How to Raise a Healthy and Happy Eater: Follow a Division of Responsibility in Feeding

What is normal eating for a young child?

Children are born knowing how much to eat. They are perfect regulators of their Caloric needs¹ and it is up to the parent to allow them to hold on to this innate ability. From birth onwards, growth proceeds at an uneven pace. Growth spurts are accompanied by an increased need for Calories and sleep, and during periods of slow growth these needs diminish.

Let’s look at normal eating for young children. Normal eating behaviors are:

• Eating a lot one day or meal, and little the next
• Picky eating
• Liking a food, then refusing to eat it the next time that food is served
• Preferring certain types of food over others – the “pasta eater,” for example
• Persistently refusing to eat some foods then suddenly craving those very foods
• Learning to sit at the table during mealtime and behaving politely
• Being able to cautiously try a new food

Feeding problems can develop when parents struggle with normal developmental eating behaviors.

During the first months of life, infants will vary their daily calorie intake by 20 to 30 percent a day. While breastfed babies vary their intake without the parents noticing, parents of bottle fed infants see this variation and often try to get their infant to eat more or less, based not on their baby’s appetite but on the contents of a bottle of milk. Infants know how much to eat, and when they need to eat. Parents can create problems by not recognizing this capability. By encouraging or forcing their baby to drink more or less, parents may be interfering with their infant’s ability to self-regulate his intake, exacerbating the very problem they hope to avoid.

Around 6 months of age, when solid foods are introduced, it is normal for the older baby to try the new foods, reject new flavors, and then accept them gradually. It may take 10 to 20 exposures before some babies will like certain foods. Research shows that 25% of parents consider their 6 month olds picky eaters. At any age, about a quarter of all parents stop offering a new food after the child has refused it just twice.²

During the first year of life, babies continue the pattern of eating varying amounts each meal and each day. Parents often focus on getting, forcing, or making the baby to eat an amount which they feel is enough, so the parents fail to trust the baby’s self-regulatory capability. Parents ignore the baby’s satiety or hunger cues. Many feeding problems begin with these struggles, as parents’ expectations don’t match the baby’s needs. Parents create problems when they encourage a baby to eat more or less than she wants or when they assume that their baby didn’t like a food because she refused it several times.

By 8 months of age, the older baby or almost-toddler is beginning to experiment with doing things for himself. An 8 to 12 month old might suddenly refuse to be spoon fed, insisting that he do it for himself. He takes interest in what the parent eats, and will benefit by eating table foods with the family at mealtimes. He may become more hesitant to eat new foods, or, in contrast, may become more bold. He is experimenting and is malleable. Feeding problems are common at this stage, especially when parents fail to recognize the new need for independence and do not notice their baby’s cues.

Toddlers are notorious for their ability to know just how to engage their parents in battles. They become opinionated about what and how much they want to eat. They may develop bizarre food preferences, or even lose interest in eating. These reactions are normal. As growth slows down significantly after 12 months, caloric needs also decrease, and total caloric intake fluctuates considerably day to day. However generally, the average intake will be at an acceptable level. Yet, parental stress over perceived and developing ‘feeding problems’ that were minor in earlier stages becomes full-blown with the toddler.

What parents can do to prevent and correct feeding problems at any age:

The parenting style for feeding children and preventing obesity that is recommended as best practice by pediatric and nutrition organizations³ is the Division of Responsibility in feeding. Developed by Ellyn Satter⁴, the Division of Responsibility describes the very dynamic feeding relationship between parent and child. It identifies both the parent’s and the child’s unique responsibilities in the feeding relationship. In a nutshell:

The Division of Responsibility in feeding: Parents take leadership by providing all of the structure needed to make mealtimes and feeding go smoothly. Children are given autonomy over their eating.

Parents are responsible for:

• What food is served
• When eating occurs
• Where eating is allowed

Children are responsible for:

• How much to eat
• Whether or not to eat

When feeding issues appear, most parents feel that it is the child that needs fixing. They force, cajole, bribe, threaten, and manipulate their child into eating certain foods or amounts. Research indicates that this is unproductive, and actually creates the problem.⁵ The Division of Responsibility focuses on the parent and his or her parenting style. Children don’t need fixing. With proper parenting, the child learns to be a competent eater.

Structure is key to the division of responsibility. Parents help children become good eaters when they schedule regular meal and snack times, eat together as a family, have rules about when and where eating is allowed, and forbid grazing between the scheduled meals and snacks. If parents do their jobs with feeding, the child can take responsibility over how much and whether to eat.

