[00:00:22] Dannelle: As parents and caregivers eating competence and how we react and respond to behaviors around food can be a major source of frustration. It can be so overwhelming trying to manage feeding your child or loved one. Keira Oseroff, a Licensed Clinical Social Worker and Certified Eating Disorder Specialist, serves as a faculty member and speaker for the Ellyn Satter Institute, an organization that helps thousands of individuals and health professionals reimagine and reshape difficult relationships with food into a healthy experience.  

[00:01:07] Welcome to The Caregiving Soul. I’m Dannelle LeBlanc. 

[00:01:14] [Music Ends] 

[00:01:14] Keira: Eating competence just refers to a healthy relationship with food. If we’re a competent eater, it means four things. First that we have positive attitudes and beliefs about food, that we enjoy eating and we’re comfortable with our enjoyment of it. We’re not mired in guilt for the rest of the day because we did something we shouldn’t do. We can eat and we can move on.  

[00:01:40] The second area is food acceptance skills. So, how picky are we? How good are we at coming to make due with what’s being offered? If we’re at an event or if it’s not our favorite thing for dinner, can I come to the table and find something to eat. 

[00:01:58] Internal regulation is the third part, and that’s how in touch are we with our bodies? Do we know when we’re hungry? Do we know when we’re satisfied, when we’re full? And being able to respond to those cues.  

[00:02:14] And then the fourth is really managing the context around getting fed. And so as an adult, that means are we reliable and dependable about feeding ourselves, planning meals, or even making sure that we stop and feed ourselves rather than skipping meals or, or grazing throughout the day and not really feeding ourselves in a way that is consistent? 

[00:02:42] Dannelle: Okay, so Keira, how do we transform the steps, the abstract into reality? 

[00:02:50] Keira: So, it’s a great question and there is absolutely a roadmap and it is called the Satter Division of Responsibility, and it is a very simple but not always easy thing to implement, but it’s very simple, and it says that caregivers have a job and kids have a job.  

[00:03:21] The parent’s or caregiver’s responsibility is the “what”, “when” and “where” of feeding. What are we offering? When are we offering it? And where is that? Is it on the floor cuz we’re having a picnic? Is it at the ball field because brother or sister is at practice? Is it at a restaurant or is it at our kitchen table? So, our job as caregivers is to decide what is offered, when it’s offered and where it’s offered. 

[00:04:04] Child’s responsibility is the “whether” and the “how much” of eating, whether or not I eat and how much of it I eat. So, this division of responsibility, yes changes over time. As children’s capabilities grow it might look like smaller kids might help set the table, older kids might be helping meal plan.  

[00:04:32] Ultimately the goal is that by older adolescence and young adulthood, as they leave the nest, that they’re able to manage the things that we manage as adults who are eating competent. How do I plan to feed myself? How do I get a meal to the table? That sort of thing. So, the hope is that by the time they leave, they are capable of doing these things. 

[00:04:57] Dannelle: The idea of the division of responsibility is a key concept because so often we feel responsible, not only for the “what”, the “when”, and the “where” of feeding, but we also take on responsibility for the “whether” and the “how much”. So, what you’re saying is… 

[00:05:22] Keira: Bingo! [Music] I’m saying that problems occur when there is not a clear division of responsibility, or when caregivers and parents try to do too much of the child’s job or aren’t doing enough of their own job. 

[00:05:42] [Music Ends] 

[00:05:42] Where a child might be handed responsibility that’s too big for them – so, a four-year-old, when we say, what do you want for dinner? A child doesn’t know what they want for dinner. It’s too much to manage that, it’s too big to manage with their capabilities at that age. So, it’s our job to get the food to the table, and then they can choose from what’s there. That’s manageable. 

[00:06:14] Dannelle: This approach also applies not only for parent or caregiver and child dynamics, but also when we’re caring for say an older adult, and specifically I’m recalling a time when my father-in-law had gotten out of the hospital, he’d had aspirating pneumonia, and it was a few weeks before he passed and I was trying so hard to get him to eat, and it took time for me to recognize, and he just loved sweets and junk food, and [Laughs] so I was offering him ice cream and he was not eating. And I was trying to take on the responsibility of not only the “what”, “when” and “where”, but also I was trying to take responsibility for the “whether” and the “how much”. 

[00:07:20] Keira: That is such a perfect example, because the motivation to do more than what is my job comes from a variety of places. For parents who are worried that their children aren’t eating enough or are eating too much, it comes from anxiety that they’re not going to grow in the way that is right for them and for you, the crossing of that boundary, cuz that’s really what we’re talking about here, is healthy boundaries had to do with the narrative that we attach to this situation, which is if he doesn’t eat, he won’t be well and I’m scared and I want him to be well. 

