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Is Mealtime Miserable? Try This

‘Division of responsibility in feeding’ is an approach that may help picky eaters and food-fixated kids alike. What it won’t do: make anyone finish their broccoli.

Credit...Juliette Toma

This story was originally published on Dec. 23, 2019 in NYT Parenting.

The other night, we had ice cream for dessert. My daughters, ages 6 and 2, were very excited because it is freezing outside, so we aren’t eating a lot of ice cream at the moment. Kids don’t care much about seasonal menu planning when rainbow sprinkles might be involved.

When our 2-year-old finished her bowl, she asked for more, and I gave her another scoop. “Are you sure?” my husband said. “Two scoops of ice cream? Is this how we’re supposed to do this feeding thing?”

We’ve been doing “this feeding thing” for six years now, ever since our older daughter was 1 month old and stopped eating completely in response to extreme medical trauma. She was dependent on a feeding tube for the better part of two years, and to wean her off, we had to challenge almost everything we thought we knew about how babies and children should eat.

It was in those early months of panicked late-night research that I stumbled across an approach called the “division of responsibility in feeding” model, developed more than 30 years ago by Ellyn Satter, a dietitian and family therapist.

Division of responsibility, or D.O.R., became the foundation for the way we approached meals with a traumatized child. But, as I’ve learned in the years since, it can also be useful — and even downright liberating — when you’re dealing with typically developing babies starting solids, toddlers who suddenly refuse all green foods and young children with the full range of eating preferences, from picky eaters to the food-fixated.

You may have heard division of responsibility referenced on this site or in social media memes. (It’s particularly popular right now with Instagram parenting and food influencers.) But while it sounds simple in theory, it can be tricky to put into practice. Here’s what you need to know.

[There’s no shame in kids’ snacking.]

D.O.R. is known as the “trust model” because it assigns specific roles to both caregiver and child — and then everybody has to trust everybody else to do their jobs. The adult is in charge of when meals happen. This means kids eat on a predictable schedule of three meals and one to three snack times a day, which you can plan by taking into account how hangry your toddler gets at 4 p.m. But D.O.R. doesn’t allow for endless nibbling and grazing.

We also decide where meals happen, meaning mom and dad can set rules like “not in front of a screen” or “not in the car.”

Perhaps most crucially, we parents decide which foods are served. But that’s the extent of our job description. Our kids are responsible for deciding which foods they’re going to eat, among the ones we’ve offered — which may mean weeks of ignoring vegetables in favor of bread or pasta. And they’re also in charge of how much they eat, whether it’s two bites of broccoli or two bowls of ice cream. (The method does allow parents to limit children to one serving of dessert if you serve it nightly with dinner, say, but also recommends scheduling opportunities for children to eat as much as they want of a particular treat, as we do with our Saturday night ice cream.)

If you’re used to scrutinizing your child’s plate and making rules like “three more bites of spinach before you eat more bread,” you may balk at giving up that kind of control.

“This is not the model to use if your goal is to get your child to eat vegetables at this particular meal,” explained Carol Danaher, M.P.H., R.D, co-founder of the Santa Clara County Public Health Department’s Childhood Feeding Collaborative in California and a longtime collaborator of Satter’s and member of the Ellyn Satter Institute’s board. “We take a long-term view. When family meals are based on trust, children will listen to their own internal drives for hunger and satiety and learn to eat a wide variety of foods.”

Danaher acknowledged that Satter’s first paper on the model in the Journal of the Society for Nutrition and Education, published in 1986, had little in the way of hard data to support it beyond Satter’s observations from her clinical practice as a dietitian.

“She saw families being miserable, having these stressful mealtimes, and felt that the traditional approach of telling them ‘Eat this, don’t eat that, limit portion sizes,’ was only making things worse,” Danaher said.

To date, there have been few empirical studies documenting the long-term impact of D.O.R., in part because it’s a difficult method to study in a controlled clinical trial. And children with diagnosed feeding disorders may well need extra support. We couldn’t have removed my own daughter’s feeding tube and immediately trusted her to feel hunger and fullness without first working to heal the trauma that disconnected her from those instincts.

Similarly, D.O.R. isn’t suitable for those in the acute stages of anorexia, since the disorder disconnects them so thoroughly from their hunger signals.

But while some therapists argue that reconnecting with hunger and fullness signals is not realistic for every child, many others see D.O.R. as the ultimate goal of their work. Satter has since published numerous books and case studies on D.O.R.; and the work of pioneering developmental psychologists like Leann Birch, Ph.D., whose studies showed how pressuring children to clean their plates backfires, affirms the underlying principles of Satter’s approach. “I held my breath every time another scientific article was published, but everything kept supporting what we did,” Danaher said.

