Episode 258: One of the most difficult aspects of being a parent can be mealtimes with kids. This week on the show I chat with Katja Rowell MD. Katja is a childhood feeding specialist. We cover Ellyn Satter’s Division Of Responsibility, Responsive Feeding Therapy, the frequency of feeding issues, typical eating and growth, the mechanics of eating, and the five steps for creating a healthy feeding relationship.
Katja Rowell MD is an author and childhood feeding specialist. Described as “academic, but warm and down to earth,” her mission is to help children do their best with eating, and feel good in their bodies.
She has a special interest in anxious and avoidant eating, food preoccupation, and supporting foster and adopted children. Rowell helps parents feed their children with a focus on relationship and felt safety, and supporting attunement with internal drives.
Along with a multidisciplinary team, she is developing Responsive Feeding Therapy for feeding and eating challenges. Learn more at thefeedingdoctor.com and at RFPro (for feeding professionals), where she is co-founder.
Her books include Helping Your Child with Extreme Picky Eating, Conquer Picky Eating for Teens and Adults, and Love Me, Feed Me (second edition due out January 2023).
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Chris Sandel: Welcome to Episode 258 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/258.
Before we get started, I want to mention that I’m currently taking on new clients. I specialise in helping clients overcome eating disorders and disordered eating, chronic dieting, body dissatisfaction and poor body image, exercise compulsion and overexercising, and also helping clients to regain their period. If you want help with any of these areas or you simply want support in improving your relationship with food and body and exercise, then please get in contact. You can head over to www.seven-health.com/help, and you can read about how I work with clients and apply for a free initial chat there. The address, again, is www.seven-health.com/help, and I’ll also include that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist who specialises in recovery from disordered eating and eating disorders, and really helping anyone who has a messy relationship with food and body and exercise.
Today on the show, it is a guest interview. Today, my guest is Katja Rowell. Katja is an MD, an author, and childhood feeding specialist. Described as academic but warm and down to earth, her mission is to help children do their best with eating and feel good in their bodies. She has a special interest in anxious and avoidant eating, food preoccupation, and supporting foster and adopted children. She also helps parents feed their children with a focus on relationship and felt safety and supporting attunement with internal cues. Along with a multidisciplinary team, she’s developing responsive feeding therapy for feeding and eating challenges. Her books include Helping Your Child with Extreme Picky Eating, Conquer Picky Eating for Teens and Adults, and Love Me, Feed Me.
I became aware of Katja through hearing her on a podcast, and I then bought her book Helping Your Child with Extreme Picky Eating and loved it, so I decided to invite her on the show. This episode is directed much more at parents and the feeding of children. While the book I read was about picky eating, this isn’t the sole focus of our discussion, because even without a picky eater, there can be worries about not eating enough vegetables or enough protein, or there can be worries about kids eating too much food and needing to police this. So this really looks at a wide variety of worries that come up with feeding children and how to approach mealtime.
Even if you don’t have kids, I still think this is a useful listen because you can reflect on your own childhood and how you were raised and the kind of food environment in your home. Or you can listen to it and think about how you currently feed yourself, because what is being recommended here for children equally applies for adults. So we can take these ideas and we can turn them inwards.
During the conversation, we reference Ellyn Satter and the division of responsibility, but we never talk about it in detail. It is something that I cover in much more detail during my conversation with Paige Smathers, which is Episode 150 of the podcast, and I’ll link to that in the show notes.
But just a brief overview of the division of responsibility, if you’ve never heard of this before: with a parent and a child relationship, the parent and child have different responsibilities when it comes to eating. As the parent, the responsibilities are to choose what food is available, so what is going to be offered for the meal or snack. It’s the parent’s decision about when to eat, when to provide these eating opportunities, and it’s the parent’s responsibility to decide where – at the dinner table, in the car, in the park, wherever. Obviously you’re wanting to do this in a supportive way, so providing food options in which the child will at least like some of what is on offer, and providing eating opportunities at intervals of time that are appropriate for the child. But those are the responsibilities of the parent – the what, the where, and the when.
Then the responsibilities of the child are to decide which of the foods on offer they want to eat, and how much of these foods to eat. They can decide to eat none of the foods and therefore have nothing to eat, or they can also decide to have one of the options but have lots of that one thing. So that is a very simple overview of the division of responsibility. We talk about it in more detail in this episode, but we didn’t actually outline the roles specifically, so I just wanted to make it clear here. I highly suggest the book Child of Mine by Ellyn Satter, which Katja recommends. I’ve read it, and I recommend it to parents all the time.
As part of the conversation, we chat about how Katja got into doing this work. We cover responsive feeding therapy and the values associated with this; the frequency of feeding issues and what typical eating looks like; what typical growth looks like; the mechanics of eating; the importance of temperament and understanding how children are different. Then we cover the five steps that are outlined in the book for creating a healthy feeding relationship and addressing if there are any different feeding issues.
During the episode, I share a lot about my own upbringing and my own picky eating, and also how we navigate eating at home with my son, Ramsay. Towards the end of the episode, I make reference to an attachment book that I love but was blanking on the title. The title is called Attachment Play: How to Solve Children’s Behavior Problems with Play, Laughter, and Connection by Aletha J. Solter, PhD. I will link to that in the show notes.
I will be back at the end with a recommendation for you, but for now, let’s get on with the show. Here is my conversation with Katja Rowell.
Hey, Katja. Welcome to Real Health Radio. Thanks for chatting with me today.
Katja Rowell: I’m excited to be here. Thank you.
Chris Sandel: You are the author of Helping Your Child with Extreme Picky Eating, which I’ve read and thoroughly enjoyed. I think a lot of the content of this conversation will be stuff that is covered in the book and just using the book as a jumping-off point.
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But before we get into that, I’d love to chat more about you and your background and how you got into doing the work that you’re doing. I guess as a starting place, do you want to give listeners a bit of background on yourself? Who you are, what you do, what training you’ve done, that kind of thing.
Katja Rowell: Sure. I am a family doctor by training, and I’ve been working in the feeding world now for almost 15 years. I certainly did not go to medical school thinking I would be focusing on this. I think the way a lot of people have big life changes – I had a child and I quickly realised that I knew pretty well what I was supposed to feed her, but I was quite lost with how to feed her. She was nearly 10 pounds at birth after an uncomplicated pregnancy. Just a fourth-generation 9- to-10-pound baby, so we were a little prepared.
But that was right around the time when the panic around childhood weight and the attention on that was ramping up, and I had this baby that was off the charts, and I had also treated – I worked also in college health for a while, so I had seen the devastation of eating disorders and also seen in my general practice adults who really struggled with their relationship with food and their bodies. I was just overcome with this anxiety feeding my own child and feeling like, how do I navigate this and family and people saying “You’re making her” – I don’t even like to use the ‘o’ word, but “Hide her bottle, you’re making her obese” and all of these different messages.
I ended up having a food-preoccupied toddler who followed me around the house signing for food all day long, and I was completely worried and anxious and feeding her from that place of fear and anxiety of “I don’t want her to struggle with weight, body image, eating disorder”, but having no idea what to do.
When she was 14 months, we were at an airport and she was inhaling this little boy’s snack, and I said, “Oh my gosh, I don’t know what to do.” This woman said, “Well, I’m a paediatric dietitian, and you should read Ellyn Satter’s book Child of Mine.” So I read it, and it was very reassuring. I did this division of responsibility at home, and within a few weeks it was a complete transformation in how she related to food. She was free to be a toddler again, and it just freed up so much anxiety and worry and allowed us to connect. It was so transformative, that was it. I had to learn more about this.
I ended up with Ellyn Satter’s clinical faculty for a few years and then branching out to talk to occupational therapists and speech therapists and psychologists and eating disorder people, and reading. Just deepening that learning and working with families then.
So yeah, it’s a personal story. It was this crushing humility of “I don’t know what I’m doing.” Unfortunately, as a family doctor, I’d been giving feeding advice, so that’s a whole other thing we can talk about: how the first line of people out there that are supposed to help parents often don’t know what they’re doing and can do real harm. So yeah, it was a personal entryway into this work, and I’ve just been so grateful for it.
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Chris Sandel: Nice. You talked about your daughter being the one that got you into this. If we go back to you as a child, what was your relationship with food like, and how was feeding in your home?
Katja Rowell: My mother’s German. We moved to the US when I was three, so every meal pretty much was homecooked, and there was a sense of ‘we don’t eat that crap’, McDonald’s and restaurants and takeout. It was frugal and health as well, so I was the kid with the pressed German seed bread that people thought was chocolate. [laughs]
I had lots of family meals that I remember very fondly, but I do definitely remember, particularly in middle school, as my body went from this lean – I ran under a 6-minute mile when I was 11 in cross country, and I was super fit and lean, and then puberty came and my body changed, and then suddenly it was comments like “Do you really need another pork chop?” So there were definitely messages I was getting around my changing body that made me not feel super great about it. I would go to friends’ houses and eat an entire bag of Doritos or have some of those forbidden foods.
But I think relatively unscathed. I think there was enough of a scaffolding early, and with my genetic predisposition or whatever else, I would say overall I was a mildly restrictive eater through my adult years. I don’t know – I’m sure you do content warnings about diets and stuff, but I tried to diet and lose some weight for my wedding, and then I tried a few years later where we did some – I don’t know what it was, South Beach or something like that where I was just obsessed with that bowl of cereal I wasn’t allowed to have.
So pretty restricted, and really the shift to me was seeing my daughter’s capability, seeing this kid who was completely food-preoccupied, who loved ice cream, at some point hand me an ice cream and say, “I’m done” and just thinking, wow, if she can do it, maybe I need to learn some more about this. So it was really through watching her capability emerge that I then tested it for myself, and I allowed myself permission. I bought the Cheetos – anything covered in that orange cheesy powder was something I always felt out of control with.
So I bought Doritos and I bought Coke, and for a long time I’d have a Coke every day at lunch or I’d eat the bag and then fairly quickly, with that permission mindset and a lot of learning and listening around some of my own thoughts about weight and health, those foods lost their power over me. I have a teenager now, and we have all of these foods at home, and sometimes a Coke really hits the spot and I’ll have it. But the bag of Doritos might be finished or it might sit in the pantry for three weeks and we have to throw it out.
So really, again, I think about this fairly often: had I not had a child in a bigger body, I think I would still be restricting today myself, and probably – I know, given her personality, we would have had so many more struggles. So this gratitude for having found this work for her and myself. It’s an interesting journey.
