Feeding and attachment

The attachment cycle is fulfilled by meeting a child’s physical and emotional needs — feeling hunger, needing attention, being wet or cold — over and over again. Feeding is one of the most reliable and obvious opportunities to help a child feel safe and cared for, and to build trust, whether you have brought home an infant or an older child.

Amy recalls an episode involving her teenaged foster son, who had a habit of running away. Soon after he was placed with the family, he disappeared for 36 hours. When he returned, “We made sure he was OK, then threw a box of macn-cheese on the stove to get him some comfort food. That floored him, because he’d been denied food in his home after his running away. I think this gesture bonded him to us more than anything else could have.”

When feeding is not going well, however, not only is the opportunity for bonding lost, but the troubled feeding relationship becomes a source of conflict that can raise barriers to trust and attachment.

“We worked hard to have our daughter with us, so I hated to admit that I wasn’t enjoying her and that our other kids were really suffering. Our lives revolved around what she was or wasn’t putting in her mouth,” says Kelly, the mother of a three-year-old adopted from China. After seeking help, Kelly now feels they are moving in the right direction: “Our stress at  mealtimes is way down, she’s happier at the table, and we can see her eating starting to improve. I am beginning to enjoy my family again, and it feels great.”

What worked for Kelly’s family and many others, including my own, was the Trust Model of feeding, developed by dietitian and therapist Ellyn Satter. If we restore or establish structured, reliable, rewarding, and healthy eating strategies for the whole family, we allow children to rely on the messages of hunger and fullness that come from inside their bodies, which helps them grow up to be competent eaters. Perhaps most important, when we feed our children reliably and with love, we teach them they can rely on us as parents. How can you bring the Trust Model to your dinner table?

A healthy feeding model

You may not know your child’s history, and you can’t change it if you do, but you will be better off if you follow his cues, consider things from his perspective, and take the lead as the parent. Satter developed the Division of Responsibility (DOR) in feeding, which is the principle underlying the Trust Model. The DOR says: Parents decide three things: the when, the where, and the what of feeding. (Infants do best fed on demand, so they decide the when. This responsibility shifts to the parent in late infancy/early toddlerhood.)

Children decide whether and how much they will eat from what is provided. The DOR is based on permission, nurturing, and providing. It rejects the idea that children should diet or worry about weight, and does not focus on avoidance or “shouldn’ts.”

It sounds simple, but it is not easy. Feeding well is hard work that you will do for years, but struggling with feeding is even harder. Most parents and children who struggle around food issues mix up their jobs. That is, the parents let the child do their job of selecting foods and deciding when and where to eat. Likewise, parents should not try to do the child’s job of deciding how much to eat by limiting food intake or by pressuring the child to take “just two more bites.”

When to feed

Reliable structure is an important way to help children with eating. Structure allows children to heed their internal cues of hunger and fullness and not to worry about eating between the scheduled meals and snacks. Generally,

  • Younger children eat every two or three hours, roughly, three meals and two to three snacks a day.
  • Older children eat every three to four hours, at about the same times every day. This adds up to three meals and one or two snacks a day.
  • If a child is new to your family, or has significant nutritional or growth delays, you may need to offer food more often at first, until you learn to read your child’s cues and he learns to trust that he will be taken care of.

Many foster and institutionalized children have extreme anxiety about food. They may have come from chaotic and  unsupportive homes, and food may have been limited. Being absolutely reliable about structure is critical. Don’t skip a snack because you are going to the park. Deborah Gray says, in Attaching in Adoption, “Successful parents have seen how much better their child performs with high structure. They work hard to provide that structure.”

Structure takes a lot of pressure off feeding. If a child eats a small meal or snack—which he will, since the amounts and types of food that a young child eats can vary greatly by day or week—he will soon have another opportunity to eat, so the parents can relax. Structure can be flexible enough to let the family eat together every night. Plan for a balanced and filling snack after school on days when dinnertime will be later. On days when an early dinner works better, plan on serving a snack before bed.

Where to feed (and with whom)

Family meals are important. All of you have to eat, and it’s better to do it together. Ideally, all meals would find the whole family around a table. However, one supportive adult eating with the child makes it a family meal. Children do best when they sit down to eat and are free from TV, phones, and toys. Meals and snacks can be fun and pleasant times to connect.

Food should be eaten with parents and should come from parents. Ivan, age 14, was adopted from Romania, with his younger sister. Marina was attached to Ivan as her caregiver. When the siblings came to live with their new family, their mother was deliberate about feeding both children. Showing that food came from Mom and Dad allowed Ivan to be  nurtured and to attach, and it was critical in allowing Marina to transfer her attachment to her parents. Both needed to be cared for and nurtured, setting them free to be children.

Kim, who adopted three- and six-year-old sisters, says, “Preparing and giving both girls food helped them see that they need me.” She did not make food available to the girls at all times. She felt it was critical to demonstrate that food came from her and that she would meet their needs. She offered and maintained eye contact during meals and snacks.

Eating with the family

  • Helps kids tune in to “hungry” and “full” cues.
  • Helps kids eat the right amount.
  • Lowers the risk of choking.
  • Helps children learn to like new foods. Seeing someone they trust enjoy a food is the best first step.
  • Aids attachment and helps children feel they are part of the family.
  • Is the best predictor of overall success in life, more than socioeconomic or educational milieu or after-school activities, several studies have found.

Read more in “Love me, feed me: part two“.

Katja Rowell, M.D., specializes in helping families with feeding and weight worries. This piece was adapted from Love Me, Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles, and More.