Helping Children Develop a Positive Relationship with Food: A Practical Guide for Early Years Professionals Interview

Jo Cormack joined us for an interview on her book, Helping Children Develop a Positive Relationship with Food: A Practical Guide for Early Years Professionals Interview. What follows are our questions in italics, and her thoughts responses.

Early on in Helping Children Develop a Positive Relationship with Food: A Practical Guide for Early Years Professionals, you refer to Ellyn Satter’s work. Please explain the significance of her concept of “self-regulation.”

‘Self-regulation’ is a concept which is central to Satter’s work. The idea that children can make good decisions about the food they need was first explored back in the 1920s and 1930s by Clara Davis, a pediatrician from Chicago. In the latter part of the last century, this work was developed by Leann Birch and colleagues. Birch showed that children regulate their energy intake both over the course of an individual meal and over a given 24-hour period.

Self-regulation, in the context of eating, means making internally driven eating decisions: eating when we are hungry and stopping eating because we are full. This is distinct from making eating decisions for emotional reasons, to please other people or to maintain autonomy. Self-regulation is an important concept because it means that children know how much they need to eat, not adults.  At first glance, this concept is extremely counter-intuitive. After all, surely if we leave children to their own devices, won’t they just eat ice-cream all day long?

To fully appreciate why a permissive approach to feeding children is not what supporting self-regulatory skills is all about, we need to understand how children’s energy needs work. First and foremost, they fluctuate. As adults, our caloric needs are pretty consistent day to day. Children, however, have changing needs according to how their body is growing. For example, between the ages of two and five, weight gain slows in young children following a period of rapid growth, especially in the first year of life. Toddlers and preschoolers usually have less of an appetite than they had before*. If we can nurture their inborn ability to self-regulate, they will naturally eat the amount of food they need, which may well be less than we estimate. On the other hand, if we pressure children to  eat because we don’t believe they are eating enough, this can contribute to ‘picky eating’ and a difficult relationship with food.

Satter’s Division of Responsibility model** gives adults a framework within which they can support self-regulation. Satter teaches that adults are responsible for what is served, when it is served and where it is served. Children are responsible for how much they eat and whether they eat. This means that food is not served in a haphazard, on-demand way, but in a structured and nutritionally sensible manner.  In this context, we can allow children to listen to their bodies and eat what they need, from the food we provide.

Can you speak about praise in regard to children’s eating decisions?

We are very used to taking a behavioral stance in relation to children, where we praise the behavior we want to see more of and  introduce negative consequences for (or ignore) the behavior we don’t like.  This may work in the context of desirable behaviors like tidying away toys, however, eating is different.

Again, this goes back to the goal of fostering children’s self-regulatory abilities. If we want children to eat in response to their body’s cues – which we do, because effective self-regulation is protective against weight dysregulation, picky eating and eating disorders – we mustn’t interrupt this natural process by providing an external incentive to eat. For example, a child may have eaten all the food their body needs. If we push them to eat a little more by praising them when they have cleaned their plate, we are giving them a reason to ignore their internal cues and eat to please us. Equally, if we restrict their eating by telling them they’ve had enough, they paradoxically become less able to tune into their body’s satiety signals.

For children who are anxious eaters and who find new foods tricky, praise can be experienced as pressure. In their excellent book *** for parents of ‘extreme picky eaters’ feeding specialists Katja Rowell and Jenny McGlothlin make the point that if we praise a child for trying a new food one day, they may feel bad when they are not able to try it another day; a child’s capacity to try foods depends on so many factors, such as how tired or stimulated they are.

What are some useful practices when it comes to the language of labeling food and bodies?

I believe passionately in staying neutral when it comes to food talk. In the UK where I live, it is common to talk about having a ‘naughty piece of cake’ or saying “I shouldn’t!” as we reach for second helpings. There is judgement in this language! It teaches children to put a moral gloss on their eating decisions. This leads to eating for external reasons and brings in complex emotions like guilt.

Similarly, when we describe some foods as ‘junk’ this can make children whose eating is really limited feel terrible. Many educational settings teach about nutrition and it’s great for children to learn about how their bodies work and where our food comes from. However, imposing moral categories on food such as ‘junk’ and ‘healthy’ or ‘good’ and ‘bad’ can leave anxious eaters feeling very rejected and worried. This is especially true of autistic children, many of whom find eating very hard and may see these descriptions of the foods they eat in black and white terms.

It’s great to help children celebrate the wonderful things our bodies can do and help them feel good about their body regardless of whether it is bigger or smaller. We are all different, and yet society is full of very damaging messages about what kinds of bodies are okay. We can strive for children to be their healthiest selves, but this doesn’t come from body shaming or pressure to eat or not to eat.