As now I head towards 50 next year, my body’s changing again. It’s bigger, even though I am far more fit and active than I was 20 years ago, and I’m healthier than I was then. Or I feel overall better. So that’s also an adjustment. My husband joked to me, “Well, now you get to practice what you preach” as my body changes. [laughs] I’m like, that’s fair. That’s probably more than you wanted to know, but I try to approach a lot of this with curiosity, and as those messages come in – I live in this culture where we’re still inundated with this, and as my body changes, helping to shepherd an almost 17-year-old through our culture, it’s humbling. But I’ve been really grateful to have found this work.
Chris Sandel: I think what you described there is actually often what happens when clients are coming to me. I work now mostly with eating disorders, but there is this awareness for a lot of the parents where “I have this relationship with food, and I do not want to pass it on to my child. I want to work out a way of how I can heal myself, but also be the role model that I want my child to have.”
I do think children are great in that way of making you want to be better. I’ve got a five-year-old son, and I don’t have issues around food – that’s never been something that I’ve personally struggled with – but there are a lot of things that he is helping me to figure out about myself and making me a better person. So yeah, there’s definitely similarities there.
Katja Rowell: Oh, for sure. As everyone says, your children are your best teachers. It’s quite a journey, and sometimes we’re willing to explore things or challenge things or work on boundaries for our children where we were not maybe willing to extend that same kindness to ourselves. That’s a whole other topic, but I think children can really motivate – and raise the anxiety. And we’re parenting also in this public era of judgment. So it’s super complicated, all of it, but yeah, definitely wanting to do better for our children is a piece of the puzzle.
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Chris Sandel: Your being an MD and then finding out about this kind of work – and as you say, you don’t want to use the ‘o’ word; I imagine you’ve found out about Health at Every Size and all of this. A lot of that is going against what you’ve been trained and what a lot of other people who are practicing as MDs talk about. How is that for you? What are the struggles? What do you come up against because of this?
Katja Rowell: Again, it really pains me to say, had I not had a child in a bigger body, I’m not sure I would’ve been open to listening to this. I also have a husband who’s bigger, and I suppose I’m bigger now as well. But yeah, it’s so difficult. My family of origin – very thin, very much equating fatness with ‘if everyone ate the way we did, everyone would be thin’ kind of thing. So there’s a lot of judgment and moralizing around it that I grew up with. And then the medical training 100% reinforces that.
One thing I would say to those listening and that I share with folks is that it took me a couple of years of really listening to people, reading people online, having conversations with fat people and fat activists, and digging into the research. I remember the first time I heard ‘you can be fat and fit’ and sitting there with my colleagues having a good laugh at that – which is embarrassing. But we’re almost trained in the medical profession to believe that weight and badness are linearly related, like every pound is 10 minutes off your life kind of relationship. And it just is not.
But it took me a couple of years of reading the research that we weren’t exposed to and listening to people’s stories and following my discomfort and my dissonance. When I had a really strong reaction to something or “Well, that’s not right. That study says this”, that’s where I challenged myself to learn more.
When I thought back to my time practicing as a physician – it’s such an opportunity, because when I practiced a weight-centred model, it was awful. It felt awful. It felt awful to patients, it felt awful to the children. It didn’t work. I was nagging and sort of cheerleading. It was deeply unsatisfying. I didn’t believe my patients when they would tell me things; I thought they were just not being compliant. I was the typical weight-biased doctor and it profoundly contributed to my job dissatisfaction.
This Health at Every Size model and promoting more tuned-in eating and looking at behaviours and wellness rather than weight – it actually, I believe, is more effective in terms of improved health outcomes, and people feel better. You’re on the same side as your patient, and it’s not this paternalistic ‘do as I say and now you’re not and it’s your fault’. This model feels so much better.
But the challenge is that our culture is still barrelling in the other direction, so the challenge is that it takes time to challenge those beliefs and do that reading and learning. There has to be space for that while also recognising, if you’re parenting children, that it’s a really confusing and really scary process in this culture that we live in.
Chris Sandel: Totally. I think it does feel like the tide is turning a little bit, but I also can see at the dieting end of the spectrum, things are also getting more extreme there as well. I do think it’s going to take some time.
Also, I only have one child, but I know for some people, having more than one child can also be helpful in this in just seeing how different their eating styles are and how different their body shape is. Even though they come from the same parents, they are very different human beings. I think sometimes that can be at least a little bit of a light bulb moment for someone if they have that experience.
Katja Rowell: Absolutely. I just shared, with permission, a picture on Instagram of twins where one, at age nine, is a good 6 or 8 inches taller. Obviously they’re not identical twins, but to your example, they’re twins. One is 5th percentile and the other is 90th percentile, roughly. So that’s really powerful that we can feed children the same foods, the same household, the same birth order, and their bodies are just going to look different.
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I feel like this has been this real disservice of this focus on higher weight and the growth chart. It’s like a report card now for parents. There are so many misperceptions around children’s growth, and often – if you look at the chart, it looks like it’s a smooth line and children really should stay on the line. But when you look at data from age zero to five, the majority of children are actually moving around potentially quite a bit on the chart. Two-thirds, I believe, under six months will move more than two of those big lines on the chart and be perfectly healthy. Most of them will be perfectly healthy.
Obviously if there are changes in growth, it’s important to look at, but if you do a full history and physical and the child is otherwise well and it’s slow movement – not something abrupt that’s happening – and you do a history and physical and things are good, it’s likely just to be that child’s growth pattern. But instead, what I see so often is if there’s a little bit of a rise or a little bit of a dip – I’m not talking weight loss, I’m just saying maybe for a little while there’s no weight gain then it’s like, “Ooh, you’ve fallen off your growth curve”, whereas if they waited six months, they would’ve shot up an inch and gained five pounds.
I see so often here’s the kid’s BMI or here’s the kid’s percentile and it’s 20th percentile. Everyone thinks that’s underweight, every child should be 50th percentile. So really profound misperceptions on the part of parents and even practitioners around weight and growth that I think set off a lot of intervention and worry and suffering that is completely unnecessary. And that’s one of my big missions with this work: Where can I reassure parents? Where can we get off that cycle and just decrease the needless suffering?
Chris Sandel: Yeah, and this is something you said a number of times through the book. It’s not just about growth. What do they like from a development standpoint? What do they like from a happiness standpoint? How is their other health? All of these other things that need to be taken into consideration when starting to look at, is this something that needs further attention or is this something that’s actually just ‘this is where this kid is at’?
Katja Rowell: Absolutely. I feel like we’ve lost looking at the child for the chart. Right now, 85th percentile, for example, is the cutoff for ‘overweight’. Any time I say those words, it’s in quotes. I have to say them because that’s what the parents will hear. And there are also ethnic differences. I’ve had parents say, “My child bumped up to 86th percentile” and for two years the doctor is saying, “He’s overweight and you have to get him to eat less and move more” and the parents are saying, “This kid’s in two sports. He’s active, sleeping well, eating well.”
It’s a completely arbitrary number. Half a pound or a pound or an eighth of an inch that kicks someone into one of these arbitrary cutoffs. There’s just no real-life urgency around these changes that suddenly a kid who was 84th percentile who’s now 86th percentile – that does not come along with an actual risk that the label implies.
Again, if all we’re doing – and I see this, unfortunately, very often – is for whatever reason a kid bumps up into or down into one of these labels now, and now we’ve turned children’s bodies into problems to solve, and parents, making them responsible. It just doesn’t work this way. And again, all of my caveats of there are times when weight is going up or down where we need to look into it. But I see so many of the kids I work with where I believe they’re mislabelled. It’s a misperception around growth, and that kicks them into these problems that can go on for years.
Chris Sandel: There’s so many clients that I work with where their history starts out because they were taken to Weightwatchers or because of some kind of intervention in a situation where actually there really wasn’t anything that needed to be done. They were a perfectly happy, healthy child, and the messaging and the advice that was given then kickstarts something that is a real lifelong struggle.
Katja Rowell: Absolutely. That deeply upsets me, and I see this, and this is why I try to talk to parents too about some of this anticipatory guidance around something like puberty. Pre-puberty growth is a very much at-risk time. I imagine many of your clients, this might’ve happened when they were 10 or 11. The growth pattern in preparation for puberty is to usually put on a bit of weight before the height growth spurt. And some kids will put on weight and stay in bigger bodies, and there’s nothing wrong with that. But we’re looking at typical growth patterns and labelling them as pathological. So many kiddos, at 10 and 11, that’s what their bodies are supposed to do in preparation for puberty and their growth spurt – to get a little bit soft and rounder tummies, and particularly for girls, adding fat.
This is such a panic point for so many parents, and fuelling the flames is often the doctor’s office and those darn labels. So that’s a dangerous time that I tend to ask parents to be aware. We also know that Black girls in general will go into puberty about a year earlier than white and Hispanic girls, so that’s something to be aware of. You might see that around age 8 or 9.
A lot of this is just information and reassurance to not get into unnecessary and harmful interventions.
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Chris Sandel: Let’s chat about your book, which is Helping Your Child with Extreme Picky Eating. The title, and throughout the book, you use ‘extreme picky eating’. Do you want to describe or define what this means?
Katja Rowell: Sure. There’s a lot of talk in the child feeding world also about the word ‘picky’. Some people say we shouldn’t use it, it has negative connotations. And that’s fair. One can say picky, moving with professionals and some parents now to talk about ‘avoidant’ or ‘anxious eating’. I personally don’t see any judgment in ‘picky’, but some folks say ‘fussy’ or ‘selective’.
Anyway, we called it that because – I wrote it with my co-author, Jenny McLaughlin. She runs a feeding therapy practice. She’s a speech pathologist at UT Dallas. So we called it that because this is what parents said. Remember when I said I started this work and I then had to learn more – I would go and do workshops on starting solids and picky eating, and parents, every time, one or two said, “This all sounds fine for my other kids or my friends’ kids, but I have an extreme picky eater. Our situation is more extreme.”
It’s an umbrella term for really any time a child is eating so little in their amount or variety that it impacts their physical or social or emotional development, or if it’s worrying the parents. That’s the piece where we’re a bit different than some of the feeding disorder labels or how they talk about that. Parent anxiety, even if it’s a typical picky eater, puts that family at risk for getting into more of those counterproductive struggles.
