went to the department of social work to get money to buy a lock for the kitchen door. Lockdown. It took the patient’s grandmother, with her wise and tireless parenting, to teach me that the division of responsibility in feeding does work – even in the most extreme cases!

Darius, age 5, gained weight fast

I used to ask, “will the division of responsibility work with this child?” Now I ask, “how long will it take?”

From growing too slowly before his surgery for craniopharyngioma, a benign brain tumor, 5 year old Darius began gaining weight at an alarmingly fast rate. The fear was that his hypothalamus, the hunger-regulating part of his brain, had been damaged by the surgery. I instructed Darius’s parents on a 1200 calorie diet. The family spent limited resources on diet foods and monitored his eating. But he continued to gain weight, and at each clinical visit I decreased the calorie level of the meal plan.

The family had lots of issues

The family was struggling with many issues and life was chaotic. The kids weren’t getting to school until 11 am. There were no regular times for eating or sleeping. And Darius was hungry. With his parents allotting food according to the meal plan, he could not get enough food at meals or snacks. He could not sneak food from the kitchen at night because the door to the kitchen was locked. But he could wander into his parents’ bedroom while they slept and raid their stash of soda and treats.

Grandmother’s love and structure made the difference

Then things changed. Darius, his brother and sister went to live with Grandma. She made sure that there was a rhythm to their day – a time to have meals, a time to have snacks, a time to play, a time to do homework, and a time to sleep. There was even time for Darius to join the park district soccer team! When Darius got up in the middle of the night to look for food, Grandma told him, “Boys your age sleep at this time of night.” With Grandma’s love and structure, Darius’ weight stabilized.

Grandma followed her own, wise, division of responsibility in feeding

Grandma didn’t call it that, but she was following the division of responsibility in feeding. Darius could eat as much as he wanted at meal times. Then she cleaned up, put the food away, shut off the kitchen light, and that was it until the next planned, sit-down snack at the table. Darius stopped worrying about going hungry and came to believe that he could get enough to eat so that he didn’t have to overeat when he got a chance.

The happy ending  . . .

I can’t claim credit for it, but Darius is a healthier, happier boy, he loves playing soccer, and he doesn’t worry about going hungry any more. Darius would still be considered overweight, probably obese, but his extreme weight gain has leveled off to consistent growth. In the future, his weight may decrease, or it may not. To follow the division of responsibility in feeding, I have had to learn to live with that, and to be realistic about what is possible. Some medical conditions, like spina bifida, can mean that the individual will just be a heavier weight. I have also learned to ask before I tell. I find out from parents what they are dealing with. I try to get to the bottom of the child’s eating issues by seeing things throught his eyes. I temper my professional goal of some standard definition of health with what is reasonable for the child and family.

The moral of the story

I used to ask, “will the division of responsibility work with this child?” Now I ask, “how long will it take?”

Pin It on Pinterest

Share This