Thursday, March 11, 2010

Feeding with respect: Stopping when they're full

This post is part of the 2010 API Principles of Parenting blog carnival, a series of monthly parenting blog carnivals, hosted by API Speaks. Learn more about attachment parenting by visiting the API website.

When Mikko was a baby, I was observing a Facebook comment thread of a friend of ours who had elementary-school-age children. She was bemoaning her middle child's lack of interest in eating at mealtimes. The girl was about five years old, and I had opinions on the mother's concerns but didn't feel comfortable voicing them, considering my child wasn't even eating solids yet.

But now that Mikko is two and three-quarters years old (I'm sure that three-quarters part is significant), I have no problem voicing my opinion on the matter. Mikko has been (kind of) eating (some) solids (when he wants to) for over two years now, so I feel pretty confident putting this message out there.

Let your children decide how much they want to eat.

That's my advice. As a caveat right off, it might not be applicable in certain instances. I can think of several medical conditions off the top of my head where following my advice might be dangerous, and I can think of situations where older children, not raised with such freedom, might abuse it.

So, if your child has a medical condition, don't listen to blogs more than you listen to your healthcare providers. But that second exception is why I think feeding with love and respect needs to start early with kids — and then continue steadily throughout their childhoods.

Here's are some of the guidelines from the Attachment Parenting site about AP Principle #2: Feeding with love and respect:
  • Encourage a child to follow his bodily cues for hunger and thirst, to eat when he is hungry and stop when he is full.
  • Forcing a child to eat, or to eat a certain food, is counterproductive and can lead to unhealthy eating habits and potentially eating disorders
  • Avoid the use of food as a reward or punishment, or of making food (or dessert) contingent on behavior
  • Rather than restricting access to certain foods, consider having only healthy options available in the home and allowing the child to choose
The best start to feeding a child healthily? Breastfeeding. If you can breastfeed on cue, your baby will naturally develop healthy attention to hunger cues, feeding when hungry and stopping when full. The baby's tastes will be gently nurtured as the taste of the breastmilk changes slightly when the mother eats different foods. And the baby's taste preference will be set for a whole and healthy food rather than something artificially sweetened.

This is not to say that bottle-feeding parents cannot help their children develop the same cues, just that breastfeeding on cue makes it happen automatically. It also, at least in my case, helps the parents lessen their control over when, for how long, and how much their child eats, because breastfeeding is entirely up to the child. When solids are introduced, these same gentle principles can be extended to keep solid-food eating just as healthy and respectful as breastfeeding.

So, back to the mother I was dying to counsel. Here was the situation. Her five-year-old was a skinny thing — not unhealthy, just naturally waif-like, and dissimilar to the rest of the family, who were otherwise stout. I think the mother had gotten used to her other family members' eating habits and was unwilling to accept that her middle daughter might have different caloric needs.

The mother wanted her daughter to eat at certain prescribed times, and to eat a certain amount and variety of food. She tried to limit her daughter's snacking and juice drinking beforehand; she tried to cajole her into eating the foods she'd prepared for the meal; she set restrictions on which foods must be eaten followed by reward foods (dessert) if the rules were followed; she was considering punishment if the proper foods were not eaten.

I wanted to tell her: Loosen up. Your child's thin, and that's ok. She's not unhealthy, just different from you. She has a small stomach and a small appetite, and there's no need to force her to eat when she's not hungry.

What I feared most was the probable effects all this mealtime wrangling would have on the girl: She would either learn to overeat, which was not otherwise her natural inclination, or she would react ever more negatively against her mother's coercion and develop deep-rooted aversions to mealtime and to certain foods.

I wanted to shout at the mother, in the Facebook thread: Your daughter is physically and emotionally healthy; she is not going to die from ingesting too few calories! She will eat if she is hungry!

For what it's worth, I'd eaten dinner at their house. The food they served was healthy and delicious. I think if they let their daughter choose her fare, she would make it just fine.

I did not tell the mother this, but I will tell you. If you have a young baby, give the best start by breastfeeding on cue or practicing "bottle nursing." As your child begins solids, consider a baby-led approach to solids rather than following outmoded guidelines of so much mushy purees at such and such an age. Particularly if your child is breastfeeding, it's perfectly fine if the majority (or, seriously, all) of the calories come from breastmilk for the entire first year.

Likewise, if your baby wants to continue breastfeeding past six months, past a year, past two years — why not! Breastmilk is still a beneficial food well into toddlerhood and even the preschool years. Again, follow your child's cues and your own (positive) intuitions and don't let cultural norms sway you from doing what you and your child desire. The Clean Plate Club we can do away with, and the idea that only young infants need breastfeeding can also go away, thank you.