It’s really if your child can’t go to a sleepover because they’re worried they won’t have food there that they can enjoy, or if they have a lot of anxiety if there’s a food on the table that’s a non-preferred food. Often this goes along with sensory processing differences. It’s much more common in autistic children or neurodivergent children. And I often see it also in children who are smaller than average. It’s often a combination of different things.
Important to note, if there was anything that made eating at any point in an infant/toddler’s life painful or difficult, uncomfortable, that makes this problem more likely. So if an infant had reflux or spen time in the NICU with a breathing tube or things in their mouth, that can make the mouth very hypersensitive to stimuli.
So it’s actually a lot of different things coming in, and certainly if there are medical or anatomical reasons, that can play a role too.
Chris Sandel: And you said it’s more likely if a child is on the smaller side. Does this also mean it’s more likely if a child is premature or not necessarily?
Katja Rowell: Yes, we do see it more commonly also with premature infants. That’s hard to tease out. Is it also because we might tend to see more sensory processing differences? Also, especially if they’re quite early, there are difficulties in coordinating breathing, sucking, and swallowing. And there’s also a lot of attention to their weight and growth and how much they’re eating.
When I did my rotations in the paediatric hospital, these kids were referred to as ‘feeders and growers’, so right from the start there’s this intense focus on how much they’re eating. And I’ve had parents I’ve worked with where they’ve been discharged from the hospital and told, “Do whatever you have to to get X number of ounces into this child.” So there’s a lot of anxiety on the part of parents, and often a lot of effort, and parents who are really under-supported in terms of a responsive approach to feeding.
I’ve had parents really desperate, getting into some desperate situations around child only feeds while asleep, or one dad was clamping the baby’s head down and trying to force the bottle in out of terror that she was not eating and would end up with a feeding tube. Meanwhile, then, the baby’s sputtering and coughing, and that’s a scary experience because she’s protecting her airway. So we can see sometimes where there’s this fear and then unsupported parents might fall into coercive feeding or trying to get kids to eat when the children don’t want to, and then we can see a protective response come out of that.
It’s complicated, and to me the bottom line is parents need far more support than they’re getting, whatever the problem is.
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Chris Sandel: I guess the overarching message or your focus with the book is the real importance of a healthy feeding relationship. There’s obviously lots more nuance and there’s stuff we’ll go into, but for me that was the overarching takeaway from the book of just how important the relationship piece is.
Katja Rowell: Absolutely. On my feeding journey, also, it was important to understand that research is pretty darn clear that the harder parents work to try to get kids to eat more, or less, as was my case, the worse children eat. I think parents are often left, if they have a child who seems to not want to eat or anxious or avoidant, they feel like “I have to get to them to eat.” So we can get into the bribing, the begging, the sticker charts, the rewards, the removing video games, all of these things. Parents feel like “My only choice is I either make him eat or he doesn’t eat.” That’s just not the case.
So I think that understanding that trying to get kids to eat or not eat and overriding their cues and their autonomy will make them eat worse and grow less well. That’s the first piece of the puzzle. And in a way, that’s very reassuring to parents. “Okay, I don’t have to have these battles. I don’t have to work so hard. I don’t have to have my toddler in a headlock to get that one bite of carrot in.” So I think it’s a reassuring message, but then it feels very scary because it’s like, “Okay, so what do I do instead if I can’t push them or restrict them?” That’s often where the advice falls apart for parents.
Chris Sandel: Yeah, there’s not the practical next steps.
Katja Rowell: Right.
Chris Sandel: What you’re describing, is that responsive feeding therapy? I know there is that overarching term, and I know you also have a platform that you’re part of called Responsive Feeding Therapy Pro. Is that what this method is?
Katja Rowell: Yes, it is. It’s based on responsive feeding. Again, it’s that feeding relationship. What’s wonderful about it is that feeding kids this way brings you closer together. We all want to be close with our children; we don’t want to be fighting or dreading mealtimes. It really is about supporting that relationship first and that child’s felt safety. If we can get a bite of mushy peas down but it’s a 45-minute meltdown, we’ve really lost any of the nutritional benefit of that.
The wonderful thing is that by having children coming to eating times as much in a calm body and calm mind that is open to relationships, they will tend to eat better. Having that calm body supports health. They have their heart and blood vessels, blood pressure is better. They’re not flooded with stress hormones. Their insulin and cortisol, which help store energy, is working better. Their immune system works better. They can actually tune in better to appetite and hunger cues instead of the battle. So then they can tune in to their body and curiosity around maybe trying a new food.
So yes, it’s all part of that responsive feeding therapy. There are five values. I can talk about those later, but it’s really a whole approach that is relationship-building, and it really does feel better to practice as a parent.
Chris Sandel: Definitely I want to touch on the values, because I think that would be useful to have a conversation around.
00:37:49
How common are feeding issues? What are the stats on this?
Katja Rowell: ‘About a third of parents will ask their healthcare provider for help with feeding. And again, this is the real travesty to me, that they’re not trained to do so for the most part and can actually make things worse. I’ve had parents go to a doctor and say, “My child hasn’t eaten anything except for bean burritos and chicken nuggets for five years” and the doctor says, “Yeah, but his growth is fine. Don’t worry about it.” Or conversely, going to the doctor and them saying, “No child will starve themselves.” That’s admittedly rare, but just false.
So about a third of parents will ask for help, and then we see from research that about half of children in the early childhood years are described as ‘picky’ or ‘fussy’ by parents. And that’s not just the US. I think there’s often this “That’s spoiled Americans with their pathetic diet. It’s just the US.” No, actually, we see Dutch studies show similar numbers. About half of children.
And then out of that, I read it as about 10% of children will struggle to the point where it impacts, like I said, that extreme picky or persistent picky eating model. So they’re very, very common.
00:39:19
Chris Sandel: One thing that could be useful to go through – and I know you do this in your book – is what typical eating for a child looks like. I think most people don’t really know what this should look like, to gauge, is there really an issue here?
Katja Rowell: Absolutely. Again, here’s this theme of misperceptions. Misperceptions around growth are a major reason why families get stuck with these counterproductive practices, these worries, ‘my child’s too big or too small’. And then misperceptions around how kids eat or how much they eat, which is ‘my kid’s eating too much or not enough or not enough of the right foods’. So I’m glad you’re bringing this up, because here’s another scenario where I can often reassure parents.
The first year, children are putting on a lot of weight and growing. They gain I think on average – was it 7 kilograms? And in the second year it’s about half that. So their growth really slows down the second year of life. I call that second year the perfect storm. We have this impression as adults, often, that the older they get, they should be eating a little bit more all of the time, and in fact, once children are weaned primarily off breast or bottle as their nutrition source and more is on solids and table foods and family foods that second and third year, it looks really erratic. It’s really unpredictable. It’s a lot one meal, it’s one blueberry at the next meal.
In the US we have the MyPlate guide where parents think they should really be eating – half of this meal should be fruits and vegetables and a quarter should be a lean protein and a quarter should be a high-fibre starch. Children don’t eat that way. We set parents up for failure and for battles.
You can’t see me, but if you take your pointer finger and you make a line up and down, up and down, up and down, that’s typical eating for young children. They’ll have a lot one meal – they tend to eat also from one or two food groups. So a parent might put out three or four things, but one meal will be eating two clementines and the next meal will be half a chicken nugget, and then the snack is whatever, it’s plain buttered pasta, and then the next is an entire apple or one bite of a cracker. And then they’re running off to play, and parents feel this anxiety of “That can’t be enough to run around and play to just have one blueberry, so I need to try to get them to eat at least one bite of protein or chicken.”
So we try to make kids eat more, especially if they’re lower weight. Or if they’re bigger, those bigger meals scare us, so we try to get them to eat less. We try to get them to eat like that MyPlate. Or here’s the pointer finger, now draw a straight line across the horizon; that’s how we want them to eat or how our health agencies often talk about it.
I think the more we try to get kids to eat to our expectations, the more it backfires. And research and experience tells us that. So absolutely expect children to pick and choose – to me, that’s where ‘picky’ comes from. They pick and choose one food group, small amount here, larger amounts there. But at the end of a day or two or three days, typical eaters tend to eat from all the food groups.
I have a book called Love Me, Feed Me, and I filled it with these examples from parents, because that’s who other parents want to hear from, of “Hey, my child only ate Greek yogurt for breakfast and then half a cup of hummus and then a piece of pizza and this fruit here. And at the end of a couple days, it evened out.” So that’s another area where I think we can reassure parents, particularly around – I’m going to keep talking, because I thought about protein, if that’s all right, Chris. [laughs]
Chris Sandel: That’s cool.
Katja Rowell: Protein and vegetables are the two big worries, and I just want to reassure parents that children often get two to three times the recommended amount of protein. So if you’re worried about protein, or anything for that matter – if you’re worried about something and that’s causing you to, at that meal, say “You have to have a bite of chicken” or “You have to have some nut butter” and you’re getting into battles over it, find out if you actually need to worry.
Oftentimes, particularly with things like protein, when I tell a parent, “Hey, they’re getting actually three times as much protein. What do you think about not worrying about pushing the protein smoothie at breakfast?” – once parents have those anxieties addressed, listened to, reassured, and they can let go of that worry, that’s a huge piece of that responsive model.
Chris Sandel: Yeah, definitely. It’s interesting; when I was reading your book, I was reflecting upon both myself as a child and also my son, who’s five, and I feel very grateful that I’d found Ellyn Satter’s work before having a child. Me and my wife are both on the same page, so we were very up for the division of responsibility. It’s really interesting; the first year and a half of his life, he ate everything. We did baby-led weaning and he was gung-ho for eating pretty much everything that we’d put in front of him, and then after about 18 months, maybe two years, he’s become much more of what could be labelled as a picky eater.
But we just watch him and know that, as you say, one meal it is just rice, or the next meal it is just the chicken, or the next meal it is just fruit, but if you tally it up across a week, he is definitely getting what he needs and he has a very happy relationship with food.
00:45:48
What’s interesting – and we can get on to this more as we go through it – is when he’s anxious or when there is more stress or when there are more things going on, which actually don’t relate to food because we’re not having those battles around food, that then affects his eating. It’s not that we’re putting pressure on or anything, but just the ambient or background effects on his nervous system then have an impact on his eating. It’s been really interesting just to notice how that is, and it feels like more recently, over the last couple months, he’s coming out of his shell a lot more. He’s coming out of being more picky. He’s trying more things without us having to pressure or do anything along those lines, just as he has started to develop more and go through a better phase.