[00:08:11] It comes from a place of well intention and love, and sometimes we just don’t know a different way. So, understanding what’s happening so that we can help people understand what’s happening is really important. 

[00:08:28] Dannelle: Absolutely. I’m thinking about the second concept you described, food acceptance, and translating that from food acceptance to an acceptance of what’s the reality of our loved one’s, our child, our person’s health. And so, that speaks to why it’s so important that we understand where caregivers coming from so that we address that. 

[00:09:05] Keira: Exactly. You know, it’s about supporting the caregiver, because goodness knows they need the support. Sometimes it comes across as pressure, usually there’s some kind of precipitating event, it could be at a well visit with a doctor, and again well-meaning doctor, might say something that causes a little bit of alarm. And so, it can cause this hypervigilance and worry. 

[00:09:32] And that worry we deal with by trying to control a situation, typically, and manage a situation. It typically backfires and makes the issue worse. That’s why it’s so important, I think, to support the parents and the caregivers, to help them calm themselves so that they can think their way through as opposed to react. 

[00:09:55] Dannelle: Yes. So, for example, if we’re at a well visit at the doctor’s office and the doctor refers to a child as being underweight, or an older adult that we’re caring for, and they’re underweight, but without any further context for, okay, what do we do with that. Because I know what I’m gonna do with that. I’m gonna, I’m just, I’m gonna get out my pots and pans. I’m gonna start – [Laughs] 

[00:10:28] Keira: Bargaining – 

[00:10:29] Dannelle: – putting down some – 

[00:10:30] Keira: – bribing, negotiating,  

[00:10:31] Dannelle: Yes! 

[00:10:32] Keira: – rewarding, pressuring. I mean, it comes in all forms, right? 

[00:10:37] Dannelle: Yes. Okay. So, let’s say that happens, what is it that medical professionals can say? How do they support caregivers in a situation like that? What else can be done to support me as a caregiver? What else do I need to know so that I can respond in a constructive way? 

[00:11:02] Keira: So, the first thing I would say is we need to do thorough assessment. We need to find out is there really a reason to be concerned. That’s the first thing is asking questions and saying, can you please help me understand what the problem is?  

[00:11:19] Dannelle: Absolutely. So, in learning more about what’s going on, can you talk to us about what are some of the most common feeding problems with children? 

[00:11:36] Keira: So, I think sometimes we want a child to be able to handle something that they’re not ready for. We hear [Music] a lot of parents and caregivers talk about, my child doesn’t eat enough of different kinds of things, that there’s a very limited number of foods that a child will have. And so, we may pressure with more exposure and some people call like a “no thank you bite”. We require them to take a bite. They can say “no thank you” after, but they have to take a bite. And that can be too much pressure, and often is. 

[00:12:17] The meltdowns around mealtime because a child is developing an unhealthy eating attitudes or negative eating attitudes and beliefs. Eating is not enjoyable because they might be forced to eat something that they don’t enjoy, or there’s some kind of interference in the feeding relationship. 

[00:12:38] So, if we’re gonna be offering new things, we also should make sure that there’s something acceptable on the table and abundant. And a lot of times that’s a carb, like it could be pasta, potatoes, bread, tortillas, you know, whatever, and it’s a way we can be confident that our kids are going to have sustenance without the pressure of, you know, they don’t have to eat asparagus. We hear a lot about pickiness. 

[00:13:08] [Music Ends] 

[00:13:08] Dannelle: So, Keira, can you share a story about what it looked like when a caregiver or parent shifted from the “what” to the “how” of eating with their child or loved one? 

[00:13:30] Keira: Yes. I have a very recent example actually, a client of mine who is in recovery from an eating disorder and absolutely dreads mealtime because the children don’t behave as she would like them to behave around the table because there are still some negative attitudes and beliefs about food, what I should and shouldn’t do. There’s a lot of perfectionism that she struggles with, what meals quote unquote should look like, and sometimes being preoccupied even about not wanting to clean up stuff all over, from all over the floor. And so, she’d rather plate everything so that there are fewer dishes. 

[00:14:19] But it was very difficult for her to grasp this idea of family style meals and allowing children to, in an age-appropriate way, serve themselves. So, if they can’t yet handle the serving spoon to, to scoop the rice themselves that she says to them, “would you like rice? Would you like me to put that on your plate?” Right? Because they’re too little to do that. But they’re in charge, right? That’s, they’re in charge of the “whether or not” and “how much”, and they can choose from what’s being offered. 

[00:14:54] So, when we really peeled back all the layers to see all the contributing factors to what was hindering her ability to allow for a healthy division of responsibility, there was a lot of fear about serving family style and helping them learn more, to be more capable and develop competency around anything from serving themselves to knowing how much to eat. And, it came from really increasing her own awareness of what the obstacles were for her, all the things that were getting in her way, the “shoulds” and the “oughts”, and the different things like that. 

