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portion minimums or maximums undermine healthy feeding

Posted by on Apr 18, 2013 in Blog Posts | 4 comments

BeakerI was giving a workshop on starting solids recently when two moms asked a similar question. “The doctor said my son has to drink X ounces of milk a day, and it’s so hard. If he hasn’t finished his pre-measured sippy cups, I end up chasing him around for an hour before bed time trying to get him to drink it.”  A recent house-call revealed a similar scenario where minimum amount recommendations invited pressure into feeding. The parents were told by the pediatrician that the child had to eat X Tablespoons or fortified cereal every day, and Mom shared that she was anxious about getting it in, which led her to push her daughter with her early eating and battles and tears at the table.  (Note, the baby was enjoying both breast-milk and formula, with the formula containing enough iron for minimums.) Another mother, on leaving the hospital with her newborn was told to feed a minimum number of ounces of breast milk a day, “Do whatever you have to to get food into that baby!” All of these absolute amounts encourage parents to freak out when the child eats less or more than recommended— inviting doubt and hyper-vigilance into the feeding relationship. (If you have a spreadsheet accounting for every ounce, it will be more likely to make you crazy than help you feed well.)

Quantity absolutes are harmful to tuned-in feeding.

If you’re told your infant HAS to eat X amount of rice cereal a day, or MUST drink Y ounces of milk every day, or ingest X Tablespoons of vegetables, and you’re anxious and fighting to get to that mark, it’s not helping.  (Same is true if your child wants to eat more and you are strictly limited to a maximum amount, as several of my clients have been directed to do, which led to increased anxiety and frantic eating over the months…) I know when my daughter was little there were meals where she ate many multiples of the “recommended” amount of banana for example. I remember getting anxious when she’d eat 1 1/2  bananas, when she was “supposed” to eat 1/4! Luckily I had learned enough to recognize my anxiety and skip the portion section, but it was still hard to reassure myself that she could be trusted.  Similarly, parents of children with small appetites who may do fine on 2-3 bites of banana panic because their children aren’t eating that quarter banana!!

Recommended ranges are far more helpful. Some days it might be less, some days more, some days none at all. Larger babies, smaller babies, babies with different appetites will eat and enjoy more or less, with a large range from one day or week to the next. Follow your child’s lead, not a portion chart, or a feeding app that tells you to get two more bites in, or a rainbow chart that admonishes you if you missed orange and yellow for the day, in spite of a lovely intake of red, orange and green.

 

IMG_3081What? No purple or yellow!!??
This is a plate a child served herself, no pressure, portions, or goading.

 

A child who is small and healthy may drink and need less milk than a child who is large and healthy. A child with a large appetite (who may be small) will eat or drink more than a child with a small appetite. (A child with lactose intolerance may not feel good when she drinks more than a cup or so of milk, or any at all.) It’s silly to make a blanket statement, or give exact calorie counts (link is worth the read…) or portions of fat by the 1/4 teaspoon—as if the child was a chemistry experiment where we could control every factor.  But doctors and dietitians make these recommendations to my clients all the time. Absolutes lead to pressure around eating to get to that golden number, which leads to resistance and weight dysregulation.

If you find yourself working hard to “get” food in, or limit intake, step back, learn more, ask yourself if it’s working and how it feels. You shouldn’t have to work so hard.

As one mom shared in my book:
“One day my toddler ate apples for breakfast, sour cream and chives for lunch, brown rice with tamari for snack, and roasted chicken for dinner. It was wild. But after three years of this, I know I can relax because she knows what she needs. Her preschool teacher tells me she is the best example of mindful eating she has ever seen. Take that, USDA food pyramid or plate or whatever you are these days!” — Hillary, mother of a two-and-a-half-year-old

What do you think? What helps you trust your child’s intake, what has undermined it? Join the discussion on Facebook!

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4 Comments

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  1. Fat Grad

    Katja, what a great post, as usual. I remember when my kindergartner was a newborn. He was in the ICU for a few days and had lost more than 10% of his weight by the time we went home. The doctors were extremely worried about it and put me on a feeding schedule where he HAD to be fed every two hours on the hour. So, if I started nursing him at 12, I had to start again at 2 no matter how long he had nursed or if he appeared hungry or whatever. They threatened me that if he didn’t gain x amount of weight within a certain time period then I would “have” to switch to formula in order to get his weight back up. Needless to say, it was an awful time for me. As if having a newborn is not stressful enough, this added pressure of the rigid feeding schedule and weight gain requirements nearly sent me over the edge. It was a long time before I was able to feed him with confidence and actually learn what his breastfeeding/hunger cues were. How could I learn them when my feeding schedule was independent of his behavior? Ugh, I get stressed out just thinking about it. Anyway, great post.

    • katja

      Ugh. This makes me crazy! Rigid schedules with breastfeeding is a way to undermine breastfeeding too. There is so much anxiety, and a loss of a sense of when to really worry. I recently did a talk to several eating disorder professionals, a new mom said that though breastfeeding went well, and her child was term, the energy from every nurse and doctor was so anxiety-provoking, so much talk and worry and attention about his weight, that she said she had to work really hard to protect herself from that and the interference… It should not be this way… I’m so glad you did learn his cues, but our professionals should support, not undermine that. (I like the SOFFI program from NICU and newborns…)

  2. JeninCanada

    I’m relearing to feed both my kids all the time; Kat is about to hit 8 months, and Gabe is 6 1/2. I watch Kat very closely when we eat for her cues; is she leaning in for more or is she pulling away from the spoon? Is she happily stuffing her chubby cheeks with bits of toast and cheese or is she just pushing them around and playing with them?

    Gabe, I fear, often doesn’t eat enough and it’s very hard *not* to pressure him. He’s definitely thin, and I worry he’s too thin but at the same time I try to respect it when he says he’s full/not hungry anymore, even if he’s only eaten a few bites. I don’t want to fight with him every night over dinner, but more often than not we end up pleading or threatening to make him eat more. :( Fail.

    • katja

      Not fail, but learning, which we do as parents all the time! It sounds like you could use some more support with your concerns and help reading cues. A GREAT resource for cues is Feeding with Love and Good Sense II DVD, Satter, and if you’re really stuck with pressuring and worry with your son, my book might be helpful, Love Me, Feed Me. It is “for” adoptive families, but is the same advice I give all my clients essentially. Intro through chapter 4 is specifically for worries around smaller kids, selective eating, how to undo the worry and the pressure, and why. Join is on facebook, and Ellyn Satter for great support and discussions! Good luck, you can get there, but you have to address and answer your worries before you can trust the process…