The Satter Feeding Dynamics Model

fdSatter, sDOR, and sDOR.2-6y

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The Satter Feeding Dynamics Model (fdSatter) is a clinically and research-grounded, practical, and theoretically sound understanding of and trust in normal child development, including growth, based on children’s natural behavioral, nutritional, psychosocial, oral-motor, and physical abilities and functioning. ^1-12 fdSatter is competency based: Children are inclined toward mastery as well as skeptical of new food. Provided adults give children appropriate support, repeated neutral exposure to food, and don’t interfere, restrict, or pressure with what or how much they eat, children eat as much or little as they need,^{13, 14} gradually accept new food,^14-21 and maintain energy balance and consistent growth^{13, 22, 23} that reflects their genetic endowment.^{24, 25}

The Satter Division of Responsibility in Feeding
fdSatter is implemented by the Satter Division of Responsibility in Feeding (sDOR). sDOR responds to children’s predictable patterns with respect to psychosocial^{26, 27} and oral-motor ^{28, 29} development. sDOR translates authoritative parenting into parenting with food, supporting parents in taking kind and nurturing leadership with feeding and giving children trusting and respectful autonomy with eating. Children of authoritative parents are less likely to be obese^{30, 31} or be characterized as picky eaters.³²

sDOR.2-6y^TM achievably tests nutrition risk
Assessing adherence to sDOR gives parents and professionals an achievable way to address their biggest feeding worry: that children are doing well nutritionally.³³ Parent adherence to sDOR is measured by the validated sDOR.2-6y ³³ Parents who were observed to follow sDOR³⁴ and also scored high on sDOR.2-6y trusted their child to eat what and as much as they wanted from what parents provided and avoided feeding pressure and restriction.³³

sDOR.2-6y^TM directly assesses sDOR adherence in parents of 24- to 72-month-old children^{33, 34} by addressing both and only the degree to which parents take leadership with feeding and give their child autonomy with eating. Correlation with other validated questionnaires indicates that children of parents who follow the Satter Division of Responsibility in Feeding, who score high on sDOR.2-6y^TM, have lower nutritional risk. Parents who test high on sDOR.2-6y^TM have higher Eating Competence as measured by ecSI 2.0^TM,³⁵ better sleep quality and psychosocial functioning, lower stress, and lower levels of uncontrolled or emotional eating.³³

Children become healthy eaters
When parents follow sDOR, children get repeated neutral exposure to food, thus allowing them to become healthy eaters. Healthy eating doesn’t mean they enthusiastically eat everything that is put before them (but not too much). It means they grow up with eating attitudes and behaviors that are consistent with the Satter Eating Competence Model:³⁶ They feel good about eating, are comfortable in the presence of unfamiliar food, eat as much as they need to grow predictably, and are relaxed about joining in with family meals and structured snacks. These positive eating attitudes and behaviors, in turn, allow children to push themselves along to learn to eat the food their trusted grownups eat and, over time, gradually eat a greater variety of food.³⁷ The goal of sDOR is not to get children to eat target foods today: It is to allow them to enjoy a variety of food for a lifetime. It can take years for some children to grow out of their natural food skepticism.^{20, 21} Parents who score high on sDOR.2-6y^TM trust children to eat what and as much as they want from what parents provide and avoid pressure and restriction,¹⁹ direct or indirect, positive or negative.

Agencies recognize positive feeding dynamics
Agencies such as the Food and Nutrition Service of the US Department of Agriculture, Special Supplemental Nutrition Program for Women, Infants, and Children, Head Start, the American Academy of Pediatrics, and the Academy of Nutrition and Dietetics endorse positive feeding dynamics, although they tend to use the term responsive feeding. While sDOR is responsive feeding, not all responsive feeding is sDOR. Feeding guidance is inconsistent with fdSatter and sDOR and likely to produce low scores on sDOR.2-6y^TM when children are viewed as being incapable—as having biopsychosocial deficits—and prompted or managed in some way to get them to eat healthy food, eat more or less, and/or gain more or less weight than they do naturally. Essentially pressuring and/or restricting child-deficit approaches include negotiation, praise, nondirective control, elaborate modeling, rewarding, or bargaining. Strategies deemed “positive” or “responsive” pressure are also inconsistent with sDOR. These include logic or reasoning, teaching nutrition goals or giving good-food-bad-food lists, teaching internal regulation and/or portion sizes, teaching children to delay gratification, reflect on how their stomach feels before, during, and after eating, and expecting them to base food consumption on family values (eat fruits and vegetables, not candy). Attempts beyond repeated neutral exposure to increase children’s fruit and vegetable intake are inconsistent with sDOR. These include mixing vegetables with food the child likes, serving vegetables first, increasing vegetable portion size, and making fruits and vegetables available for eating as desired throughout the day. It is inconsistent with sDOR to use structure as a mechanism for covert control by emphasizing “healthy” food for both parents and children, avoiding eating out and/or purchasing “unhealthy” food, and stressing selective availability of food in the home.

sDOR supports children’s capability
Children—even those who are ill or need particular help with maintaining their nutritional status—are born wanting to eat, knowing how much to eat, and able to grow in the way nature intended for them. The task of their grownups—parents, teachers, and their advisors—is to raise them to have positive eating attitudes and behaviors. Setting aside efforts to get children to eat certain amounts and types of food allows their grownups to support them in learning to enjoy a variety of food for a lifetime.