Supporting Parents’ Love:
Using the Feeding Relationship Approach in WIC

Charles Slaughter, MPH, R.D.
Nutrition Consultant, Oregon Health Division
charles.w.slaughter@state.or.us

A mother came with her two-year-old son for their routine WIC eligibility visit. The boy’s growth was in the 50th percentile. His hemoglobin value was normal. The mother’s answers to the health history questions didn’t reveal any problems. Only a low number of reported servings of milk and milk products constituted a nutrition-related problem that qualified the child for WIC.

Ordinarily, Julia, the registered dietitian who conducted the interview, would have reviewed the foods that make up the milk group, talked about the number of servings a two-year-old child needs each day, and suggested some ideas to get the child to consume more milk and milk products. But Julia had just completed a three-day training course on the feeding relationship, given by nutritionist and author Ellyn Satter. So Julia asked the mother the simplest screening question about the feeding relationship that one can ask— “How is feeding going?”

The mother replied, “I’m really tired of holding his mouth shut until he swallows his food.”

This reply shook Julia—why shouldn’t the description of a process that is so emotion-laden for mother and child evoke strong feelings in a practitioner? Fortunately, Julia’s training had prepared her not only to ask about the feeding relationship but also to respond helpfully. She knew that the mother’s ability to speak openly about her behavior and feelings suggested a readiness to change. She also knew that her job was to stay focused on the mother and trust her capacity to change the way she fed her child. Julia worked in partnership with the mother to understand and incorporate Satter’s concept of division of responsibility between parent and child in the feeding relationship: The parent is responsible for what the child is offered to eat; the child is responsible for how much (Satter, 1986). Over time, in the context of a safe place and a trusting relationship, the mother was able to change her behavior, with life-giving benefits to her child and herself.

Feeding is a place where nutrition, development, and parenting meet. WIC agency leadership and WIC staff have the opportunity to create a place where parents feel safe in disclosing the struggles they are having with feeding or with their child’s eating, and where families can get developmentally appropriate information and support to help them provide both nurture and structure for their young children.

Based on my experience in the Oregon WIC Program, I would recommend two principal strategies to incorporate a feeding relationship approach into our services.

1. Questions to open a discussion with parents

We use both open-ended and specific questions to learn more about participants’ feeding relationships and their current concerns. One open-ended question to encourage a discussion about feeding asks parents to list one thing they like and one thing they would like to change about their child’s eating. Pregnant women can be asked to recall one eating experience they had as a child that they would like to repeat with their own children, and one eating experience they would not like to repeat. Specific questions about parental feeding behaviors ask whether and how often the family eat together, if the parent sits with the child when the child is eating, and the extent to which parents let the child decide how much or how little to eat.