This is the final of a 5 part series. Read Part 1: Healing a Child’s Food “Obsession”: Max’s Story
The Trust Model (division of responsibility) is healthy feeding and was described as “responsive feeding operationalized” in the Journal of Nutrition and Education (2011). You provide, plan, and feed so your child can let go of the anxiety, fear, and worry that is making it hard for him to tune in to his internal cues and eat well, and to just be a kid… This long post is a brief introduction to a complex process of supporting food preoccupied children so they can learn to tune in again (or for the first time). What this process entails is often a complete shift in thinking and approach to feeding. Not easy.
Follow the DOR. You decide: what, when, where. Your child: how much from what you provide. And:
- Accept your child as he is right now.
- Try not to focus on your child’s weight.
- Focus on behaviors, such as sitting down for breakfast or not grazing.
- Establish and maintain bedtime routines and aim for adequate and regular sleep.
- Provide the opportunity for regular, fun movement.
Meals and Snacks
- Serve a small portion of dessert with the meal.
- Two to three times a week, serve a “treat” snack that includes “forbidden foods.”
- Eat meals together if you aren’t already.
- Serve family style: put all the food out in bowls.
- Be sure you have plenty of food.
- It’s okay to say “no” if there isn’t enough to go around, or if a food is expensive. Your child can satisfy his hunger and appetite with other foods. “I’m sorry, there isn’t enough steak for anyone to have seconds, you can have more potatoes or salad if you’re still hungry.”
- Serve regular meals and snacks—every two to three hours for younger kids, every three to four hours for by around Kindergarten.
- You can end meals at around 30-40 minutes (you don’t have to let them sit and eat for two hours.) “In five minutes, we’ll go play Legos.” (Rather than, “Dinner is over, you’ve had more than enough.”) He might try to eat a lot and quickly when it’s time for the meal to be over. in the beginning.
You don’t get to forget a meal or snack. You remember it so they don’t have to worry about it.
- Make snacks balanced and filling. Yes, offer her more—even if you worry about weight. When a child can be satisfied in terms of hunger at meals and snacks, she can stop thinking about food until the next time to eat in a few hours.
“Snacks were supposed to be 1/2 cup of plain fruit or vegetable. She would wolf it down and want more. I think she was really be starving by the time dinner came around and she would eat fast and beg for more. There were days I could control her eating, and then others where she ate massive amounts. I never understood how my chubby child was always saying she was hungry.” — Kayla’s mom (Turns out the intake analysis proved what mom was observing with some days around 900 calories, and others closer to 3000. Interestingly, her weekly average was within the recommended range even though her BMI was in the “overweight” range.)
- Include low, medium, and high-fat choices.
- Don’t “accidentally” run out of the high-calorie, or “red-light” foods.
- Don’t try to skip snacks or meals if she is busy doing something else.
“I was told to lie to the kids by our RD (dietitian). It felt absurd. My kids were smarter than that. They figured out that I only ‘ran out’ of the stuff they really liked and wasn’t supposed to let them have, like rice, pasta, meat…” —Leah, mother of two
How the Process Usually Unfolds
Once parents institute structure, family meals and the DOR (critically, allowing the child to decide when he’s had “enough”), this is how the transition, which can be divided into two general parts, typically unfolds with clients.
Stage One: “This Is So Scary”
Predictably, at first he will likely eat more. A lot more. (See the first several sections of Max’s Story.) This is when, without proper preparation and support, most parents panic and give up. Many parents I hear from have already “tried” to let the child decide how much and couldn’t get through the transition. It was simply too scary. Stage One is called “This is So Scary” from the parent’s point of view because it’s mostly about parents’ fear of weight gain, uncontrolled eating and doubt that their child is capable of knowing what ‘full’ is. There are also a lot of practical questions about how to apply this model that come up day to day.
Amy, mother of Teresa, age four, wrote on my blog, “We did it for four days, and I couldn’t stand it. She ate more than my husband, so we went back to preplating her portions.”
Try not to react to how much she is eating. Your child will eat more than you are comfortable with. Don’t count slices of bread or pizza, and don’t comment. This is tough. You will want to chime in with, “That’s your fourth piece of bread. Honey, aren’t you full yet?” It won’t help, and it could make her want to eat more. It distracts from her internal cues. When you pick her up from a party and her friend’s mom says with a frozen smile, “She is such a good eater; she ate six pieces of pizza,” try to deflect attention and say, “Oh, I’m glad she enjoyed it, sounds like it was a great party. Thank you.” Avoid explaining or apologizing in front of your child. Stay calm and send your daughter the message that you trust her, and she will figure it out.
