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The Satter Method & Sick Kids

The Satter Method & Sick Kids

By Amalah

Hi Amy! Long time reader of both this column and your blog. I’ll just dive right into my issue:

T just turned four (we also have a ten month old), and for the last two years we’ve struggled with the food thing. We’ve been doing this Satter thing, albeit imperfectly (our work schedules make regular family dinners challenging), and we have seen minor improvement.

We’ve also been struggling mightily with potty training (he’s still fully in diapers). We finally figured out that the real culprit here is idiopathic constipation and encopresis. We got an abdominal x-ray and little buddy has a fecal impaction and is backed up six ways to Sunday. We suspect he’s been constipated for ages, at least a year, but possibly since he fully weaned at 21 months. Poor little dude.

Besides the obvious issues this causes, it can also cause stomachaches and alter appetite. I’m thinking our meal problems may not really be power struggles at all, but that he’s just too full of poop to fit any food inside. Of course he doesn’t want to eat when he feels awful all the time!

Anyway, now we know what’s going on and we have a treatment plan. However, this involves buttloads (ha!) of laxatives and trying to get lots of mineral oil into him with his food. Which he doesn’t eat. Because of course. So I’ve been going rogue lately, letting him eat whenever he will because I’m trying to get his meds into him, and also because I know his appetite is all out of whack from his constipation. But now I’m worried I’m ruining his food habits again before we even got them fixed, and help me please!

– FOS, literally

Yeah, I think the specifics of your situation require some input from a medical professional. I would HOPE that in light of your son’s diagnosis, his doctors gave you some guidance on diet and how it might fit into a long-term treatment plan. If they did NOT (or if it was completely unrealistic/unhelpful), find a dietitian. Preferably one who specializes in young children with medical issues. Ask your pediatrician for help finding one. A lot of children’s hospitals have programs for kids who need therapeutic diets or have other eating/feeding challenges. Your son might qualify for one given 1) how long his issues have been lurking. and 2)  your ongoing difficulties in getting him to eat pretty much anything, much less the kinds of high-fiber foods he’ll need to prevent the issues from returning/continuing.

(I repeat: a DIETITIAN. Not a nutritionist. Here’s a rundown of the differences between the two.)

I SUSPECT, though, that while a dietitian will be helpful, they will echo some of what I’m about to say: Just do your best. Do what you can. Getting his meds into him is Priority One right now. Calories (in whatever form he’ll take ’em) is probably Priority Two. At some point, once the current impaction is worked out, you’ll want to focus on a therapeutic diet high in the right kind of fiber and enough nutritional variety to prevent another one. (And if you need to get the fiber and nutrition in him via sneaky methods, like smoothies and hidden veggies/supplements in kid-acceptable dishes, SO BE IT.)

But the ability to have him sit at the dinner table and eat whatever you put in front of him without question? Yeah. That can probably stay low on the list for awhile.

Your little guy still isn’t feeling 100%. He probably doesn’t even remember what it’s LIKE to feel 100%. For a long time, he’s likely equated food and eating and meals with feeling sick and bloated and yucky. That’s going to take some time to undo. Remember that the #1 step/goal of Ellyn Satter’s method is to MAKE MEALTIMES PLEASANT. Your son’s poor little body has made this all but impossible for a very long time.

So I would step back and focus on making food in general to be something pleasant for him. I’d  personally probably pause the Full Satter goal until he’s feeling better, but again, a dietitian will probably give you more informed guidance.

At some point in his life, he’ll be mature enough to grasp that while he would love to eat nothing but overly ripe bananas and white rice, these foods don’t agree with him and make him feel yucky. Little kids seem to lack this cause-and-effect understanding, unfortunately. So I’d eye his current “acceptable” foods for opportunities to sneak in extra fiber and vitamins, Sneaky Chef style. (If you haven’t bought any of the Sneaky Chef cookbooks, do it. We eat most of our meals as a family but when I do make “kid dinners” I absolutely employ her techniques to boost the nutritional content of kid-friendly fare.)

