Aubrey Phelps, MS RDN PPCES IFNCP CLC
Anyone who weans with GIE will hear about DOR, almost from the first moment they reach out to us. Commonly, as families near the end of their tube-weaning journey, they’ll begin to ask, “So, when can we stop doing DOR?”
And the short answer is.... never. And here’s why.
Division of Responsibility isn’t specific to tube weaning. Instead, it’s a philosophy to utilize for as long as your child (and you!) are growing as an oral eater. The premise of DOR is pretty simple: everyone (parents and kids) has a job to do, and no one gets to do anyone else’s job. Caregivers choose what to offer, where, and when to offer it, while children get to choose if they eat and how much.
Expecting kids to decide what’s on the menu is asking too much of a small person who doesn’t have the development to know what’s nutritionally adequate for them and others, and so we leave the grown-up jobs to the grown up, and we make space for your child to develop autonomy around how they choose to fuel their bodies. That’s why your child’s job is to decide what to do with what you offer. Whether it be a bottle, breast, meals, snacks, water, milk, or something else altogether, you are a competent parent who can trust what they choose to offer their child. And this trust applies from birth to whenever your child becomes responsible for making their own meals!
During a wean, DOR is at the core of whether or not the wean will be successful. Almost all tube-fed children, whether they have an oral aversion or not, experience some level of anxiety and distrust around eating. Whether that be because they have had negative eating experiences in the past or eating orally is just completely new and foreign to them. In any case, establishing clear roles and adhering to them is essential to cultivating a sense of safety and control for your child and their eating experience. This safety helps to regulate your child’s hunger hormone system and gives them the confidence to learn how to respond to the cues their body sends.
At its best, though, DOR also takes the pressure and angst off of you, as the parent. You are not a feeding tube. And it is not your job to “get” food into your child. There’s freedom in that!
If you can truly embrace this philosophy and remember that your job ends as soon as the plate hits the table, meals suddenly become much less stressful and much more enjoyable for everyone. So, if you dread sitting down for meals because of the arguing with your child over what to eat, how many more bites, etc., it’s time to come back to DOR.
Yes, we know, DOR is simple in principle, but much more challenging in practice, especially as kids test boundaries, refuse to eat what you slaved over, and are in the middle of a wean where you know they’re getting less and less from the tube. But if you are feeling like every meal is a battle, then come back to the realization that there’s nothing to argue about when everyone does their job. If your child is only eating snacks and fun food, then come back to the realization that you get to choose what you want to offer – and if you don’t want them to eat something, you don’t have to offer it. If you are worried that your child ate less than they “should,” come back to the notion that what comes out of your child (pees, poops, energy, growth) will tell you so much more about their safety than what goes in.
I have four kids, and while meals can be loud and a bit stressful because they can’t stop trying to make each other laugh or practice their loudest bodily functions, there is never really stress over their eating. There are meals when they eat everything and ask for more, and meals when they barely touch a thing and say they’re done within minutes of sitting down. But regardless, my enjoyment of the meal isn’t affected by theirs – not because I don’t care if they eat or because I don’t want them to enjoy what I made, but because I know it’s not my job. I made the meal. I made sure it got on the table when they would normally eat. And now I let them listen to their bodies and eat if they want to and the amount that feels right to them.
And you can do the same.