Our experience

I want to give you some real-life experience with "aberrant" solids eating behavior and weight gain, so you can see I'm not someone whose child learned to eat along some idealized curve and now thinks no one else should be worried because they must also have perfectly normal children.

But, no, no — we have a freak. And I say that in the lovingest way possible.

Mind if I take you through a photo journey of baby food and baby fat? If you don't feel like seeing a bajillion hilarious pictures of my pudgy child, feel free to skip to the end.

Mikko weighed 11 pounds, 13 ounces, at birth. Yup. And he was totally, completely normal and healthy. Just, you know, big. (And the birth was fine, too, thanks for thinking of me.)

Here he is at barely four months old, still absolutely tremendous. Go ahead, laugh. I snicker when I see it. At the time, I was so busy defending that he was completely normal that I missed the evidence that he was hilariously humongous. But healthy!

For instance... No, seriously, get a load of those rolls! That is some awesome bulkage right there. And that's nearly all from breastmilk at that age, eight months old.

Here he is at a year old, finally pulling that bulk to standing! He sat early (his large bum was very stabilizing!) but walked rather late — but now is just fine, thank you very much! (Except for the balance thing, which is to be expected.)

And here he is at two years old, still weighing the same as he did at about eleven months, but suddenly much taller. Look — skinny legs! Still healthy, still active. Granted, he still has a huge head, but that's genetic, too.

Here is Mikko's growth chart, from when he was 10 months old. Ha ha ha ha ha ha ha ha ha! Ohhh, I never get tired of the hilarity. The top is height, and you can see his purple line that generally follows the top percentile curve. The bottom is weight. You can see his heftiness broke free of the confines of the chart. Take that, chart!

Here's a little trip through his solid food adventures:

One sign of solids readiness? A fascination with your grown-up food! Six-month-old Mikko eyes the Christmas fondue.

Trying out broccoli — most of it ended up outside, and that's ok. Early solids, especially when practicing a baby-led version, is all about exploration of tastes and textures, not ingesting a significant amount of calories. And remember: Their stomachs are still very small!

Pickle or ice cream? Babies can't tell the difference, apparently.

Ill-met attempt by my parents to spoon feed Mikko mushed banana. My mom insisted on trying. Mikko insisted on projectile vomiting on my dad. (Not pictured. Sam and I were too busy laughing.) Some babies have very sensitive gag reflexes, which is why letting them take solids at their own pace is beneficial.

Baby's first taste of lemon. Don't be afraid to let kids try foods you find unappealing. They can sort out their tastes for themselves. I try not to give Mikko cues that he "should" or "shouldn't" like a particular food. He has eaten lemon since, if you were wondering!

Enjoying mashed cauliflower (a tasty and nutritious substitute for mashed potatoes), mashed all over his face

Relishing sushi at eighteen months old

Scarfing down smoked salmon

Contemplatively covered in yogurt. Letting kids feed themselves, even if it's messy, helps them learn fine motor skills AND develop their attention to hunger cues. It also makes them feel more included at family meal times when they have their own utensils and dishes.

Start out breastfeeding and lay the groundwork for a healthy attitude toward eating.

Keep at it, and your growing child will continue developing his healthy eating style!

Seriously, Mikko still has days when all he eats is breastmilk. And you know what? I trust that that's what he needs on those days. Often it's because he's not feeling well and his body knows it needs the extra antibodies. Other days he wolfs down everything solid in sight, and asks for more, and that's fine, too.

We've been babysitting some other kids recently, and I've been amazed at how much they put away. They're skinnier and younger than Mikko, and they eat three times as much as he does, solids-wise. I don't believe they're still being breastfed, though I'm not sure. It doesn't worry me, though. I know some people would still consider Mikko to be fat, but he's just right for himself. Others might worry that he hasn't put on any weight in the past two years, but I'm not concerned. He piled it on fast and furious right at the start, as breastfed babies are wont to do, and it's completely natural for growth to slow way down in the second year and beyond. I mean, if he'd kept at the pace he'd started, he wouldn't fit in the house anymore!

So there you are. If my kid were on the lighter side, I'd be telling you the same thing. Again, barring medical condition, children — like adults (duh!) — are a range of sizes. Someone has to be on the lower end, and someone has to fill those upper percentiles. It's fine if you or your kid are in one or the other of those camps.

Feed your child the way you'd want to be fed: with autonomy, with empathy, with healthful choices, and, most of all, with trust. The rest will work out just fine.