But at the end of the day, if you’ve managed to get his medicine and a somewhat decent amount of calories into him (and managed to do both without a power struggle), consider it a success. Even if the calories were mostly nugget-based and the medicine went down with a spoonful of sugar. (Solid advice from OG Mary P.)



Published August 14, 2015. Last updated August 14, 2015.
About the Author

Amy Corbett Storch


Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to [email protected].

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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  • leslie

    August 14, 2015 at 1:43 pm

    So one of my best friends went through this very same thing with her daughter. Severe constipation. Potty training issues as a result. Just like your son. They (and their ped) decided the best approach (and I don’t say this to scare you but encourage you) was to check her into the local children’s hospital for a couple of days and administer several enemas. She was four at the time, just like your son. It sounds dramatic, but it was actually a huge blessing, as it got rid of all the back up in short order without them having to deal with all the miralax and getting oils into her food, etc. And she did great with it. They do such a great job of making kids feel really special at hospitals. So, if you continue to struggle with the current treatment plan, or if it doesn’t end up helping, there are definitely alternatives. And I agree with Amy (and you!) 100% on letting go of the Satter method for now and just focusing on getting him to eat anything and be comfortable and happy. Don’t stress about any sort of method until the bigger issue is taken care of. I don’t think you’re ruining his food habits. Once the constipation is relieved, I bet that kid will be eating like gang busters!! Good luck!

  • Myriam

    August 14, 2015 at 1:51 pm

    I’d even add that Satter’s method is “you choose when and what, they choose if and how much”. Nothing is preventing you from choosing food that will help you make sure he takes his medication. You are allowed to choose his favorite food and serve that for dinner! Don’t make him a separate meal, jut put all the food on the table, including the grown up option and the “acceptable” food you know he will eat. Let him choose whatever food he wants. Also, just a quick question? Have you read Satter through or just know the general guidelines? If you haven’t read her cover to cover, I’d suggest you do. I’m pretty sure she addresses that somewhere!

  • Sabrina

    August 14, 2015 at 9:13 pm

    As a dietitian I just want to say thanks Amy for referring people to my profession 🙂

  • Melinda

    August 15, 2015 at 11:44 pm

    As a side note, I tried to find the Satter book and found a bunch… which should a newbie with a baby get nd read?

  • Lexi

    August 16, 2015 at 3:06 pm

    You can also get him involved in preparing vegetables and fruit for dinner and snacks as a way of getting him familiar with the look, texture and smell of this healthy foods before introducing them all at once as his new diet. He might be more open to trying small bites of new foods while he learns how to prepare them without it being too much of a change until he feels better. This could also make mealtimes more fun/pleasant for him as he gets to be responsible for a side dish that he’ll be proud to serve everyone.

  • S

    August 16, 2015 at 7:53 pm

    We had a similar problem. We worked with a pediatric gi for several years. My son still has a diet plan for school. We had to stabilize the situation with meds first, then a planned diet. We had to use pediasure to get vitamins and calories. We also discovered he had severe gerd and food allergies which are also controlled with meds and diet. It gets better. Find the right specialists. Speech pathologists and occupational therapists work on feeding issues after kids are medically cleared. There is a great program out of a hospital in Southern California and another in Philadelphia. Check the American speech language hearing association. These facilities treat as a team with psychologists nurses dr slp ot and dietician for a comprehensive approach for the family. They call it the picnic program meeting twice a week for therapy. They treat the most severe cases and take children on referral. They will sometimes collaborate via telepractice with your providers. We meet with our specialists every six months now for med reviews. Look up childrens feeding centers. Hugs. 

  • margie s

    August 18, 2015 at 12:58 pm

    Been there, done that. Try mixing the mineral oil emulsion in chocolate milk. Lestoil for the inevitable oily stains on the underwear. And keep in mind that this child may have a tendency to constipation any time the routine changes – camp, grandparents house, vacation. Good luck to you both!

  • S

    August 19, 2015 at 9:38 am

    Different feeding issues here (autism stuff, failure to thrive), but yes, it’s easy to just ask for a dietician and yes, do it.