[00:15:33] Dannelle: So, that goes back to the division of responsibility because so often we’re trying to not only control what we need to do as caregivers and as parents, but also control the response, not because we’re just inherently controlling, but because we’re trying to achieve a specific result, of making sure that our child is well fed. And so, it’s a shift in perspective. Ah, that is so interesting. 

[00:16:13] Keira: I mean, we are in an age where we see things on Facebook or Instagram, and everybody looks so happy, and again, we’re ruled by what we think it’s supposed to look like. So, it’s, it’s challenging sometimes to be honest and say, I need some support. 

[00:16:31] Dannelle: Yes. 

[00:16:32] Keira: Cuz it doesn’t look like this for us. [Laughs] It is – 

[00:16:35] Dannelle: Right! 

[00:16:35] Keira: – a struggle every day. 

[00:16:38] Dannelle: Yes. Oh my gosh. So true. Can you tell us what this, so what we’re talking about, I’m calling it Empowered eating. I don’t know if that’s real or if I just, if that’s – 

[00:16:55] Keira: Sounds good to me. 

[00:16:56] Dannelle: Okay. Or if we, we just made, we just made that up? [Laughs] So, what does that look like when integrated as part of the larger healthcare system?  

[00:17:12] Keira: So, there is a focus in this society on weight and with a lack of acceptance of what we would call the “a health at every size approach”, meaning that there is a focus on health way more than there is a focus on weight and health means a lot of things. But when a doctor starts talking about a child being in a, an at-risk, area of the growth chart, it can be alarming to parents. And we shift into gear and try to control the “what” and then our kids might hoard and sneak and hide and all these things. And breed shame and low self-esteem, which just lead to more unhealthy eating behaviors, like binging or whatever the case might be. 

[00:18:04] So, this idea of sitting and really talking about, how’s feeding going? How’s it going? And really getting to the bottom of that. I think sometimes the physicians need help and that’s where we come in, because we can support the physicians. Dieticians can, therapists can.  

[00:18:22] So, I think, what does it look like? My hope is [Music] it looks like it’s a team effort, because when we’re really siloed and working independently without what we call a multidisciplinary team, it’s just too hard to do it alone.  

[00:18:39] [Music Ends] 

[00:18:39] Dannelle: This idea of multidisciplinary – 

[00:18:43] Keira: Mhmm. 

[00:18:39] Dannelle: teams – 

[00:18:45] Keira: Mhmm. 

[00:18:45] Dannelle: – is key because I’ll tell you what, walking into this conversation, my awareness, my connection to my own personal experiences, you’ve provided this context where I understand, okay, that’s what was happening. 

[00:19:06] Keira: I’m so glad. A team approach is to me, like the healthcare equivalent of “it takes a village”, right? 

[00:19:14] Dannelle: Yes.  

[00:19:15] Keira: Mhmm. 

[00:19:15] Dannelle: Okay. That’s it. What else would you like our listeners know in this conversation? 

[00:19:24] Keira: I think I’d like people to know how much information is available for them. The Ellyn Satter Institute does a really beautiful job of, there’s so much information on the website, so it’s almost like rabbit holes you can go down, but there’s so much information that’s freely given away, and there are communities that can support them. 

[00:19:47] Dannelle: Wonderful. Keira, thank you so much for joining me today on The Caregiving Soul. I’ve learned so much. 

[00:19:55] Keira: I am so glad. It has been such a joy to talk with you. It’s been really fun. 

[00:20:05] [Music] 

[00:20:05] Thank you for joining our conversation with Keira Oseroff. 

[00:20:10] A huge eye-opener in speaking with Keira was understanding the division of responsibility when food is offered and the connection with how we support a child or loved one we care for, in their choice of “whether” and “how much” they eat. When we as a parent or caregiver understand what is and is not in our control, we can better empower our loved one to eat what feels right for their body on any given day. 

[00:20:43] Check out our show notes to connect with and follow Keira and the Ellyn Satter Institute.  

[00:20:50] Every episode of The Caregiving Soul has a page on empoweredus.org where you can find the extended show notes, including tips and takeaways, transcripts, and relevant resource links.  

[00:21:02] For additional bonus content from this episode, and to connect with us, be sure to follow the Empowered Us social channels on Instagram @empoweredusnetwork and Twitter @empowereduspod.  

[00:21:17] The Caregiving Soul is an Empowered Us original, presented by Good Days, hosted by me, Dannelle LeBlanc. If you liked this episode, be sure to rate and subscribe to the show wherever you get your podcasts. 

[00:21:33] And remember, the right care includes care for you.  

[00:21:41] [Music Ends] 

Read Less