Here are some links you might find helpful:

How has feeding your baby, toddler, or child gone for you? Are there any eating issues are you trying to avoid passing on to your children?


Olivia said...

My baby is 11 months and is eating mostly solids during they when I'm at work. She doesn't eat a lot though. A bit of yogurt or fruit puree (we get a lot of baby food thru WIC and might as well offer it), 1/2 slice of bread with peanutbutter, and water or diluted prune juice (she's prone to constipation).

Our approach at meal times is to offer her bites off our plates and if she doesn't like it, then offer the baby food. Sometimes she eats a lot and sometimes it's only a bite or two before she wants to nurse. She loves my husbands spicy, Nigerian dishes.

I wanted to lead her to eat solids earlier than I might have if I didn't work because I wanted to quit pumping. We just reached that point a couple of weeks ago. Now she grazes during the day, and nurses a lot when I get home. She also nurses on demand at night.

For older children, I have heard it suggested that if the child doesn't want what was prepared for dinner, then tell them they can have (healthy) cereal. This is so the child isn't being forced to eat something, but keeps parents from becoming short-order cooks. What do you think about that approach?

Jamie said...

This is very comprehensive! Love it!

My in-laws think Jude is huge, clearly they have no idea! Look at Mikko go through the years! He's awesome.

We're doing baby-led weaning as well, for the reasons you mentioned. It's interesting, it seems like Jude is very interested in what *we* are eating and not at all interested in mashed up "baby food". I love that photo of when your parents tried to give him some banana, that totally happened to me last week. He's just not interested, he wants to feed himself and not be fed by me with a spoon. So we'll just follow along and do what he's interested in at the time.

Learn and explore!

Anonymous said...

My oldest (18) and youngest (10) were boys and were pretty rolly-polly at times. My daughter was stick thin as a baby and child. All three were breastfeed!

I still remember my oldest' great-grandmother insisting I was nursing him too much because he was so chubby and then 3 yrs later insisting my daughter wasn't nursing enough because she was so thin. Funny part of that was that she nursed so much MORE than he ever did :)

Anonymous said...

Mikko is so cute! Also...someone with a baby that started out bigger than mine. (D was 11 pounds, 9 ounces.) Of course, mine decided to gain slowly and was 30th percentile or so at his 1-year appointment, but he's healthy, happy, eating what he wants when he wants, and hitting milestones. So it's all good. (And may I just say how pleased I am that he has had a pediatrician from day one who said that as long as he was gaining, which he was, and hitting milestones and happy, then obviously THIS was normal for HIM and therefore fine? I mean, I knew that, but it's nice when the doctor agrees so you're not having to fight it or doubt yourself or whatever.)

Breastfeeding was a challenge for us at first. (Various and multiple screwups by two hospitals, resulting in nipple confusion.) Now it's going beautifully. And he loves his solids - in their time and place, and in whatever he considers reasonable amounts. I'm amused and gratified by what he enjoys. Curry lentil soup? One of his early favorites. We had to help with the delivery - we'd hold the spoon and he'd guide it to his mouth - but there was no doubt that he wanted more. NOW, if not sooner. Hehehe. So cute.

When we go out to eat, he prefers the salad bar place, because he likes...the cold peas and corn. And other veggies, but...cold peas and corn. *shudders* Well, he's happy, and I'll eat the more traditional salad stuff.

Marilyn (A Lot of Loves) said...

I have two kids ages 3 and 17 months. Neither child is breastfeeding anymore. On some days they eat so little I wonder how they survive and on other days they out eat me - especially my son the 3 year old.

I try not to force food because I was forced to eat everything on my plate as a child and wasn't allowed to leave the table until it was gone. I have grown up to have issues with food - most notably I never actually feel full so I can overeat very easily. I now have Type 2 diabetes and struggle to keep my weight down. I really don't want to pass that on to my kids.

I do have rules about food though. Dessert is not a daily occurrence and is served only a few times a week and to eat it a decent amount of dinner needs to have been consumed. I like the kids to at least try a bite of everything and if they've tried it and spit it out then that's fine for the night. We'll try it again another day.

Melodie said...

First of all, congratulations for having so many wonderful pictures of Mikko eating food! I have maybe one or two per child. I am realizing that this is so not enough. But your visual presentation was very helpful in letting go of misperceptions about what babies can and can't eat. Way to go!
As far as mine have been concerned both lacked interest in solids until late. I worried about both of them. For as much as I know on the subject I haven't been able to get past some of the worrying I do. When it comes to food that's just the way I am, I guess. But you'd never know to look at either if them that they have ever lacked. Both are off the chart for height and in the 90th percentiles for weight. Amazing what breast milk can do!!

