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The Feeding Relationship
This article highlights the importance of the feeding relationship; summarizes current knowledge about the effect of feeding problems on young children's physical, social and emotional development; and suggests both prevention and problem solving strategies.
In this resource
Written by Ellyn Satter, M.S., R.D., A.C.S.W., edited and synopsized from the Zero to Three Journal, June 1992.
Feeding is a reciprocal process that depends on the abilities and characteristics of both the parent and the child. The child indicates an interest in being fed, with more or less clarity, and the parent responds to that interest readily, reluctantly, or not at all. Once feeding starts, the parent and child work on the process with more or less flexibility and skill. Some parents are very skillful and resourceful, and some are awkward or rigid. Children respond to their parents’ limitations in a similar variety of ways. They may react positively and with adaptability of their own, or they may withdraw or scream. The parents may be accepting and supportive of a child’s constitutional endowment for growth and body shape, or they may be dissatisfied and controlling.
Interactions involved in normal feeding propel an infant from a state of isolation and self-absorption to an active engagement with other people and the world (Dowling, 1977; Freud, 1946). High-quality feeding interactions during the first years of life tend to be positively linked to the child’s subsequent cognitive and linguistic competence and to more secure attachments to major caregivers (Barnard, Hammond, Booth, et al., 1989). This article highlights the importance of the feeding relationship; summarizes current knowledge about the effect of feeding problems on young children’s physical, social and emotional development; and suggests both prevention and problem solving strategies.
What is Optimal Feeding?
Infants have considerable capability in food regulation and eating. They are interested in eating and invested in their own survival. They instinctively suckle and take in nourishment. They can regulate their food intake (Adair, 1984; Birch, McPhee, & Shoba, et al., 1987; Fomon, Filer, Thomas, et al., 1975; Gessel & Ilg. 1937) and grow in a way that reflects their genetic endowment. They naturally consume a variety of foods (Davis, 1928; Rolls, 1986). They are driven by their internal developmental processes to progress from suckling to taking semisolid foods to mastering increasingly difficult foods and eating styles (Satter, 1984). Furthermore, these capabilities are not fragile. It takes considerable interference to disrupt children’s capability in food acceptance and regulation.
To manifest their eating capability (as well as to develop in other ways), however, children need appropriate supports from parents. The parent must acknowledge and respect the child’s capability and autonomy, but also provide the proper food, in a form the child can manage, in a social environment that is loving and accepting.
Problems in feeding, growth, and food acceptance may stem from any or all of the following causes: 1) medical or physical condition of the child; 2) inappropriate food selection; 3) inappropriate dynamics around feeding. For example, if parents are overmanaging or insufficiently supportive, the development feeding of feeding skills is likely to be disrupted. Unless they get positive rewards for their efforts, children’s normal drive for development is blunted or transformed into non-productive struggles with parents.
Positive approaches to feeding allow a child to accomplish developmental tasks at any age (Satter, 1990). Feeding the newborn goes best when parents adjust their approach to the infant’s timing, preference, pacing, and eating capability (Ainsworth & Bell, 1969). Infants eat less well when parents are overactive and overmanaging in feeding, and best when parents calm them and feed them in a smooth and continuous fashion (Ainsworth & Bell, 1969; Brody, 1956; Crow, Fawcett, & Wright, 1980; Pollitt & Wirtz, 1981).
Feeding requires a division of responsibility between parent and child. The parent is responsible for what the child is offered to eat, the child is responsible for how much (Satter, 1987). Parents must provide an appropriate milk feeding (Committee on Nutrition, American Academy of Pediatrics (AAP), 1976), but they must allow the infant to regulate the amounts. Parents must offer solid foods in response to signs of developmental readiness (Committee on Nutrition, AAP, 1980), but they must let their child take the initiative in accepting foods.
Parents must provide the toddler with appropriate food and feeding structure and limit negative behaviors during meals, while at the same time allowing the child to decide how much and whether to eat (Satter, 1987). Toddlers are naturally phobic about new foods (neophobic), but accept most foods with repeated neutral exposure (Birch & Marlin, 1982). Toddlers and preschoolers are less accepting of new foods when they are rewarded or otherwise pressured to eat them (Birch, Marlin, & Rotter, 1984), but more accepting when they get social support at eating time (Birch, Zimmerman, & Hind, 1980).
Structure and limits are essential if children are to mature in food acceptance and learn the social behaviors associated with eating. The patterns established in the toddler period build an essential framework for eating that persists throughout childhood. Children need the support of regular and reliable meals and snacks, and they need the limits of not being allowed to beg for food handouts or dictate the family menu. With eating, as with other interactions between parent and child, it is frightening for children when parents fail to provide them with structure and discipline.
Eating is a complex behavior with skills and attitudes that are learned slowly, over time. For the typically developing child, if the relationship around feeding is positive and the food is appropriate, the child will eat and grow, although the amount and range of food may remain limited.
The focus in feeding should not be on getting food into the child. Such an emphasis puts pressure on both the feeder and the child, often resulting in disrespectful feeding tactics that preempt the child’s initiative. Such pressure tactics limit the child’s possibility for success and instill long-term negative eating attitudes and behaviors.
Instead, the focus should be on the feeding relationship and on the achievable goal of helping the child learn eating skills and positive eating behaviors. The principle underlying all interventions is to establish a smooth and congenial feeding relationship that is appropriate for each child’s developmental stage, nutritional needs, and neuromuscular development.
Parent Behaviors That Support Attachment
Follow the baby’s signals about what time to feed.
Feed promptly when the baby is hungry, before the baby becomes aroused from heavy crying.
Hold the baby so you can look at each other during feeding.
Hold the baby securely but not restrictively.
When using a bottle, hold it still at an appropriate angle; don’t jiggle the bottle or the baby.
Be sure the nipple flows at an appropriate speed.
Stimulate the rooting reflex by touching the baby’s cheek.
Let the baby decide how much to have, and at what tempo.
Let the baby pause, rest, socialize, and go back to eating.
Talk and smile, but don’t overwhelm the baby with attention.
Burp only if the baby seems to need it; don’t disrupt feeding with unnecessary burping and wiping.
Stop the feeding when the baby refuses the nipple or indicates satiety and lack of interest in eating by turning away, refusing to open the mouth, or arching the back.
Behaviors That Support Separation and Individuation
Feed when the child wants to eat, but gradually evolve a time structure that is appropriate for everyone in the family.
Seat the child straight up and facing forward.
Sit directly in front of the child.
Hold the spoon so the child can see it.
Be engaging but not overwhelming; take care not to overload the child with talking or behavior.
Talk in a quiet and encouraging manner.
Wait for the child to open up and pay attention before feeding.
Let the child touch the food and eat with fingers.
Let the child self-feed when ready.
When the child is self-feeding, remain present in the situation, but don’t take over.
Let the child decide how fast to eat.
Let the child decide how much to eat.
Respect the child’s food preferences.
Respect the child’s caution about new foods.
Remember, all children learn to eat eventually.
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