In order to help children develop a positive relationship with food, we must focus our energies on giving children exposure to a varied and tasty diet in a pressure-free and joyful environment. This is encapsulated by a responsive approach to feeding: a way of feeding children that prioritizes innate self-regulation and asks adults to be attuned, warm and respectful of children’s autonomy. Responsive feeding helps children build skills and confidence against a backdrop of positive relationships with the adults caring for them.

Please highlight some of the benefits of social eating for children.

There are so many benefits of social eating for children. Eating is an inherently social practice and much of what children learn about food, they learn by watching others. In fact, the biggest influence over what foods children accept is what foods the adults in their lives eat and serve. If you want a child to enjoy cabbage, eat cabbage with them regularly. No amount of persuasion or talk about how cabbage makes us healthy will go anywhere close to giving them a lifelong love of cabbage. In fact, research shows that children who were made to eat certain foods as children are highly unlikely to eat them as adults.****

Beyond modelling and exposure, there are many many benefits of eating communally in relation to the development of social skills. Meals and snacks can be a time for children to practice talking and listening, to share, to think of others, and to enjoy the company of their peers. Professionals working with children can do them a great service by focusing on the social side of meals rather than on individual children’s eating decisions.

Your words address early years professionals. Please share your thoughts on these professionals having a “food policy.”

Not only is a policy useful for a setting because it helps staff think through how they wish to deal with food but it also helps them share key messages with parents. While nutrition or healthy eating policies may be commonplace, it is useful to extend these to include the needs of children who are very limited eaters or even have a diagnosis of Avoidant Restrictive Food Intake Disorder (ARFID) which is the name for clinically significant extreme ‘picky eating’. Sometimes, healthy eating policies can get in the way of these children’s needs being met, for example, where a child is not allowed to have access to accepted foods because they are deemed unhealthy.

It is also very positive to extend the food policy beyond nutrition, to encompass a setting’s food ethos. Staff may wish to make a written statement about their commitment to a responsive approach to feeding which champions children’s right to autonomy and a positive, pressure-free eating environment free from body or food shaming.

What are some skills early years professionals can offer parents when addressing the food concerns they have for their children?

If early years professionals are trained in responsive feeding and have an understanding of how to support a positive relationship with food in childhood, they can help parents in several ways.

  • Signpost to appropriate professional support as needed
  • Help parents understand developmentally normal eating behaviors
  • Share resources and good practice

Above all, if a child is finding eating difficult, great communication with parents is key. If parents feel listened to and understood, this in itself will go some way towards alleviating anxiety and will enable staff and parents to work as a team, with the child’s best interests at heart. Sometimes, parents may be using socially normal but problematic approaches at home, such as bribing or pressuring children to eat. Staff can provide non-judgemental education about responsive feeding practices and talk about how they approach food at school and daycare.

How can adults use food to show respect to children?

We can ask ourselves, would I tell my friend who had come over for coffee and cake, to try just one more bite? If she said she wasn’t in the mood for cake, would I tell her how long it had taken me to make it and that she had to have some? Would I tell her to eat it up then praise her for doing so? No – because we respect our friends and see them as autonomous individuals who have a right to eat no cake, half their piece of cake or all of their cake.

We can accord children the same respect by seeing them as people who are able to tune in to their bodies and make eating  decisions that are right for them. Simultaneously, we can give them the gift of exposure to a broad and tasty diet by serving up appropriate meals and snacks and always making sure we include something they can handle. Attuned adults who hear childrens’ ‘no’ while creating a positive eating environment, can help children enjoy meals even if they are not necessarily ready to eat a varied diet.

About the author:
Jo Cormack MBACP is a PhD candidate at Bishop Grosseteste University, UK. She is researching parental responses to child-feeding problems. Clinically, Jo focuses on working therapeutically with food anxiety in children and working with parents on the feeding relationship. Jo has an interest in how food is managed in educational settings and is the author of Helping Children Develop a Positive Relationship with Food (Jessica Kingsley Publishers). She writes for various media outlets on the psychology of feeding children, in particular in relation to Autism Spectrum Disorders, food in schools and avoidant eating. Jo is a co-founder of www.yourfeedingteam.com, a support platform for parents.

References:

*Leung, A. K., Marchand, V., Sauve, R. S., Canadian Paediatric Society, & Nutrition and Gastroenterology Committee. (2012). The ‘picky eater’: The toddler or preschooler who does not eat. Paediatrics & child health, 17(8), 455-457.

** Satter, E. (1991). Child of Mine. Palo Alto. Bull Publishing Co.

*** Rowell, K., & McGlothlin, J. (2015). Helping your child with extreme picky eating: A step-by-step guide for overcoming selective eating, food aversion, and feeding disorders. New Harbinger Publications.

**** Batsell Jr, W. R., Brown, A. S., Ansfield, M. E., & Paschall, G. Y. (2002). “You will eat all of that!”: A retrospective analysis of forced consumption

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