Katja Rowell: Absolutely. I love that story. We had the same thing. I think that there’s also such a relief, right? I don’t want to put you on the spot, but you probably socialise – maybe less so with Covid, but socialising with friends with young children who don’t do it this way, and there’s so much emotional energy and attention and conflict and stress, particularly around food. It’s amazing.
And I was there. I was doing it, so I come to parents with such an empathic – empathetic, I guess, rather than empathic – empathetic, with empathy, and just that it feels really counterintuitive in our culture where we feel like we have to control and educate and narrate and talk about nutrition and mould their palates and control it. Letting go of that control and that worry was such a relief. And when I have parents who say, “This feels so good, I don’t have to be the food cop anymore” – particularly that food side of food-preoccupied kids that I work with – when parents can tap into and lean into that relief and the relationship with the child, it’s just so liberating somehow, this model.
And then when we accept children for what they’re eating now, it’s a bit of that motivational interviewing or this idea of radical acceptance, all of this. When we accept how kids eat now, it opens the space for their own curiosity and hunger. And that’s why we eat, really, as humans. We eat because something looks good or smells good or tastes good, primarily or first.
When it’s not adults trying to manage and curate how they want their kids to turn out with food, which usually backfires, with a lot of love and effort, it can make space for those discoveries for kids. I remember the same thing. My daughter, we put dozens and dozens and dozens of salads in front of her for years, and she would eat the cucumbers off the top or a few things, but didn’t touch lettuce.
And this is another message I want to share with parents. Waiting for this process can feel very frustrating, and there are a lot of parents who want to jump in and make it happen faster. But she then at age probably six, without any comment from me or her, put some lettuce on her plate, ate it, and said, “Oh, I love lettuce!” Six years of me not saying anything is pretty difficult in our culture, where we want to say, “Look at the lettuce! It’s green like the leaf on the tree! Look, I’m going to paint ketchup with this piece of lettuce and we’re going to do art and we’re going to touch it.” Even if we’re not pressuring or coercing, the attention, the talking about it, the nutrition, the art, the playing with it – for many kids, that slows down their internal process and can result in resistance.
It’s something to train towards, that art of not saying anything when you’re like, “I know you’re going to like this if you would just try it.” It’s really a fascinating process.
Chris Sandel: As you’ve said in the book as well, kids are smart. They can understand when you’re pressuring them, even if you’re doing it very subtly or you’re trying to do it in a playful way. So yeah, I like the ‘let’s plate everything up and put everything on the table and then you get to decide what you want to do with this’. Not putting the pressure on.
I think for me, as well, I can reflect on myself as a kid, and I just wasn’t that interested in food. I didn’t feel like I was picky; food just didn’t appeal to me that much. There were other things I wanted to be doing with my time. I remember having quite an aversion to certain tastes and textures. I didn’t like anything fatty because of how it would taste. And I outgrew all of those things and really love food and can eat basically anything.
But I also think that’s in part down to my parents, my mum in particular. I can’t ever remember her trying to pressure me to have certain foods or ‘just have this thing’. I outgrew it at the point that I outgrew it, which was probably not until I was in my very late teens or even early twenties.
Katja Rowell: It’s so fascinating. I think it also speaks to – I’m imagining that your basic nutritional needs were met. This is that piece of “How’s the child doing otherwise?” If you’d been suffering malnutrition, she may have intervened.
Chris Sandel: I wasn’t suffering malnutrition, but I was small. There are pictures of me in my school photo where it looks like I’m standing in the wrong year because I was small. But I had been small from the day I was born, and that was just how I was. I don’t know about growth charts and if they were looking at that, but I imagine I kept to the same percentile the whole way through.
Katja Rowell: I feel like we’re in this weird situation, particularly in the US, where I see so many children getting therapy that I don’t think needed it. And there are many children and infants who need help who aren’t accessing it. You sound like so many of my clients that I see who’ve come to me after they failed desensitization therapy for a year and a half, and now they’re crying at the table because they’ve had to be expected to kiss or lick or poke a food.
So I see so many children like you with some sensory differences or preferences – kids who don’t like the feel of meat, or they don’t want to have mixed textures, or they have these preferences. This is also a bit of this neurodiversity-affirming piece. If we have a child who’s smaller than average but doing well, they’re not distressed, they’re meeting their nutritional needs, and they just say they don’t like the feel of meat or they don’t like mixed textures – can we just let that be and accept that humans come in a range of shapes and sizes, and some will be smaller than average and some bigger than average, and people have their preferences.
So much, I see a rush to therapy around kids just like you. And then I see them when they’re five and six and they’ve failed sensory therapies and now they’re eating less and now they’re crying at the table because they had to do these therapy snacks that they didn’t enjoy.
One thing I guess I’m sharing from this is if we can look at smaller than average but healthy, maybe has some different preferences but they’re covering their nutritional needs and they’re doing well, do we need to rush in with pressuring, bribing, rewarding, or therapies that sometimes pressure, bribe, and reward – versus letting it unfold.
Anyway, it’s fascinating, your story that having the space, you were able to find that for yourself and grow into your own relationship with food. That’s really interesting.
Chris Sandel: Yeah, and I know, again, from chatting with friends of the family and relatives, they were always concerned about me or concerned that I was never eating. But I never felt that in my family home. I never felt pressure. Just how much of a godsend that was, because I didn’t know what I didn’t know. I didn’t know how much I really dodged a bullet there, because it could’ve very easily gone on a different way.
Katja Rowell: It’s very interesting. I could’ve seen you now being labelled low appetite sensory subtype of avoidant restrictive food intake disorder, where the diagnosis is saying ‘not growing to expected’ or ‘growth faltering’. I see sometimes kids labelled when they’re really meeting their nutritional needs and they’re doing okay.
And again, because I’m a doctor in the US, I have to do all my disclaimers. [laughs] There certainly are children who are struggling, or teens and adults, who need help with this, but I do question that we are potentially over-labelling and over-therapizing situations that may just be variants of typical or what we might see eating with sensory differences.
00:56:16
Chris Sandel: I think it would be useful to talk about the mechanics of learning to eat, because this was something I hadn’t really thought about until reading the book. I’m in a state now where I eat where I don’t have to think about eating and I don’t have to think about what my tongue or my teeth are doing. So just talk about how that develops and how things can go awry.
Katja Rowell: Sure. I just want to be clear, it’s not my area of expertise. I can speak to it in a broad sense, but that’s why I wrote it with an SLP and why our Responsive Feeding Professionals group has speech therapists, occupational therapists, psychologists. We all have these areas of expertise.
Learning to eat involves so many things, and it’s pretty complicated. For the vast majority, it goes off pretty smoothly. There are 27 muscles involved and coordinated in swallowing. You have to be able to hold your body up, so you’ve got the gross motor, the fine motor of trying to pick up foods and get them in your mouth, and then hopefully everything’s working well with your mouth. I know that we are seeing tongue ties and issues like that, where the tongue is tied either in the front or you might have a tongue tie in the back. So functionally, how are things working?
If you have a newborn who is really struggling with breastfeeding or bottle feeding and isn’t gaining weight, then they need to have an evaluation with somebody who’s really trained in looking at the function and how the tongue and swallow is going. And it may not be just the person assigned to you at the hospital; you might have to find more support. So we do see tongue ties and tethered tissue.
I’m also wondering if we’re now over-diagnosing that as well. It’s always really complicated, finding professionals who will look at the big picture and function, and the relationship is really important. So just to say that there’s a lot that goes into it.
And then the sensory, the oral motor piece, is can they feel what’s happening inside their mouths? Can they feel when they’re swallowing a food? A child who’s learning to eat solids who is constantly gagging or choking, that could be a sign of a sensorimotor problem. Or it could be that, for example, baby-led weaning, which you mentioned, is really popular. I do think that that’s a difficult thing to prepare those foods in safe ways, potentially. So if someone’s doing baby-led weaning, I always recommend the specific cookbooks and really following what they say.
For example, my daughter, I would give her a teething biscuit, and anything she would chomp off – she was a huge chomper and then would have the giant chunk and would promptly gag impressively. She was there before bay-led weaning really took off, and we just did a combination of mashing foods and spoon-feeding and her feeding herself. Anyway, that’s a bit of a digression.
And then in terms of learning to eat, there’s also misperceptions there. If I have a parent of an 18-month-old say, “I’m really worried about protein and he’s not eating meat,” which I hear a fair amount, the molars to really grind and do that rotary chew pattern don’t usually come in till about age two to three. Again, it’s about age three before they have the adult chewing pattern where they’re really able to grind and manipulate food and swallow it the way an adult would.
So it’s a process, and there are some red flags, like I mentioned, of really frequent gagging or choking. If they’ve had aspiration, pneumonia. Usually you’ll know if something like that’s happening. I’ve had calls from parents of a two-and-a-half-year-old saying, “They’re only having purees from the pouches or yogurt or very meltable, mashable foods.” Then I’ll dig a bit deeper, and “No, they never mouthed objects as infants. Oh, that’s right, I didn’t have to babyproof with this one. Oh yeah, and my older child was managing many more complicated foods by this age.” So that’s someone I would refer to a qualified speech pathologist or a paediatric dentist to make sure that we’re not missing something functional in that situation.
01:01:11
Chris Sandel: Then there’s also the feeding temperament piece, which I thought, again, very much reflected upon myself and my wife and my son when reading it. I think this is useful to know, and I think if the child’s temperament matches up to the parents’, then maybe it’s going to be okay. But if there’s a difference there, that could then be seen as a problem.
Katja Rowell: Yeah, for sure. I have lots of parents who are foodies and love food and had in mind, like we all as parents do, sort of fantasize about having sushi with their six-year-old. And then you have social media, where you have a parent saying, “Oh, look, here’s Amelia having her green smoothie” and it’s from a mason jar and the comment is “Mama did something right.” [laughs] I actually unfollowed an acquaintance over that, because then the not-so-subtle message is if your kid’s not eating green smoothies, Mama did something wrong. And that’s just not the case.
We come with different temperaments and different approaches to life in general, and that includes food. There was a fun study about five years ago where they put toddlers in front of a new food, and later in front of new toys. They found that there were kids who just jumped in with both and immediately explored them, and other kids – and one is not better or worse than the other; just the other child held back and didn’t jump into those new experiences.