Anonymous said...

I have a 5-year-old, and I can say from first-hand experience that it is VERY hard to be zen when your toddler with a wide palate morphs into a picky preschooler. Very hard. I share your approach to solids, but I will admit I had a few mini-meltdowns when my child stopped eating foods she previously enjoyed and subsisted on crackers and yogurt.

I did trust my child, and we did make it out. At 5 she's becoming SLIGHTLY less picky, and I am actually a little bit too happy about that. Being able to present food without incurring a meltdown is nice.

I am glad I didn't force the issue. But I can also understand why some parents freak out, especially because medical professionals do, too. When my child started dropping on the weight curve (from 50th to 10th percentiles) we had to leave one extremely alarmist doctor who was advocating weaning and force-feeding. But there's really nothing you can do except offer a variety of foods and back the heck off, and know that healthy children will not allow themselves to starve.

LindsayDianne said...

Let me start by saying that both your spirit and your sense of humour about this topic are incredible. This whole post is intelligent, well thought out and factual, while being gentle and reassuring which is not something often found.
Food is such a point of contention for so many families who are just trying to put everyone into the same shaped mold.
You're absolutely right, of course.
I always think of something I had read by the Sears family doctors, along these same lines. It basically said what you've said here... Kids won't starve, let them do what they have to do, don't fight with them about it and make it into a giant issue when they're probably just not hungry.
But don't be a restaurant, either.
If little one doesn't want what's for dinner, fine... But don't offer up something they'd like more.. that is, unless you want to teach them to hold out for something better.
My daughter goes crazy for juice and milk, so I try to only give her water at mealtime to avoid her just being full of liquids, and that being the cause of her not eating. If she finishes her water and her dinner, then she gets watered down juice. And I try to give her almond milk instead of cow's milk a lot of the time.
Everythig has to be customized to fit your own personal needs, but this was just a great post from start to finish.
And both of you are just beautiful.

Anonymous said...

Love the post, great job. Healthy foods and healthy eating habits is a big passion of mine so I really appreciated it. It was v. comprehensive and fun with the pics included of Mikko. (I wish my skinny guy would have been a bit more roly-poly like him! I always joked that I must have diet breastmilk.)
Introducing solid foods too soon is one of my biggest pet peeves and I know soooo many people who do it. I speak up only sometimes... same reasons you had for not speaking up at first. But I love the Kellymom website, which I didn't know about, and will now refer people to without worry. Thanks!

Michelle @ The Parent Vortex said...

great post! My daughter is at the 98% percentile for height and weight, and it's very reassuring to see another healthy, happy, breastfed baby who is just as hilariously humongous. Thanks for sharing your photos and story. :)

Geeks in Rome said...

beautiful! Those rolls look edible! filled with Grade-A fresh breastcream!

Another great reason infants do well eating with the family on someone's lap now and then: They get a chance to see and sample solids when they're ready. It also helps make food be a cause for celebration and not misery if meal time is about nutrition and enjoyment and not threats and power struggles. Brava for such a beautiful post. :)

Inder-ific said...

I have been going through this with my ten month old son. He's also a BIG BOY (though not as big as Mikko!), and he also LOVES to breastfeed, but is so-so about most solids.

I wrote a blog post on my attempt to chill out and go with baby-led solids for him:

Like some other posters, I am trying not to worry ... and succeeding some of the time, at least! At any rate, my idea that my son would eat more solids and then need less breastmilk at night? Pure fantasy, apparently!

Thank you for this post, it is incredibly validating for me.

Jenny said...

I saw this the other day and wanted to finish reading and comment, but I must've been late somewhere. The skinny little girl you describe reminds me so much of my daughter Suzi, who is just Mikko's age. I don't threaten her with punishment for not eating, but I do insist that she eat an actual meal before dessert--and I can see how this might backfire/not work. What I really want to do is go shopping and buy only healthy, minimally processed fresh items. Anything like cookies and candy I want to banish to a high cabinet to be pulled out when Suzi goes to bed or as an occasional surprise, because if she can't see it, she will usually forget it's there. This way, like you said, Suzi can pick whatever she wants to eat in the house and it's bound to be something good for her. We just joined a local food co-op and have found a couple of good things she likes, such as quinoa pasta and wild rice. I so wish I had encouraged her to keep breastfeeding through my pregnancy with Ivey!

