Feeding neglected children mandates division of responsibility in feeding 

by Ellyn Satter, Registered dietitian and Family Therapist 

Children may enter foster care or adoptive homes neglected, underfed, untrusting, and emotionally isolated. Following the division of responsibility in feeding makes it possible for parents to reach these children and reassure them they will be cared for. To do the best parenting with feeding, parents must follow sDOR in a persistent, loving, respectful, and developmentally appropriate way.

Adoptive twins are obsessed with food

Mom: We have twin 3 year-olds we got from foster care when they were a year old. Since they ate such shocking amounts of food and threw up right after meals, we restricted them. For the past two years, they have been extremely food obsessed and binge eat, hoard, and steal food any chance they get, so we have continued to search for answers. We were told about the division of responsibility in feeding and it resonated for us. Now, on sDOR day 4, our twins eat for hours and eat insane amounts. Meals and snacks blend together with a short break between breakfast and snack time and during their nap. Am I doing this right? We offer unlimited food of what we are serving and always refill when they ask for more. I really don’t want to set a time limit in fear that they will see this as our still restricting them!

ES: My previous article in this series about adoptive and foster children will tell you more about what you are dealing with. Hang in there! Throwing up after eating is coarsely tuned food regulation. As you go on, your boys’ food regulation will become more finely tuned: they will begin to be aware of their hunger and fullness and respond to them, rather than being driven by them.

Mom: After a week of following sDOR, the twins are more readily saying they are done and getting down, and are eating a lot less and for a lot shorter time. They still gorge themselves at least one meal a day, which is great compared to every meal and snack! They follow me around and run as fast as they can if I enter the kitchen. They ask about the next meal every 10 minutes.

ES: Following sDOR takes steady nerves and a leap of faith! It is little wonder that you were frightened by such extremes of eating behavior and felt you had to restrict. But, as you discovered, restriction makes the food obsession worse.

Mom: They have been in foster care since birth so these problems came unfortunately from a foster home. We have done almost constant therapy for attachment failure and Post-Traumatic Stress Disorder (PTSD). Nobody [of their mental health providers] has addressed food. They keep telling us that it will pass eventually, it just takes time.

Neglected children experience feeding as toxic

Unfailing care and attention allows the emotionally isolated child to gradually break through his own anxiety and resistance and let his parents get through to him.

In order to be available for love and the joy of eating, a child must become willing to connect. He must break through his own mistrust and give up his isolation from others and from himself. This is in contrast to the neglected child’s previous experience of isolation, self-protectiveness, and distancing from whatever was toxic with feeding and in relationship.

• Instead of depending on others to provide, he has learned to attend to his food needs by scavenging, stealing, storming, dictating, or otherwise keeping control of getting fed.
• Neglected children protect themselves from the devastation of abandonment by not allowing themselves to feel the love and caring of important adults and by not letting themselves depend on others to feed and provide for them.
• Neglected children protect themselves from the agony of starvation by “eating without eating.” That is, they disconnect from the food itself by eating automatically and rapidly, not looking at the food, not engaging with eating, and/or not feeling the sensations related to taking in food. They eat until they can eat no more. 

Mental health treatment does not address feeding problems

In failing to make appropriate and sophisticated use of sDOR, their mental health professionals miss a profoundly healing and effective intervention. Parents’ unfailing care and attention with feeding will allow their emotionally isolated child to gradually break through his own anxiety and resistance and let his parents get through to him

• For the infant and young child, nourishing is synonymous with nurturing. Even newborns long to be understood, and parents express their understanding by paying attention to, trusting, and responding to their baby’s expressions of what they want and need.
• Feeding problems reflect a distortion in parent-child interaction – with food and overall – distortion that interferes with the child’s ability to feel positive about self and others and therefore trust and attach.¹ Profound problems reflect profound distortion. 
• Correcting these distortions by feeding according to sDOR offers a powerful way of getting on the same emotional wavelength with a neglected child. Since food is as much about nurturing and relationship as it is about physical sustenance, feeding is best done in the context of relationship.

Emotional healing with the division of responsibility in feeding

To do the best parenting with feeding, parents must follow sDOR, and do it in a persistent, loving, respectful, and developmentally appropriate way.

• Feeding according to sDOR is always in the context of relationship.
• Parents who do the what, when, and where of feeding provide their child with security and the reassurance he they will be cared for without being dominated.
• Parents who let their child do the how much and whether of eating demonstrate to the child that he can be his own little person without being abandoned.

Be prepared for the long haul

From the perspective of the feeding relationship, for a child to have a chance of healing, parents must be ready for the long haul.

• Parents have to unfailingly provide ample food and lovingly persist in offering warmth and  companionship at feeding times.
• Parents have to make clear to the child, in word and deed, that they will provide, that they are accepting, that they will give him enough to eat, and that they will be present with him when he eats.
• That is, parents will not go off and leave the child to eat on his own, and they will not allow him to scavenge for food.
• Instead, parents regularly reassure the child – again, in word and deed – that another feeding is coming soon, that there will be plenty of food, and that he will be allowed to eat as much s she wants.