So that temperament is really important. Also, if you have a child who really wants to do things their way, their time, very independent – some parents call it stubborn – if you ask that child, “I just want you to take a ‘no thank you’ bite and then you can have more mashed potatoes”, the easygoing child who jumps in will say, “Okay, I’ll take that bite of kohlrabi. I’ll try it.” They might even say, “Yeah, that’s not bad.” But then the child who’s very independent and would rather fight for half an hour struggling to put a shoe on than have a parent help them, when you ask them to do a ‘no thank you’ bite or a tiny taste, it’s a 45-minute meltdown or tantrum.
That is often a piece that’s really, again, reassuring to parents. This is how they are, and it’s okay to be cautious and, Ellyn Satter says, ‘slow to warm up’. It’s okay to take your time with learning to like a new food. It might be six years before they try the lettuce, and that’s all right if they’re meeting their basic nutritional needs. Temperament may explain – if a parent says, “We use the ‘no thank you’ bite and it works great”, and then the other parent says, “Well, it works for two of our kids, but for the third it’s not” – so that temperament piece is part of that as well.
Chris Sandel: Yeah. Again, when I reflect on my son, his eating matches up with his temperament. Reading your book, I was like, okay, this makes sense really clearly.
Katja Rowell: And same with my daughter. She went off milk for about a year. For some months, I said, “Okay, that’s fine.” She wouldn’t drink it. So I was cooking with evaporated milk or trying to find different foods with calcium just to support it in other ways. Then finally at one point I reached out to a colleague, and she suggested, “Try just putting glasses of milk out for everyone at lunch and saying, ‘We’re all having milk today.’” I tried it, and she immediately, “What do you mean we’re having milk today? I want water. Why do I have to drink milk?” and it was this immediate battle. So I thought, okay, we tried that and that was a useful piece of information.
I completely backed off again. “Of course, go get yourself some water.” And then maybe six months later, she started drinking milk again and has been off and on milk for years.
Again, a big part of this process of feeding kids is, what can we control? What do we think we can control that might be making things worse? And if we realise we can’t really control their weight or what or how much they eat, we can put that energy into – and it’s a lot of effort – “I’m going to get food in front of my child five times a day and I’m going to try to have pleasant mealtimes where we can eat together”, if that works for your family. It’s shifting the energy and the focus from things we can’t control to things that we can.
And I really think that when we set up the environment to be one where a child feels comfortable and safe and welcome and the discussion at the table might be about their art project or what the cat did before mealtime rather than “You haven’t tried a bite of kohlrabi yet and I really need you to take one bite” and where the focus is on what or how much the child is or isn’t eating, it just opens this world of possibility in terms of supporting the child’s relationship with food, and really with their body as well.
01:06:46
Chris Sandel: Let’s go through that in more detail. I know in the book you talk about STEPS+ as the acronym for the steps as part of doing this. Let’s start with Step 1, which is ‘Decrease stress, anxiety, and power struggles’. Do you want to talk about this and then I can ask any specific questions?
Katja Rowell: Yeah, absolutely. If you dread mealtimes, then you have opportunities to decrease that stress and anxiety. When kids and adults are anxious, it’s like the saying ‘if you have butterflies in your stomach, then there’s no room for the food’. You mentioned with your son, when he’s agitated, even if it’s not about the food, you notice that that impacts his appetite.
We want to set up a mealtime where the child can come and feel that felt safety, where their body and their mind are as calm as possible. And this will look different for different families, by the way. If you have a child who has sensory differences or needs to stand or needs a weighted blanket or even a fidget at the table, each child will have a slightly different thing to make that mealtime a safe and pleasant experience for them.
The main thing, I think, that decreases anxiety is supporting the child’s autonomy. They get to decide, once they come to the table, how much and what are they going to eat from what you provided. You’re not battling over extra bites. You’re not trying to get them to eat more or less. It’s really the child’s autonomy and their choice. So they have a sense of control over what goes into their body. That’s probably the first thing.
This is just a little random thing, but sometimes parents say, “What do I talk about if all we’ve been talking about is nagging him to eat more?” Just anything. What happened at soccer? Who did you sit next to? Letting the child lead. There are little games where you can have conversation starters. I try to shy away from the idea of “What’s your best and worst thing?” because sometimes kids can get stuck in the worst thing, and then that appetite decreases.
That’s that responsive piece. One child may like to unburden themselves and they feel better and they eat more, whereas another child gets really stuck in the fight they had with their friend at recess. So this is that piece of trusting parents to set up that environment.
Chris Sandel: I liked the piece where it’s like, what are you anxious about and what is your child anxious about? Asking it from both sides. Because I think both of those matter. If a parent is anxious about the fact that “I want the child to eat more of this thing” or “I worry that they’re not getting enough protein or enough vegetables”, that’s going to have an impact. But equally, if the child is worried that they’re going to be forced to eat something they don’t want to eat, they’re going to be having this uncomfortable mealtime, and that’s going to have an impact as well. So I like the fact that it was looking at this from both sides.
01:10:07
Katja Rowell: Absolutely. It’s a relationship. There are two or three or four people in the relationship, depending on the mealtime. This is that bit about – you mentioned it briefly – family-style or buffet-style serving. That’s a big piece, probably one of the number one pieces of advice, along with serving dessert or something sweet with the meal. We can talk about that next. But number one practical advice for decreasing the power struggles and supporting autonomy is to let children serve themselves at mealtimes. And yes, they will only serve themselves their preferred food for a while. They’ll put mashed potatoes, and then maybe they’ll have seconds of mashed potatoes before they’ve touched that kohlrabi.
That’s where having the faith in this process helps to not say, “You have to eat a piece of kohlrabi before you can have more mashed potatoes” because it doesn’t work. I think that’s the piece, too. When you find yourself as a parent saying, “I can’t let them have seconds on mashed potatoes before they have kohlrabi”, pausing and thinking, “Why am I going to do or say what I’m about to do or say? Well, it’s because I want them to eat the kohlrabi.” And then, “How has it worked for me so far, this method? Okay, it’s not working. So I have to have faith in waiting.”
And really, what we see from research and from the clients I’ve worked with is with a bit of time, children will branch out, pretty universally. Even kids with sensory issues or who are neurodivergent will often branch out when the pressure is off.
So serving family-style. Let’s say, though, it’s soup and they need help, or it’s lentils and your child is 18 months old. The goal is to preserve autonomy, so I might hold up whatever it is and say, “Is this okay?” and they say more or less. “This much?” “Yes.” “Point to your plate where you want it.” Then they can point where it is so they’re not immediately saying, “That’s too much, that’s touching that, you know I don’t want that.” You might even get those plates that have the little compartments, so if you have a child that’s upset when foods touch each other, use a plate with compartments for a time, or always.
So it’s figuring out – this is where following your child’s anxiety, the conflict points to opportunities to make changes. Definitely self-serving really helps.
Let’s say it’s a food-preoccupied child that you’re doing this model with, and let’s say there are six corn muffins and immediately the kids are realising that there’s not enough for everyone to have two, so they’re pouncing on them. You might serve that for a child. So there’s ways to modify this where, “Okay, there’s only this many corn muffins, so I’m giving everyone one on the side of their plate.” All of this is flexible based on preserving that calm mealtime for that child and for that family if at all possible.
Chris Sandel: I know for us, sometimes it is putting everything on the table and it’s serve yourself and tapas style, but often I will plate up for my son, but he knows he doesn’t need to eat any of those things, he can eat some of those things; if he wants more of anything, he can ask. But for him, having it already plated up doesn’t really matter because he knows there’s not going to be any pushing of he has to eat those things.
Katja Rowell: Absolutely. That’s where you find what works for you. We also pre-plate, often, or I’ll serve the green beans because it’s closer to me. Now, once my daughter got older, I didn’t want to be doing all the dishes, so we just have hot pads on the table and the pots come right on the table once that was safe to do. So we serve each other sometimes.
I think some of this stuff is a bit transitional. Especially if you have a really anxious or food-preoccupied child, you might be really sticking with this structure in place and this scaffolding, and then seeing where you can build in more flexibility with it, as you’ve done with your son.
At one point – I have to admit, too, I don’t follow all of these ‘rules’. My daughter was four or five. I tried this for a while where she was choosy and would say, “I don’t want that” and I’d say, “Okay, can I put a little bit on your plate? You don’t have to eat it.” She said fine, and maybe half the time she would taste it and eat more. But it didn’t upset her, so I did it. But with the milk, that was very clearly, ‘ooh, this is different’. So I think there’s leeway for parents. I know I talked to another dietitian and she said, “I have three kids and one of them would never take something, so I will often, with his permission, put something on his plate, and then half the time he eats it.” And there’s no upset. He’s not upset. He knows he doesn’t have to eat it. It’s almost like a motor planning or an initiation thing.
That’s responsive. That’s what I love about this responsive piece. You can have three kids and realise that for one of them, maybe putting something on their plate is what’s actually supportive for them, whereas the one next to them, they would fling the plate across the table and then not eat for two hours. So there is flexibility in all of this to a degree.
Chris Sandel: It’s meant to give you a bit of a guide and then you understand your child and their temperament and what works through trial and error, and then you make it look the way that it works best for you.
Katja Rowell: Yeah. But I want to say, the one piece where I feel like we really, really, really need to not think that there’s flexibility and almost always we preserve is that the child is the one who decides what and how much goes in their mouth. So there might be flexibility on pre-plating or sweets with a meal or you even might ask them to try something. There might be flexibility around the routine and offering food for some children between meals and snacks. But the part where I stand very firm in almost every situation is the child decides when they’re done eating, or starting.
Chris Sandel: I guess the one caveat I would have for that is in eating disorder recovery, where someone’s doing FBT and it’s part of that child has to finish what’s being offered. I think that would be the exception. But I agree with you in every other case. Yes, it is down to them to decide.
Katja Rowell: For sure when there’s weight recovery and malnutrition, that’s a different story. Thanks for mentioning that.
01:17:05
Chris Sandel: I would also say your comment about kids not wanting to try something, I always think of tricks where I’ve been in, I don’t know, Thailand or somewhere, and you go into a market and in the market they have crickets that have been roasted, or they’ll have foods that I have never even considered eating, and I try to think, that’s often what it’s like for a child. So even though we are very used to eating prawns or olives or whatever it may be, for a child it is the equivalent of walking into some market where they are facing completely new foods that feel very strange to them.