I have some bad memories of my own childhood re: eating, so I can say from experience that coercion at the dinner table is a no-no. My mom got really aggravated when I wanted more juice before I'd eaten enough food (duh, I was thirsty!) or if I didn't want whatever meat item they were having. My parents are no high authority on healthy eating. My mom has long struggled with weight issues and conditions stemming from them, and my dad developed type II diabetes when I was in high school. We live in the southeast, where mac-n-cheese is considered a vegetable in many households. (Just kidding--sort of.) So reinventing the wheel when it comes to food is probably a good thing for me. I need to get a new cookbook. "Hippie Whole Food Cooking for Dummies," or something like that. We are going grocery shopping later so maybe I will see what I can find online! Thanks for the great post, it was really encouraging.

Also, I love how you've redesigned and are putting so many family pics on here. It adds a lot of personality to your blog, and you have a beautiful family!

Lisa C said...

I wavered on whether to offer purees or do baby-led weaning, so I did a little of both in the beginning. He quickly bored of the purees and wanted real food and to feed himself. He's always enjoyed a healthy variety, and he goes through phases of what he prefers. He's never eaten very much, and is on the small side, but is very energetic, bright, and healthy.

I was just like the little girl you described in your article. I was skinny and my mom thought I should be eating more. At five years old, I was being spoon-fed. That's humiliating. I also had to sit at the table till I cleared my plate, which meant I had to sit there all by myself while my siblings went off and played. Sometimes I wasn't hungry, and sometimes the food just made me want to gag. I felt like I was being punished. Dessert was only available to those who finished their dinner, so I tried really hard. To this day, I still feel like I need to clear my plate, even when I'm full, and I try hard to override that training.

mrs.notouching said...

Thanks - this is very timely for me. My 14month old is pushing all the growth charts and is eating every 2 hours... pretty much anything I give her. I don't normally worry, but lately I've been hearing a lot of "wow, she eats A LOT!"... and since she is my first I started to question myself, but you are absolutely right - I need to just let it be.

Melissa Neece said...

One thing though - if your child seems to be craving a food incessantly - wants it all the time - s/he might have a food allergy towards it. This is especially true of cow's milk - wants 4 or more glasses daily, or of wheat - wants bread, cereal, pastas all the time. These should be red flags, and be referred to at your next doctor's visit. A simple Ig Elisa food allergy blood test (they draw a little blood, and then test the blood) can usually determine most of the common food allergies.

MrsQriist said...

I just have to say that those rolls are amazing :) _I thought my guy was big at 10'11" go, Mama!

Jeanette said...

I totally agree with your post and love the photos of your boy. However I, like your friend, had a slim baby despite feeding on demand about every two hours. This was fine with me but didn't go down well with my mother who has a huge complex about food stemming from her own childhood when she was neglected and malnourished. She truly believed that I was starving my own baby. Instead of offering her support, she instilled her fears on to me making me doubt not just feeding my son but all aspects of my parenting. This was hard for my young, fragile mind to cope with not to mention that I was doing it on my own after my husband left when I was pregnant.
I could go on but just want to say please don't judge your friend for her anxieties. I understand that by writing about it you are helping to change parents bad attitudes towards food which is ace but just remember that everyone has their own reasons.

Unknown said...

I get so happy when I read this! My daughter now 15 months, she is still mostly breastfeeding, although the solids are slowly increasing. She also has/have had a strong gagging reflex.
She's a big girl, not at birth but turning 1 she weighed in at 15,3 kg and 80 cm (sorry I only know the metric weight).. So I recognize the weight curve you're showing. :) Unfortunately I also recognize the comments and I'm sorry to say that the constant talk about her weight and all that talk about me stopping with breastfeeding, since she is getting to fat, have made it harder to just sit back and enjoy her rolls and feel confident in that I'm doing the right thing with breastfeeding her and introducing solids according to BLW.
But I just love seeing these pics on your son, he is truly adorable! Makes me feel more confident that when people say that she always will be fat doesn't know what they are talking about. :)
So thank you for a nice blog and a post that I can relate too.

Lauren Wayne said...

@Unknown: I just wanted to give you a little update that my pudgy little guy is now 6 and a half and is well within the normal ranges for both height and weight — still larger than average (around 80th percentile for each) but that's to be expected in our family. He kept on springing up in height but staying the same weight for years! And he still doesn't eat that much, but he's clearly doing just fine. :) So I hope you do enjoy your little girl's rolls and feel at peace with her breastfeeding and your nurturing of her. All the best to you!

Unknown said...

Wow thats a really big baby!! How can he crawl or roll over?

Lauren Wayne said...

@Unknown: He preferred to scoot rather than crawl, but he did just fine. :) He's 8 and a half now so prefers to walk, ha ha!

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