[How to navigate the holidays with a picky eater.]

Since Satter’s initial groundwork, many feeding therapists, dietitians, pediatricians and others in the pediatric feeding world have championed the approach. “I discovered it when I was a brand-new dietitian in the outpatient clinic at Children’s National Medical Center in Washington, D.C.,” said Anna Lutz, M.P.H., R.D., a dietitian in private practice in Raleigh, N.C., who specializes in eating disorders and family feeding.

Lutz sees D.O.R. as a tool for preventing the kind of disordered eating struggles that can manifest as children enter the tween and teen years, and encourages parents who are concerned about their child’s weight to use D.O.R. to ensure the child is eating according to his hunger and fullness cues, rather than resorting to a diet.

“Eating disorders have many underlying causes, but we know a history of dieting increases risk,” she said. “Teaching children to listen to their bodies rather than restricting portions is a crucial way to avoid that.”

At the other end of the spectrum, Marsha Dunn Klein, OTR/L, M.Ed., a pediatric occupational therapist and author of “Anxious Eaters, Anxious Mealtimes,” described D.O.R. as “the foundation” for her work with infants and children who are severely picky, have been diagnosed with “failure to thrive” or are feeding tube-dependent.

“These children are often forced or pressured to eat because parents and pediatricians are panicked,” she said. “But as adults, it’s our job to offer food, and it’s the child’s job to decide what they’re ready to accept. It’s a communication, a back and forth, and division of responsibility helps parents shift their mind-set.”

With babies and toddlers who aren’t able to express all of this verbally, Klein trains parents to look for physical cues of readiness, such as a “positive tilt” toward the spoon or food on the high chair tray, and to respect the signs that a child is either full or just not ready to eat a particular food — if he’s turning his head, pushing food away or getting restless or fussy in the high chair.

Transitioning to D.O.R. can involve a steep learning curve for families. “People either perceive it as really restrictive or really permissive, depending on their own parenting style,” Lutz noted.

If you’ve been short-order cooking for your picky eater, making meal after meal of chicken nuggets or allowing lots of between-meal grazing (which can make it harder for kids to tell when they’re hungry), it will feel daunting to start putting other foods on the table and imposing a schedule.

With preschoolers and elementary school age children, it may help to explain why you’re trying a new approach — and emphasize that they are now in charge of how much they eat in a way they probably weren’t before. Offer new foods, but keep one or two “safe foods” on the table.

“Classic Satter is to always have bread and butter alongside the meal,” Lutz said. “Or you might build up a list of their safe foods and rotate them in throughout the week.”

At my house the undisputed safe foods are pasta, flour tortillas and various kinds of bread — but rotating through these enables me to make dinners like lemon-garlic salmon with asparagus and pesto pasta, tacos of all sorts (our kids fill their own with guacamole and shredded cheese) and a squash and chickpea curry served with store-bought naan. (They reliably ignore the fish but eat some curry.)

To other parents, letting children decide to eat only the pasta night after night might look like total anarchy. Kids who tend to fixate on food will eat amounts that parents may find alarming, while cautious eaters will retreat even further into their chosen safe foods.

In both cases, the child is likely testing out how much you really mean it when you say you’ll trust them — but if parents stay the course, Danaher said, they’ll see kids start to relax and self-regulate their intake, and begin incorporating new foods. “Plan ahead for how you can keep yourself calm when your child keeps reaching for the butter and not eating anything else,” she advised. “We need to acknowledge that it may be stressful for parents to watch kids eat in a normal way.”

Lutz emphasized that it’s also normal for children to favor different food groups at different meals, so at a first glance, it may look like they eat nothing but carbohydrates — but when you consider their intake over a day or several days, you’ll likely notice them also getting a decent mix of carbs, fat, protein and other nutrients.

She tries to get an idea of parents’ desired outcome when they say D.O.R. didn’t work for them. “I always ask, ‘Well, what does “working” mean?’” she said. If “not working” means your child isn’t eating kale yet, or still prefers carbohydrates to most other foods, it may be time to adjust your own expectations.

“To me, ‘working’ doesn’t mean the child will try a million new foods right away, or suddenly jumps up or down on their growth curve in a big way,” Lutz said.

Instead, consider whether your family meals involve less screaming than they used to. Are you able to talk about other things besides what everyone is eating? Maybe even enjoy your own food? View family meals as a source of connection, rather than a battleground? “We want our children to grow up to be competent eaters,” Lutz said. “But we have to remember, that will look different for every child.”

[The truth about food pouches.]


Virginia Sole-Smith is a journalist, the author of “The Eating Instinct: Food Culture, Body Image and Guilt in America” and co-host of Comfort Food Podcast.

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