Following sDOR: Don’t Interfere With Children’s Eating

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

Interference is insidious, at times difficult to identify, and pervasive. It is such a part of our eating/feeding culture that it is the soup we swim in.

The scope and magnitude of today’s influences undermining trust in children’s capabilities with eating and growth is profoundly concerning. The 150 references I cite in my just-completed webinar, Resist Interference with Children’s Eating, portray children as being incapable of eating and growing in healthy ways. The problem is the agendas, not the children. Health policy sets the stage for child-deficit thinking by applying to individual children 85^th/95^th overweight/obesity cutoffs appropriate only for population-wide data gathering. This diagnoses as overweight 15% of perfectly normal children, stimulates extreme Dietary Guideline recommendations for fruit, vegetable, sugar, and fat intake, and precipitates a cascade of child-deficit research. In contrast to Satter Division of Responsibility in Feeding (sDOR) trust in children’s even-extreme eating and growth capabilities (Trust Children’s Eating webinar), child-deficit nutrition researchers see children as doing poorly nutritionally and having obesogenic unwillingness eat vegetables and other “healthy” food. They experiment with “responsive” or “positive” pressure, attempt to overtly or covertly control what and/or how much children eat by reasoning, praising, and complimenting, teach children to be happy with smaller portions, and/or coach them in accepting family values about eating vegetables instead of sweets. Psychobehavioral researchers characterize children as being behaviorally susceptible to obesity: They enjoy eating (eating enjoyment is considered obesogenic), want to eat more than their parents are comfortable giving them, and/or are slow to warm up to unfamiliar food. Ill and neurologically atypical children are said to be incapable of regulating food intake and likely to persist in being finicky.

Distorted feeding dynamics explain children’s deficits

Most child-deficit research is done in classrooms. The few studies that observe feeding dynamics detect parental eating/feeding attitudes and behavior that explain children’s seeming deficits. Eating Competent mothers enjoy eating and are comfortable with their infants’ food enjoyment. This is in contrast to mothers who restrain themselves, are vulnerable to tempting food, and see their infant as being too food responsive (“My baby frequently wants more milk than I provide”). It’s a vicious cycle: Parents’ convictions about children’s deficits, often growing out of their own distorted eating attitudes and behaviors, precipitate controlling responses to children’s presumed deficits, and each exacerbates the other. Year after year, parents use food for instrumental reasons (“I reward my child with something to eat when s/he is well behaved”) and see their child as being food responsive (“My child is always asking for food”). Five- to nine-year-old food-restricted girls eat more “junk” (high-calorie/low nutrient) food when they can and become progressively heavier. Parents who are upset about their preschooler’s “picky” eating (“My child refuses new food at first”) have the same complaint five years later, whereas children of unconcerned parents are far less likely to be picky later on. Children of authoritarian and over-indulgent parents are most prone to outside influence on their eating and those whose parents are least interfering are least prone.

Pressure on what and how much is pervasive

Parents have gotten the message, and well over three quarters bribe, cajole, and cater to get children to eat, and pressure children to eat beyond the point they say they are finished. We pressure parents to breastfeed and delay solids introduction. While the advice is good, the coercive attitude is not, and research support is low. Rather than formula-feeding and/or early solids introduction making infants fat, parents of big, hungry, fast-growing babies tend to wean from the breast and/or start solids early. Those eager-eating, rapidly growing babies are likely to be taller and leaner at age 8 years, not fatter. Short-term trials focus on getting children to eat less by manipulating portion, plate, and serving utensil size, serving-bowl amounts, and serving dessert with the meal. Not only do children regulate over the long term and thus make up for short-term errors in regulation, we wonder “less than what?” The nutritional goal with feeding children is supporting them in eating enough so they can grow well, function well, and be active. For the many undernourished children seemingly forgotten in the midst of today’s obesity hysteria, the critical need is providing enough food and a supportive environment so they can eat and grow well.

Interference precipitates child deficits

Interference growing out of misinterpretation of children’s normal eating and growth precipitates children’s eating/growth deficits. Consider trying to get parents to admit their child is overweight, presumably so parents will do something about it. But longitudinal research shows parents’ seeing their child as overweight correlates with more child weight gain, not weight loss, and even ambitious, multidisciplinary weight loss trials show little or no impact on child BMI. Striving to correct adolescent “misperception” that their “overweight” is “about right” in hopes of promoting weight loss attempts falls in the feeding-errors category,. In reality, weight-loss attempts make adolescents fatter, not thinner. Then there is the whole broader culture which is permeated with so much situational, social, and emotional interference that it creates a kind of static with respect to children’s being able to eat and grow well. Children whose families are of lower socio-economic status and/or who suffer from food insecurity are more likely to have BMIs above the “overweight” or “obesity” cutoff. So are children who suffer from cumulative risk: child psychiatric disorders, behavior problems, multiple psychosocial stressors.

Do some consciousness-raising

The take home message: Interference is insidious, at times difficult to identify, and pervasive. It is such a part of our eating/feeding culture that it is the soup we swim in. The Interference webinar helps you know what you are dealing with. Protect yourself and your families against interference. Show parents how to follow sDOR and support them in trusting their child to grow up to eat the food they need and get the body that is right for their genetic endowment.