Katja Rowell: Absolutely. Sometimes when I do workshops, I do an empathy exercise. I would ask you and your listeners to think for a minute: has there ever been a food that you had a really bad experience with? Whether it was food poisoning or you vomited or a really aversive experience. I’m curious, Chris, if you’ve had a bad experience with something.
Chris Sandel: The first thing that comes to mind is whisky. [laughs] Not a food, but I remember getting sick on whisky as a teenager and not being able to drink it for probably 15 years.
Katja Rowell: Yeah. To give a food example, for me it was freshman year of college. Salsa. I threw up salsa and I didn’t eat it for probably five years. For those of you listening, if you think of a food like that where you’ve had a bad experience and what’s happening in your body as you think about that food – maybe your forehead is crinkling up and you feel a bit of disgust and even a memory of nausea – that’s part of why I talk about when we pre-plate.
Imagine, Chris, if at every meal you sat down to there was a little teaspoon of whisky sitting next to your plate, or for me there’s a bowl of salsa, and every meal you come and there it is on your plate. Maybe you don’t have to do anything with it, but maybe you know that someone will say you have to dip something in it or lick it or take one bite before you can have mashed potatoes.
I think often putting those empathy exercises in of, “Okay, so when I ask them to eat this thing, it could be a really similar aversive experience.” What reward would’ve enticed you to have a shot of whisky in those 15 years? Thinking about, for children, when they come to a meal where they don’t feel good around a food, their body is in an anxious state, often. And now they can’t even tell that they’re hungry; the hunger cues are gone, the curiosity around new food is gone, they’re not having a good time.
This is often when parents say, “I get so annoyed. They say they’re not hungry at the meal, I dismiss them, then as soon as I’ve cleaned the kitchen, they come back and now they are looking for that granola bar or the chips or the crisps or whatever it is.” When I talk to them, I say, what happened was at mealtime, they were so upset because of the pre-plated food and they couldn’t have what they wanted and they were already whining and negotiating, so they can’t actually tune in to the hunger.
Then they’ve left the table, they’ve gone to their Legos or their book or their iPad, and then their body calms down again and there are those hunger cues. So they’re going to now look for food. It’s not being manipulative or naughty; it’s just that they really, at a mealtime that was all about negotiating and attention on their eating and trying to figure out how to please the adults, or maybe they’re old enough that they’re no longer interested in pleasing adults and they just want to get under their skin [laughs] – it’s a lot going on. Particularly with young kids, though, it’s not naughty or wilful. It’s just that they couldn’t tune in to hunger in that setting.
We want kids to eat or not eat based on what’s going on inside of their bodies, not to either please or tick off the adults in their lives. That’s tuned-in eating: eating for reasons of hunger, curiosity, connection, fuel, rather than “I’m eating to earn a reward or a sticker or I have to stop eating because I’m getting a withering glance from my auntie” or whatever it is. We want to support that internally driven eating.
Chris Sandel: Definitely.
01:22:02
Then Step 2 is ‘Establish a routine’.
Katja Rowell: Yes. Very often, when children are felt to not be eating enough, they get the advice of “Try to get food into them whenever you can.” I’ve had adults chasing kids around with a bite of sausage or a Tupperware container or a liquid supplement like a PediaSure type of thing. That doesn’t really support appetite. Then they’re not eating generally to fullness. Pretty much universally with child feeding folks, the routine helps to support appetite cues; it gives them the opportunity to get a little bit hungry but not ravenous between eating opportunities.
That usually looks like eating every 2 to 3 hours for younger children and maybe every 2.5 to 4 hours for older children. That tends to support appetite for children where there may be challenges in terms of interoception, that ability to tune in for whatever reason. Maybe they had food insecurity or there was a lot of pressure or they’ve been restricted. So that structure allows some of those external supports to offer food at a pretty regular interval.
It just helps, particularly with food preoccupation, when kids know they’re going to be fed versus the impulse of “Oh, he’s playing at the park and he’s distracted from his food, and I’m worried he’s too big, so I’m going to try to stretch this out.” That impulse often leads to them looking up and realising, “Oh, I haven’t been fed. I can’t count on this” and now they’re more frantic or more anxious. That reassurance of we’re at the park and calling the kids over and saying, “Let’s sit for a minute and have a snack and then you can go on to play” – it’s that reassurance of knowing, particularly where there’s been food insecurity or restriction around food, “I’m going to be fed, so I can let go of that anxiety.” I saw that in my own daughter as a toddler, and I see it in clients as well.
Chris Sandel: Definitely. Also where the child can say, “I’m perfectly happy playing; I’m not really hungry right now”, and that’s also okay, and they continue on doing what they’re doing.
Katja Rowell: Absolutely. It’s offering the opportunity, and then you might decide as the adult, they were at the park playing, so they’re quite hungry, so I might offer an extra little snack before dinner or we’ll move dinner up half an hour if we can. We are managing that structure in ways that are supportive.
Chris Sandel: Yeah. It’s not that every day you eat breakfast, lunch, and dinner at the exact same time. It’s going with the ebbs and flows of life, like, “We were a bit busier so this happened a little later” or “We had this thing a little earlier just to make this work.”
Katja Rowell: Absolutely. I do think, though, when I am working with food-preoccupied clients or where there’s been food insecurity, that’s again that transition where in the beginning, it will be clockwork, if at all possible. Just offering every 2 to 3 hours. With the foster kids that I work with, it might even be every hour and a half for the first few days of just “You will get fed” and allowing that to sink in, that sense of safety.
Again, in some situations they might really need a bit more of that more firm structure and more of that effort, but that generally is transitional as well in terms of then being able, once they’ve experienced that in their bodies and trusted that “I don’t need to worry that I’ll get fed”, then they often can have a bit more flexibility into that.
Chris Sandel: Definitely. One of the things you mention in the book that I didn’t know was a thing but is something we do here was the ‘rescue snack’, which is the snack in the evening around bedtime or just before bedtime. Ramsay much prefers snacks to meals. Dinner, he often doesn’t have that much, but then in the evening, often in bed while doing a book, he will have a couple of pieces of fruit because that’s what he wants as a snack and that’s the snack we offer in the evening. He often will eat more in bed as part of that snack while doing books than he did at his dinner. But that’s how he rolls and what he likes.
Katja Rowell: And if that works for you, then that works for you. This timing piece also around dinner, that’s a story I hear quite often. “They won’t eat dinner.” One of the beauties of the scaffolding of the structure is that we don’t get to decide when they’re most hungry. Often, kids are really, really hungry right after school, so as frustrating as it is, planning on a filling snack – it might be an entire sandwich and some baby carrots or whatever it is, leftover whatever.
But what I often see parents trying to do is there’s so much attention on the healthy food, and here’s the worry of “Well, I’m going to have the veg with dinner.” So child comes home at 4:30, everyone’s frantic trying to get dinner on the table at 5:30 and make the most of that hunger, and meanwhile the kid’s pestering for food, and everyone’s upset. Some people call that the witching hour. Playing around with that schedule, just saying, “Look, he’s hungry. Let’s get him something” – and maybe you as well. I often have something in the mid-afternoon. “Let’s sit down when he gets home.” And maybe he decompresses by talking at you or with an iPad for a few minutes. Have a snack that’s substantial, and then move dinner back till 6:30 or 7:00.
So playing around with that schedule in ways that work for you and trying not to have this frantic rush to get dinner on has been such a relief for so many families I’ve worked with. For some reason, it’s “I’ll give them three pretzels at 4:30 and then they’re whining and begging, so then I’ll chuck a few more pretzels at them to keep them quiet” and then dinner comes around and they’re not hungry.
01:28:40
Chris Sandel: Then Step 3 is ‘Enjoy pleasant family meals’. Maybe just to start with, what is a family meal? How would you define this?
Katja Rowell: A family meal, we can also just call it eating together or connected mealtimes. I think sometimes ‘family meal’ takes on this like “I can’t do it, I can’t cook the roasted chicken and the mashed potatoes.” It feels like it has to be from scratch and everyone has to be there. Really, just one connected, attuned, responsive adult eating with the child is a family meal.
So letting go of some of that it has to be everyone at the table – it doesn’t. With split shifts or other things going on or a single parent, one adult eating with a child, who’s engaged and has a warm regard for the child and is offering that connection, that’s a family meal. It can be homecooked, it can be takeout, it can be convenience, it can be at McDonald’s, it can be parked in the parking lot of a restaurant where you’re sitting. I used to pick my daughter up from her daycare/preschool, and even though they had a snack right before the end of the day, it was always like a pretzel stick and a dixie cup of water, so she was ravenous. So I would pick her up and it was about half an hour, 20 minutes to home. We would just sit in the parking lot and she’d sit up front and play with the radio and I’d had a snack. That’s a family meal. That’s a connected mealtime that’s supportive.
So letting go of some of those ‘shoulds’ and images, and also recognising that a lot of adults did not grow up with pleasant family meals – that sometimes mealtimes were super stressful. A little content warning, but food trauma around mealtimes, if you had a parent who was unpredictable or chaotic or if you ever got smacked at the table or had to eat something – bad things have happened to people at family meals, and it doesn’t have to be that way. If a family meal is really daunting or stressful or triggering for you, maybe the first family meal or eating together is like I described, eating together in the car at the parking lot, or it’s on a blanket outside and building these positive connected experiences that are safe and also satisfying for the adult as well.
Chris Sandel: I think the sentence that I highlighted from this that I really love is “You are the most important thing at the table, not the vegetables.” I think this sums up this whole approach of how important it is to be connected and really establishing that happy environment – or ‘happy’ might not be the right word, but the right kind of environment around food.
Katja Rowell: Absolutely. Even our modern kitchens work against us, where a lot of people are eating at the kitchen island. When I’ve done home visits, here’s Mom or Dad, basically like a short-order chef, sort of “Here’s the first course” and this is coming out of the oven and the kids are lined up on the barstools. That certainly can happen at mealtimes, and there’s nothing wrong with it within this context, but I think that if we can sit down with children, having them help set the table and then sitting down with them to eat – and they also then get the message that we are worthy of being nourished as well, eating together.
When the connected mealtimes are that safe place, it’s really a reliable touchstone. As my daughter has gotten older and now she has more homework, mealtime is the place every day – we connect at breakfast and dinner most nights.