While in stage one and still eating a lot, children may rather quickly become less anxious, and more calm at the table and maybe away from the table as well. He may seem happier and more playful. This is the progress you want to watch for in Stage One and it is critical, the basis for all other progress.
Another child, two weeks in, shows signs of recognizing what it feels like to be full, leaving food, and leaving the table without extraordinary measures. “Today at lunch, she didn’t eat much, asked for more of something, then as soon as we gave it to her, she said she was done. Another day, she left the table voluntarily to go play, something she had never done in her two and a half years.”
‘Normal’ in the Transition
Knowing what is ‘normal’ will help you get through it. During the transition, your child is aware that things are different and is trying to figure out the new rules, asking if she can have more chicken, even with chicken already on her plate. She is learning to trust that she decides how much to eat from what you offer and that she doesn’t have to be preoccupied about when she will eat next, because you are being reliable about that. This will all help her learn to tune in to cues from her body, instead of being ruled by anxiety and that feeling of scarcity. The younger the child is and the more able parents are to stick with it, the faster the transition usually goes. For my clients, with young toddlers, Stage Two can come as early as a few weeks in, and often by two months, there are many signs of progress. Older children, or with more severe restriction may take longer. Preschoolers usually show progress in a few months, and within six months are well into Stage Two. Adolescents may benefit from their own support around food or body image issues. (Because of my practice model, most of my clients have been preschoolers or early grade-school.)
Stage Two: Emerging Skills
If parents can make it long enough to see even these earliest glimmers of self-regulation emerging, as well as less food obsession, it helps build faith in the process. Stage two is characterized by emerging skills, but he will still “overeat” and seem food preoccupied much of the time.
“Well, we went for a burger, and lo and behold, she had about half the bun, one bite of meat and said she was done. We were so surprised. I have learned that what she loved one day does not always mean she will like it in the same amount or at all the next— which is a change, because she used to eat anything and everything in large quantities.” — Alexis, mother of Greta, in Stage Two
More signs of emerging skills to look out for (and journal):
- She is less frantic or preoccupied with food.
- His rate of eating is slowing down.
- He is playing with food.
- He is opening up to the idea of sharing foods, as in, “This is for my brothers,” or “I had mine, that is Daddy’s.” (Even if he goes on to eat the food, acknowledging is step one.)
- She may appear to savor foods more, rather than gulping or stuffing.
- She will leave food on her plate.
- He will leave a meal voluntarily.
- She becomes more choosey about what she will or won’t eat.
- He is consuming large meals but also smaller ones, as in, “He ate a huge amount at dinner, and it was really scary, but I noticed he ate less at breakfast the next day.”
- She engages more with others at mealtimes, and plays at play dates and parties after checking out the food.
- You begin to see patterns, such as more at breakfast or after nap and less mid-morning.
- He is getting a little more “naughty” at the table. He’s not preoccupied with how much he can eat and is testing other limits like any other child.
Many parents report that once the child was less preoccupied with food, spontaneous play and movement increased on its own—even very early into the transition. The child who in June wouldn’t leave her mother’s side at the beach (because she was constantly begging for food) was running and splashing in the water by the end of summer. These children discover the playground when they are not wandering from one parent to the next for snack handouts.
Realize that people (kids are people too) differ with their level of interest in food. Some children will always eat faster or take more pleasure in food than others. (There are studies that suggest this is an inborn trait, with “picky” eaters showing different sucking patterns even as infants.) Clearly, some children get more pleasure from eating, and this is not a problem within the context of a healthy feeding relationship.
Remember also that these are emerging skills. She will still pester you about treats and perhaps eat quickly or “overeat” at times. In addition, many of these behaviors are normal for small children, and even the child who is eating competent will occasionally beg for treats and “overeat.”
“We were all still sitting at the table talking when she announced she was DONE and wanted to get down to go and play. I let her down with no comment, of course, but I was jumping up and down inside!!” — Rebecca, mother of Adina, age two-and-a-half
There is hope…
See my resources section for one page handouts (feeding tips for preschoolers sample) to fill in some of the blanks. Recommended reading, Your Child’s Weight, Helping Without Harming and my book, Love Me, Feed Me
If you would like to join a new private facebook group for parents (moderated to be a safe space), send a “friend” request to Bonnie Appetites (little girl with pony tails) and you will be invited to join the group (and then she will promptly unfriend you). She’s not being mean, just protecting privacy.
Parts of this post are excerpted from my book, Love Me, Feed Me
If a young person is also dieting, or you suspect s/he is purging or is concerned about body image, you may be dealing with an eating disorder. For more information, visit NEDA’s website and talk to your child’s doctor if you are concerned.