feeding and adoption

I am posting another of Ellyn's family meals focus newsletters in it's entirety. I seem to be getting more and more calls from families with adopted children who are really struggling with feeding, sometimes for years. A common scenario is a child adopted under two years measuring in the "failure to thrive" range on the (U.S) growth charts when she comes to live with her adoptive family. Concern over nutrition and size  often led to advice from the doctors like in the article, "Do whatever you have to to get food into that child!" Pushing, coercing and tricking the child into eating more in an effort to put on weight often had the opposite effect. It may be four or even seven years later when I hear from desperate parents who's child is still small, and now picky and anxious about eating or heading into the tween years with concerns about disordered eating. I just think, how could this have been different if these families and children had been supported with best feeding practice right from the start?In my fantasies, I envision classes for families before their children come to live with them, to arm them with information, resources and support to help every child, no matter what their growth or feeding history... When I researched several books on adoption and attachment, feeding didn't even seem to be on the radar.  Feeding though, is parenting, and is perhaps the most powerful way that families can attach and nurture and help children feel secure, cared for and trusted.What do you think?January 2011 • Family Meals Focus #53 • Adoptive and foster children and distorted eating attitudes and behaviorsEach adoptive or foster child has a unique food history that you can “read” by paying attention to information coming from that child. Offering a nipple, spoon, or soft pieces of table food and observing what she does with it gives clues, as does observing her urgency of eating and growth pattern.Annie, a two-year old orphan from Haiti, eats like a starving person: gobbling her food, cleaning every crumb off her plate, insisting on more and more food, and crying when she is removed from the table. Sometimes Annie eats so much she throws up. Annie is always on the lookout for food and panhandles when her mother is in the kitchen.  Her parents follow a division of responsibility in feeding and have given her lots of food at structured times. But they encourage her to slow down. She seems to understand and tries to cooperate.Annie has known hunger and is terrified that she won’t get enough to eat. Her terror takes the form of embedded, non-verbal memory. She needs to know in her very being that she will get enough to eat, and that will take months and months of absolutely reliable, every 2-or-3-hour feeding. These parents understand Annie’s dilemma, but their alarm about her food-gobbling and occasional vomiting has led them to try to slow her down. To Annie, this feels like food deprivation. Instead, Annie needs lots of reassurance, "we are finished now but there will be another meal (snack) soon and you can have as much as you want then." When she begs for food between times, "it will soon be time to eat, and then you can have as much as you want." Annie will recover from her terror, she will begin eating at a more moderate pace, and she will learn to detect her fullness cues so she doesn’t overshoot and throw up. Until then, her parents can show her how to throw up without making a mess. Annie’s parents also need to avoid doing anything that seems like food restriction—such as encouraging her to slow down. While structure may seem like food restriction, it isn’t, and it is important for another reason. Letting a child graze for food puts her in charge of feeding herself. Instead, she needs to learn to depend on her parents to take care of her.Six-year-old David and 3 year-old Sean are new to foster care. Sean is David’s shadow, particularly when it comes to food. Sean begs David constantly for food and will only eat when David is there. Then he eats a great deal.Growing out of their neglectful home environment, David has become Sean’s parent. The task is to relieve David of that job by becoming a nurturing parent to both of them. Have meals and snacks at regular times, make sure that there is plenty of food at those times, be sure David has his own plate that he doesn’t share with Sean, give lots of reassurance, and be a nurturing and non-interfering presence at both meal and snack time. Draw the boys’ attention to the leftovers at the end of the meal, and show them that there is plenty of food in the cupboard. Talk with David in front of Sean and say, “it’s all right, David, you don’t have to worry about feeding yourself and Sean. I will take care of that.” Be firm with David about this. At the same time as feeding his little brother is a too-big burden for David, he won’t give it up readily. It makes him feel important and has given him a measure of security. Letting David be a child with food is tremendously important. Feeding is the most powerful way of reaching a child who has given up on being nurtured.Three-month-old Chi-Ho, adopted from China, weighed at the 5th percentile. The pediatrician assumed she was undernourished and said, “do whatever you have to to get food into her.” So Chi-Ho’s adoptive mother force-fed her. She concentrated her formula, and repeatedly put the nipple in her mouth until she ate the amount the pediatrician prescribed. She started solids early and did the same thing with the spoon—she held the spoon in front of Chi-Ho’s mouth until she gave in and ate. By age seven months, Chi-Ho’s weight was up to the 75th percentile.The pediatrician assumed he knew more than the Chi-Ho did about how much she needed to eat and how she needed to grow, and encouraged her parents to get her to eat more than she readily accepted. It would have been better to follow her feeding cues and see what happened. If Chi-Ho were truly undernourished, she would have eaten more and grown faster. His advice was tragic for both parents and children. Attachment powerfully takes place around feeding. To feel loved and to love back, Chi-Ho needed her parents to go along with what she wanted and needed with feeding.Two year old Alexi was adopted from an institutional setting in Russia. He was 5% for weight and 50% for height. Alexi arrived with a bottle with a cross-cut nipple to allow fluid—and perhaps solids—to come through rapidly. Alexis was anemic and wouldn’t look at his parents. Going by what he was able to do, Alexi’s adoptive parents held him close to feed him formula by bottle, cuddled, talked gently, and gazed at him while they fed. Alexi began gazing back, at first briefly, then longer. At family mealtimes, they offered him pureed and mashed table foods by spoon and formula from the cup. He gradually began feeding himself soft finger foods and over several months lost interest the bottle. Alexi’s hematocrit improved, and after a year, they phased out the formula.Making eye contact with feeding or play supports attachment, but don't force eye contact. Let it happen. Look at your baby, and let him look and look away. He looks away to calm himself. When he is ready, he will look back. Continue looking so you are available when he looks back. For more about feeding children (and for research backing up this advice), see Ellyn Satter's Child of Mine; Feeding with Love and Good Sense, Bull Publishing, 2000. Also see www.EllynSatter.com to purchase books and to review comprehensive educational materials that teach stage-related feeding and solve feeding problems.Copyright © 2010 by Ellyn Satter. Published at www.EllynSatter.com.Rights to reproduce: As long as you leave it unchanged, you don't charge for it, and you include the entire copyright statement, you may reproduce this article. Please let us know you have used it by sending a website link or an electronic copy to info@ellynsatter.com.