01:32:55
I’m going to segue into another bit here. Maybe for you, this is something you haven’t really faced yet, but particularly in the US, the extracurricular activities and the team sports come fast and furious, or art class or theatre or whatever it is. It’s something, if you have young children, to talk about your values. Because of our start and my work, for us, prioritising family meals was a main value for our family. I think it’s as important as learning an instrument or being on a travel team, if not more important, to help kids get this foundation. So that was our family value.
So when our daughter was doing synchronized swimming as a second grader, which is super cute – as cute and hysterical as it sounds – one year was great because it was one Wednesday an done Saturday. But that was nine months where we gave up every Saturday morning and a Wednesday. By two years later, it was three nights a week, and we opted out, even though she was really good at it and apparently had the right toes or whatever. That’s hard to say no to opportunities. And the same thing happened with the swim team in seventh grade. And just this last year, volleyball in high school.
I’m going to rant a bit about sports. I don’t know where you’re located, but youth sports in the US, 4 to 7 p.m., five days a week is volleyball, or whatever the sport is for our town. And then two days a week they’re travelling for games where they’re on buses for 4 to 6 hours each day. And she loved it, and she was good, and she’s tall, and we just said no. When she started last year, we said, “We’re going to see how this goes. If you’re not eating, you’re not sleeping, you’re anxious, it’s interfering with your social life or studying, we’re going to pull you out because that’s our job.”
I think having those discussions before those opportunities come up is helpful and is important. And she’s had to sacrifice some of those opportunities. I think we’re all okay with it. But having those discussions in advance is important.
Chris Sandel: Yeah. As you said, you need to work out, what are your values and what you think is most important or more important, and then making decisions based on that. At this stage I haven’t had to make any decisions along those lines.
Katja Rowell: And if the team sport is the value, then figuring out, “Okay, we’ll pick you up at 7:00 and we’re going to eat right after and you join us”, or making sure they’re getting fed. I know you do eating disorder work, and I see this so often. These kids are having lunch at noon and then they have half an hour and then they’re going until 7:30, or they’re eating their dinners from vending machines. I think it’s something that is kind of this, yes, youth sports are great for kids, but there’s also that side of really having to look at each child and be thoughtful about, “Is it great for this kid? Is this sport great for this kid and this family?” It’s complicated.
Chris Sandel: Definitely. It’s not just “Is this sport right?”; it’s “Is this amount of this sport right?” and how it fits in. So I’m glad you went off on that tangent and mentioned it, because I think it’s definitely an important thing. And for so many of my clients as well, their issues started when they got into the cross-country team or started when they got a scholarship to go and play hockey. So I think it’s helpful that you’ve mentioned it.
Katja Rowell: And you know what, honestly, I’ve given this advice too: if you’ve got a seven-year-old who’s low appetite, struggling with eating, low weight, maybe ballet isn’t – maybe not signing up for these really – not identity-heavy; the looks or the individual sports. That might be a child where, “Let’s look at soccer or let’s look at something else.” Or maybe wrestling isn’t the right – maybe we just have to pull them, even if they love it. These are really hard decisions. Tears were shed over volleyball, and yet we all know and agree it was the right decision. Hard stuff.
And like everything in the US, it feels like, or maybe this is everywhere, it feels like it’s all or nothing. With food, it’s all or nothing. With volleyball, literally it’s 30+ hours a week or it’s nothing. That is a lot of cultural shifting that hopefully will happen someday.
01:37:51
Chris Sandel: Yeah. Then Step 4 is ‘Build skills in what and how to feed’.
Katja Rowell: That is really to parents, and that’s around considering things like menu planning or shopping or having different meals for different days of the week. So if Wednesday is the soccer day, then Wednesday might be getting takeout on the way home. That’s the not really sexy part of planning on how to get food in front of us roughly every 2 to 4 hours. That can be very, very tricky for some. Some really enjoy cooking; others don’t.
Again, I think if we can address some of the nutrition worries, that’s helpful. Lots of kids like fruit, and fruit has a lot of the same nutrition benefits as vegetables, so sometimes it’s as easy as saying, “Don’t worry about the vegetables. Have fruit. Put fruit in your smoothie.” So it’s about supporting the nutrition piece and thinking – in the book, we go into things like, what flavours does your child like? So bridging to different foods to offer. If you have a child who likes crunchy things, you might think of serving crunchy things. If they don’t eat a lot of fruits and vegetables but they like crunch, you might do freeze dried vegetables or fruits, or offer these different things.
If they have a condiment they like – I just did a reel on this on Instagram – if they like ketchup, put ketchup on the table at every meal, or even sprinkles. It was a bit tongue-in-cheek, but my 16-year-old doesn’t eat a lot of breakfast food, so here’s another thing. Let them have the leftover stir-fry for breakfast. Food is food. So letting go of some of those ‘shoulds’. My daughter hadn’t eaten a waffle in probably five years, and my husband and I had waffles and she came down and surprised us and said, “Can I have one?” We bit our tongue, and then she got up and got sprinkles out and ate half a waffle with her hands, a little quarter like a piece of pizza, with a little bit of sprinkles and syrup on it.
So things like sprinkles or syrup or crunchy – it might be sesame seeds or panko crumb in the air fryer. Thinking about, what does your child like or prefer now? And that can help in terms of what to offer. Yeah, lots of different ideas on that one.
Chris Sandel: Yeah, there was lots of different suggestions there. I think there was the comment as well of not trying to hide foods, how that can also backfire. I think that’s often the advice. “Just try and smuggle these things in.” What you suggested was adding them but telling the child you’re adding them so that there is, in a sense, consent to them knowing about this thing and then tasting it and being able to say, “Oh, I don’t actually notice it that much” or “It doesn’t put me off that food” or “Actually, no, I don’t like it when that thing is in there.”
Katja Rowell: Right, absolutely. And a lot of times parents who are sneaking don’t need to because the children are meeting more than their basic nutrition needs. And there’s research out that picky eaters get their basic nutritional needs and tend to grow just as well as other children. Even with the extreme picky eaters, we see lower weight, but we also see extreme picky eaters who are normal and higher weight.
So if you have the impulse to sneak, I would say dig deeper into your worry. Do you need to worry? Can you let it go? Then I would say, again, be very, very careful. I hear all the time from parents of kids who eat 10 foods and are very limited and say, “I tried to put riced cauliflower in his scrambled eggs”, and of course, these kids can sense a fleck of pepper. And she was heartbroken. She said, “Now the trust is broken and now he won’t even eat scrambled eggs”, which was probably the most nutritious food the child ate.
So be very, very careful. I pretty much never recommend sneaking if at all possible.
Chris Sandel: Sometimes we’ll make a smoothie to go with breakfast and made a fun game of trying to guess what’s in the smoothie. The smoothie will end up having like 15 things in it, even if I put the tiniest bit of kale or mushroom or whatever it is that you can’t even taste. It’s mostly fruits. But that then made it an interesting way of “Who can guess the most things while we drink this?”
Katja Rowell: Oh, that’s fun. If he’s engaged in that, awesome. And that probably works with your son because he hasn’t been pressured along the way. This is often the kind of thing that feeding therapists will suggest to do, and for kids who’ve had pressure around their eating – and I believe that a lot of therapies pressure – they will not generally go for this. So just a heads up that if one of your listeners tries that and the kid’s upset or isn’t really into it, I wouldn’t worry about it.
I think a smoothie is another really great example with nutrition where perfect can be the enemy of the good. For example, personally, I don’t find the colour of a green smoothie appealing. I think this is some of my own background; any time I feel a ‘should’ or that health, like “I should have a green smoothie”, I have that internal resistance to it. And kids will have external resistance. And I tried back in the day adding flax oil to smoothies, and I could taste it, and I thought it didn’t help the flavour of it particularly. Different things like that.
I think there’s so much pressure to have the green smoothie, whereas our go-to smoothie – and again, my child doesn’t drink a lot of milk unless it’s with a sweet or a baked good, and then she chooses milk. So breakfast, where more times than not she’s eating the turkey curry from the night before, we’ll have a smoothie and it’s milk, a little bit of heavy cream, frozen bananas, and frozen strawberries. It’s kind of a milkshake. Just has maybe a bit less sugar than a standard milkshake. But we all really enjoy it. We usually all have some. And for me, too, I try to think with my gentle nutrition of getting calcium. It’s a great source of protein and fat and carbohydrates and energy.
So for parents, rather than fight over three sips of green smoothie, then you open the door to these benefits of these delicious smoothies that do offer really good nutrition but just not that image of ‘perfect’ nutrition. Striving for perfect can really undermine pretty good nutrition in scenarios with kids as well.
Chris Sandel: Definitely. I’m wanting to make it as enjoyable for me as well, so I will taste it and there’ll be times where I’m like, “That’s not great” or “That’s just not sweet enough”, so I’ll be adding in sugar or maple syrup or whatever to sweeten it up, because I’m like, I know that it doesn’t taste particularly sweet to me, so it’s going to taste even less sweet to a five-year-old. The goal is that I want him to drink it but also enjoy it. So let’s stack the deck in my favour of making this most likely.
01:45:39
Katja Rowell: That’s another scenario, to me, where it’s kind of all or nothing with things like sugar. For example, a lot of yoghurt has a lot of sugar in it, but then you see advice on Instagram – “Do plain Greek yoghurt.” That’s quite bitter. It’s like, we don’t have to do all or nothing with sugar either. We can find a balance with these things. Sugar is probably, alongside protein – I just want to mention sugar real quick if I can help reassure parents.
I do not believe that sugar is addictive. You probably have shows on this; we can refer to that. But there’s so much panic about sugar and this sense that “If I let them have sugar now, they’ll be sugar fiends and won’t be able to control themselves.” I do see kids who are really sweets-preoccupied and they are binging and they are sneaking in when they have access. The second grader who came to our house to bake cookies who wasn’t allowed sugar at home sat on the counter spooning sugar from our sugar bowl into her mouth.
I see this so often that, again, with that permission and rotating those foods into those regular meal and snack times, kids learn to trust that they will get them and manage them, and that preoccupation goes away. It looks like an addiction, it can feel like it, but it’s not a physiological addiction.
Again, I think a lot of the worry and concern around sugar and fruit juice is tied into weight bias and diet culture. I just read another review study of dozens of studies that looked at fruit juice and said, no, there’s no link between higher weight and fruit juice in children, and yet people treat fruit juice like it’s a cigarette for children. Really, feeding from a place of worry and anxiety and avoidance generally gets families and kids into trouble with food.
