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Content note: eating disorders

One of the baffling things in parenting is trying to make sense of conflicting schools of advice.

Sleep advice is the first one many parents encounter:

• One school of thought is that staying connected with your baby, ideally by sleeping in the same bed, will allow you all to sleep better. Forcing your baby to sleep without parental comfort will make them anxious and insecure.
• An opposing school is that at some point, babies need to learn to settle themselves without you, and everyone will be happier once they gain this skill. 

Discipline is another contentious area:

• A mainstream / traditional view is that children should learn to obey adults, and this will lead to better outcomes for the kids.
• Noncoercive parenting says that children should be treated as equals, whose preferences are as valid as those of adults. And this, not coercion, will lead to better outcomes for the kids. Better to learn from experience early: “Do you want your kids to discover the downside of spending all day playing video games when they’re 12, or when they’re spending $100k a year in college?”

It seems to me that any of these schools of thought, applied by capable adults, can give good results. People who resonate with a method can often carry it out skillfully. 

When I asked someone who helped found a microschool about the particular approach at that school, she said the main teacher is a talented educator who’s developed a method that she carries out really well. If the parent were cofounding another school, she wouldn’t look for a teacher to implement this same method. She’d look for a talented teacher who has ideas about what they’re excited to carry out, even if that method is quite different from what worked for this first teacher.

Take it or leave it

One thing a lot of these methods emphasize is that you must stick to them strictly. Methods that rely on consistency (which I think is great and important!) mean that you shouldn’t expect good results if you’re inconsistent. 

In sleep training, you should expect that randomly coming in when your nerve breaks will encourage the baby to continue crying until you come in. Meanwhile, attachment-based approaches say you’ll get a happier, more well-adjusted child if they never have to go through that.

Approaches based on children’s autonomy seem like they must be pretty difficult for parents at times, but proponents say the children will come out more capable in the long run¹. Meanwhile, approaches that emphasize parental authority also say it’ll get harder before it gets easier. Of course children don’t want to do chores or go to bed on time, but everyone’s lives will be better once they’ve learned to do these things.

If you try any of these approaches and have a bad time, I suspect you’d hear, “Well, the payoff is long-term.” Or “You’re seeing bad results because you didn’t apply the method thoroughly enough / early enough.” This is indistinguishable from the method being a bad fit for this family!

“I knew in my heart it was right to stick with this method, and it paid off” is a catchy narrative. I suspect some more common narratives are “I blundered around trying a little of this and a little of that,” or “What I thought was a great method the first time around worked much worse for my second child.” Often we come to something that works by trial and error, not by a leap of faith.

Schools of thought on eating

We’re currently dealing with this on eating. 

I had hoped to raise my kids to eat everything. My parents, and Jeff’s, were of the school of thought: “No child ever starved in the presence of food.” I thought of the toddlers I’d seen in a daycare in Ecuador, calmly eating vegetable soup that American children would likely have refused. (But I also thought of the older children there who didn’t finish their food, and how adults would spoon it into their mouths while the children sat passively, knowing resistance was futile. I never wanted to do that.)

One of our kids had difficulty with eating starting in infancy. Later when we put her in daycare, she was increasingly unwilling to take a bottle for the caregiver, and after a few weeks it was clear we couldn’t just continue hoping she’d change her mind. When she was slow in learning to walk, our pediatrician’s best guess was “not enough calories.” I no longer held out for her eating beans or vegetables; I just tried to get her enough food.

In 2013, the DSM added avoidant/restrictive food intake disorder (ARFID) as a diagnosis. This is essentially a pattern of very limited eating, sometimes because you’ve had a scary experience like choking, sometimes because you’re bothered by the taste or texture of food, and sometimes for no clear reason. 

Last year we realized our kid had stopped growing. We doubled down on making sure she was eating, and her physical growth got better. But she often just hated eating. Eventually we talked to a therapist who said, “This is ARFID and you need a more serious program with nutritional advice.”

Part of me thinks: ARFID seems likely to be somewhat culturally-specific, worse in societies that foster it somehow². I’m sure that the society I live in, known for its emphasis on hyperpalatable foods and accommodating picky children, is a factor. Maybe my child wouldn’t have this if we hadn’t catered to her tastes. But that doesn’t make it go away; I can’t just choose not to live in this society or to have spent the last decade parenting differently than I did. 

I looked to advice that I’d found sensible before, from dietician Ellyn Satter. In her division of responsibility in eating, parents choose the foods and the mealtimes, and children decide whether to eat the food provided. Satter’s advice for ARFID is that parents must take “the leap of faith necessary to let their child do the how much and whether of eating.” “Parents have to remain consistent with [the method] and withstand outside interference.” But after watching my child’s anxiety about food get worse over the last year, I didn’t want to just continue waiting for things to get better.

Instead, we enrolled in a program based on family based treatment for eating disorders. At least for some disorders, parents serve a plate of food to the child and require the child to eat what’s on the plate. The program braces you for things getting worse before they get better: your child will scream that they hate you and will throw food across the room. They say you won’t see improvement in your child’s symptoms until they’ve gained significant weight, because the starving brain can’t think properly. They tell you that insisting on finishing meals is the best way to help your child recover the ability to eat independently.

This sounds pretty scary! Normally if my kid is screaming and throwing things, I don’t take that as a sign of progress. But I think the method is well-supported for anorexia, a particularly deadly illness. There are a lot of areas where I think parents should avoid pointless power struggles with their kids, but anorexia seems worth actually struggling over (if the evidence indicates the struggle will help).

But does this approach really make sense for a child who’s not particularly underweight? How will I know if difficulties worth pushing through, or if the method just isn’t working? We’ll be trying to figure out what parts of the program, if any, make sense for our child’s situation.

I don’t have an answer here, just an acknowledgement that these decisions can be so hard and confusing.

Related:
How much to coerce children?

1. The main point of this approach is not outcomes, though, but treating people right. Advocates would say this is much as you don’t treat your spouse fairly because you think it’ll lead them to develop into a better person, but because it’s the right thing to do ↩︎
2. ARFID also has a significant genetic component, 79% heritable in a twin study. But anorexia is also around 50% heritable, and yet it seems to have not existed in some societies until it was spread there by Western culture. Things can have a genetic component but never get activated. ↩︎