Eating is a learned skill that children must be taught:

Parents are skilled teachers. They teach their child how to read, dance, and play sports. These learned skills require lots of practice, limit setting, the teaching of rules. Parents who teach their child a new skill expect that the child will master that skill. Mastery expectation is the norm.

Same applies for eating. To become a competent eater, a child requires the same type of teaching and mastery expectation from their parents:

• Practice: In order to learn to like vegetables, a child may need many exposures (practice). Parents who give up on their child after he refuses a food two or three or even 10 times deny the child the practice he needs. When the child refuses a food, parents should not force the child to eat it. They should, however, assume that by continuing to eat that food themselves, and offering it at mealtime that their child will learn to eat it. Eating together with a family is the best way for children to learn to like new foods.
• Teaching rules and setting limits: Every game has rules that must be followed. So it is with eating and learning to eat at the dinner table. Mealtime rules for children include how to: behave; say “no thank you;” refuse food politely; eat off his own plate; and know that once he gets up from the table or begins to misbehave, mealtime is over. Parents who expect that their child can master the skill of being a pleasant mealtime participant, will have the patience to teach these skills over many years.

Solving common feeding problems:

• My child refuses to eat anything green or new – Follow a division of responsibility in feeding. You provide the food, eat the food at mealtime with your child, offer the food to the child, and accept her decision to try it or not. Trust that she will learn to like it one day. Support these decisions by allowing eating only at scheduled meal and snack times. Here is how to develop trust so that your child can become willing to taste new foods: Allow her to taste without swallowing; teach her how to politely spit out the food if she doesn’t like it; and if she eats one bite, don’t try to get a second bite into her or praise her. Stay neutral. Have patience.
• My 3 year old won’t eat unless I feed her or sneak food into her while she’s preoccupied by television: You have taken over your child’s responsibility to determine how much and whether to eat. These techniques do not teach your child to be a competent eater and interfere with her ability to self-regulate her intake. If you do your job of offering the food at scheduled meal and snack times, offering her the same foods as the rest of the family and letting your child take responsibility over how much or whether to eat, she will gradually learn to eat the amount she needs and a greater variety. If your child refuses to eat at mealtimes, don’t let her panhandle later. She needs to learn that eating occurs at the table, during scheduled meals and snacks. Never feed a child with the television on. It’s hard to let this learning occur, as she may indeed eat very little as she tests you to see if you will be consistent with your new rules. Change can also cause tantrums or fights as she struggles to eat on her terms and push you to capitulate. Your child’s growth chart will tell you how she is doing. As long as her growth is fairly consistent along her appropriate growth percentile then you probably don’t need to worry.
• If I don’t limit the amount of food my 4 year old child eats, he has no stopping point and will gain too much weight: Studies suggest⁶ that food restriction increases a child’s weight (and thus his BMI) and eating in the absence of hunger. Food restricted children do not trust that they will get enough to eat. Food restricted children become preoccupied with eating, and will overeat whenever possible. You need to follow a division of responsibility. Key to establishing normal eating in your child is that you provide consistent structure around the what, when and where of eating. Limit eating to scheduled family mealtimes and snacks, never in front of the tv, and no eating in between times. However, when your child sits down to eat at a meal or scheduled snack, he is responsible for how much he eats. Parents may try to get around this by allowing him seconds on only low Calorie foods. That is restriction, and he knows it. He may overeat for 4 to 8 weeks until he no longer feels that he will be restricted, then he will be able to calm down in the presence of food.
• Where can I get more information: Go to www.ellynsatter.com. Satter has written a number of books that can help you raise your child to be a healthy and happy eater. Her website contains many useful resources.

1. Gesell A, Ilg FL. Feeding Behavior of Infants. Philadelphia: J.B. Lippincott, 1937.
2. Carruth, Zeigler et al, JADA 2004 Supplement
3. American Academy of Pediatrics, American Dietetic Association, Society for Nutrition Education and Behavior, American Medical Association 2007 Expert Committee Report on the Assessment, Prevention and Intervention of Child and Adolescent Overweight and Obesity
4. www.ellynsatter.com
5. Fisher, Mitchell et al. JADA 2002
6. Rhee, K. Childhood Overweight and the Relationship between Parent Behaviors, Parenting Style, and Family Functioning. Annals Am Academy of Political and Social Sci 2008; 615;11

Carol Danaher, MPH, RD
Carol Danaher directs a child obesity prevention collaborative in San Jose, CA