Chris Sandel: I totally agree and I think we’re on the same page in regard to sugar.
01:47:54
The final step then is ‘Strengthen and support oral motor and sensory skills’.
Katja Rowell: That’s written more for parents of the kids who have the sensorimotor problems like we talked about earlier. If you have the child like I described who’s two or three and only eating really those soft foods or has other red flags, then working with a speech therapist or occupational therapist. And oftentimes it’s really just getting ideas for what is appropriate to serve with their skill level and then what things to serve next, and then pointing out progress, and “Oh yeah, now we’re seeing a bit more tongues lateralization or lip closure around the spoon.”
So if there are those red flags, I believe working with someone who’s using a responsive approach to those issues can be very helpful. And if you see someone who’s telling you you have to do these desensitization brushes where you’re putting the brush in their mouth and the child’s screaming and fighting – basically, if you’re asked to do something that makes your child more anxious, upset, gagging more, it’s probably not a responsive approach and probably not going to ultimately be helpful.
Chris Sandel: I would say the part with this that might be appropriate for everyone is just I got the sense of how you make food more fun, especially if someone has had a situation where food has been connected to something fearful or enjoyable. How do you bring it back so that food is no longer attached to being something fearful?
You gave different examples in terms of filling a box with rice so kids can then play with the rice and have toys in the rice, or all of these different things that start to bring back a different relationship with food.
Katja Rowell: Yes. Again, if that is felt to be needed, I do think that working with someone could be helpful. But yeah, having positive experiences. Sometimes if there are sensory differences, maybe what will help the child have that positive experience is going on a swing right before a meal, or bouncing. It may not have anything to do with food at all. Prizing the child’s autonomy is what helps them have those positive experiences.
I think also, I just want to caution that authentic play is different than adult-directed play. So if you are saying, “We’ve had this really tough start. My child had a feeding tube or we had this horrible experience with feeding therapy where he was restrained and it was really bad, and now we’re working on making it pleasant again”, you can have play with food, but I think, again, if it’s like “We’re going to have this printout sheet and then I’m going to cut apples and we’re going to make stamp art and we’re going to paint with ketchup and finger paint with these things” – sometimes, even if it’s playful, it can still feel like pressure to the child.
Going to do a U-pick, if you have that opportunity, where they can go pick blueberries, or if they want to smear whipped cream around because they’re having a piece of cake, that’s fine, whatever it is. But I think just being careful. Sometimes therapies that say “We do play or sensory play”, it can still feel like pressure to the child.
That’s the responsive piece. “Is my child actually really excited about this or just complying and going through the steps?” Again, there’s nuance.
Chris Sandel: Definitely. I’m blanking on the name of the book, but I will mention it in the intro or in the show notes, all about attachment play that we found to be incredible. We’ve used it with our son and played different games to have the child in a lot of ways have that autonomy and have points where they feel more in control. It’s been great.
Katja Rowell: I absolutely love that, and I want to mention that with my colleagues, often the first step they’re doing is repairing what can sometimes in these extreme situations be a very fraught relationship. When feeding is not going well, it can bleed out into the greater relationship. I’ve had parents say, “My kid hates me. All I do is try to cram food into him, and meanwhile Dad gets to do the bedtime story and he doesn’t run to me for comfort.” So when there’s been a lot of stress and conflict – I love that example of attachment games and focusing on that relationship first.
I interviewed an OT, Suzanne Stratford, and she said as OTs, particularly around food work, it’s not so much the sensory-based food play or mindful eating exercises. That isn’t where the gold is. It’s with exactly what you’re talking about: these moments of connection. It’s the cuddle, it’s the singing, it’s the reading the book and the trust and having that warm, connected, attuned relationship that then continues into the feeding relationship.
I see so many parents who are gentle parenting or they’re talking about natural consequences, and they’ll offer choices to children – up until they get to the table and the child refuses the chicken, and then it’s like somehow food is different. There’s an anxiety, there’s all this baggage there, where the same parent who before was very collaborative and responsive, now when food is there, it turns into a 40-minute battle over two bites of chicken and the hostage of the strawberry ice cream, and the child’s miserable and the parent’s miserable.
So I love that you have that book and just bringing that same collaborative, respectful, authoritative – it’s still the parent offering those safe boundaries and structure while supporting the child’s autonomy within that structure. I love that you brought that up because that’s often where we start when there’s been really profound challenges with that feeding relationship.
Chris Sandel: Definitely. For us, when we started using that, we had struggles with Ramsay trying to go to nursery, and it completely backfired. When we then started to use the examples in the book and to really have attachment play be a lot of the way that we were parenting over a couple of month period, his eating changed a lot. Him wanting to come to the table and being happy to be at the table changed a lot. We didn’t put any focus whatsoever on the actual eating part, but it was just a natural consequence of the rest of the relationship changing.
Katja Rowell: I love that. I’m excited to read the book. Having an almost 17-year-old, I often think, “I wish I’d had that when she was three or four!” It is wonderful that there’s so much more that we talk about.
And it’s so important to note, this isn’t blaming parents. Especially in the eating disorder world, it’s almost like the word ‘attachment’ – many in the eating disorder world have this huge negative reaction because it’s almost like back in the ’50s, ’60s, ’70s where everything was blamed on mothers. If it’s an eating disorder, it’s the mother’s fault and it’s attachment this.
So I love that we’re bringing back relationship and attachment in a way that is empowering parents to have this mutually satisfying relationship that supports children to do their best with eating, but it’s not blaming parents. I was a doctor giving feeding advice, and I got really stuck in this anxious, counterproductive pattern. I just am really grateful that I found the information I did when I did. So I think it’s lovely that you are bringing that up. It’s really that relationship, and feeding is part of the parenting responsive relationship. It’s not separate, and we don’t have to somehow treat eating as wholly different from other things in terms of our philosophy around parenting.
01:56:40
Chris Sandel: Yeah. The final thing I want to ask, and this connects to this and closes a loop on something we mentioned earlier, is responsive feeding therapy. You said there are some values that would be useful to mention.
Katja Rowell: Yes. We’ve kind of touched on all of them. The first three values – my co-author and founder with RF Pro, Jo Cormack, she’s a brilliant PhD psychologist. We’ve talked about the basic needs theory, that humans need three things, ideally, to thrive, and that’s having autonomy, having relationships or relatedness, and a sense of competence.
Again, the sense of competence will be different. We can have a child who has neurodevelopmental differences who can still feel competent in their environment. So it’s not as much measured competence. So those are the three big ones: autonomy, relationships, and that sense of competence.
That then gives rise to the fourth value, which is intrinsic motivation. We want children to eat because of all those internal drives that we talked about, not to please or cheese off the adults in their lives, or for other things, external reasons that might come in.
And then the final value is really using a whole child lens of looking at the child and their situation. Was there food insecurity? Is there a parent with either an active or a history of an eating disorder that’s impacting the parent’s ability to show up? The parent might be struggling and need support themselves, because nothing will push our buttons and trigger old issues as much as a child with growth or eating differences.
And then looking at ability or the situation around cooking or meal planning or the cultural differences, the grandparents, what’s happening at daycare – which, of course, we didn’t even get into, but school and daycare is another whole area with a lot of external messaging coming in that’s not helpful.
So those are the five values: autonomy, relationship, competence, the whole child lens, intrinsic motivation, that helps us look at each child in their family as a unique situation and find responsive ways to have an environment that helps them do their best with eating. And that’s a nutshell.
Chris Sandel: Nice. As I said, I think it ties into everything we’ve chatted about. I’ve really enjoyed this conversation. Where can people go if they want to find out more about you?
Katja Rowell: My website is www.thefeedingdoctor.com. I’m on Instagram, @katjarowellmd. Facebook has changed its platform and I now find it confusing. [laughs] I will just admit that I’m not very active on Facebook. But Instagram and my website, and if you’re a professional, Responsive Feeding Pro has training. And then I have the books. Just finishing the second edition of Love Me, Feed Me for adoptive and foster parents. But really, I’ve used it with a lot of clients with food preoccupation. That’s my go-to book for that concern.
And then my co-author and I also wrote a book for teenagers and adults, so if you’re an adult with selective eating and want to explore your own eating, we wrote a book called Conquer Picky Eating for Teens and Adults, and that’s a workbook.
Chris Sandel: Perfect. I will put links to all of that in the show notes, and thank you once again for coming on. This has been great.
Katja Rowell: It’s been my pleasure. I’ve really enjoyed it.
Chris Sandel: That was my conversation with Katja. If you have a child and you have any concerns about feeding, then I highly recommend checking out her books. Even though we covered a lot in this episode, there was just so much that we didn’t get to go over, and she provides such sound and sane advice.
02:00:54
The recommendation that I have this week is for a book. I recently read the biography of John Peel by Mike Wahl. John Peele was a DJ on Radio 1 in the UK. He passed away in 2004. I actually never got to hear him on the radio. The first time I heard his name was in 2005 when I went to Glastonbury Festival and they had changed one of the stages to the John Peel Stage. I found out a little about him at this point, and then I think I bought the book, his biography, a while ago. It was some point over the last decade, but I just never got round to reading it until now.
He was the longest serving of the original BBC Radio 1 DJs, broadcasting from 1967 until his death in 2004. He was a DJ who championed new music, and music that really no-one else would play. Many bands and artists are lucky that he was around because without him, they wouldn’t have had the careers that they did. He was responsible for the popularity of bands like The Clash and The Undertones and The Smiths and was really at the forefront of the whole punk scene.
He had this incredibly diverse range of musical interests that continued right up until his death. Whether it was left field electronica, reggae, indie, extreme metal, British hip-hop, he loved it all.
I really enjoyed the book, learning about someone who, if I’d been born in the UK and lived here my whole life, I think I would’ve had a huge amount of fondness for him and would’ve listened to his show, but I didn’t move here until 2003 and just didn’t listen to the radio at that point, and he passed away in 2004. So if you are into music, it is definitely worth checking out. It is called John Peel by Mike Wahl.
So that’s it for this week’s show. Asi mentioned at the top, I’m currently taking on new clients. If you want help with an eating disorder or disordered eating, chronic dieting, poor body image, exercise compulsion, getting your period back, any of the topics that I cover as part of the show, then please reach out. You can head over to www.seven-health.com/help and there you can find more information.
I will be back next week with another episode. Take care, and I will catch you then.
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