Why Autonomy is the Missing Piece in Paediatric Feeding Therapy (And How to Support It)

When we think about feeding therapy, we often focus on oral motor skills, sensory experiences, or nutrition. But one of the most overlooked yet critical elements is autonomy.

Children don’t just need to learn how to eat; they need to feel in control of their eating experiences. Without autonomy, even the best therapy strategies can fall flat. In the Circles to Feeding™ Approach, autonomy is a key foundation for moving toward Feeding Freedom – where mealtimes feel safe, nourishing, and free from pressure.

So, how do we respect a child’s autonomy while still supporting their progress? Let’s explore why autonomy matters in feeding therapy and what it looks like in practice.

Autonomy & The Division of Responsibility (DOR)

If we want to support autonomy, we first need to make sure we’re giving children the space to make decisions about eating—and that starts with Division of Responsibility (DOR).

The DOR model, developed by Ellyn Satter, is a simple but powerful framework that helps define the roles of the parent and child in feeding.

[H3] How does it work?

👩‍👦 The Parent’s Role:

• Decides the what, when, and where of feeding (structure).

👶 The Child’s Role:

• Decides how much or whether to eat (autonomy).

This balance helps children develop trust in their bodies, their caregivers, and the eating process itself.

What happens when this balance is disrupted?

❌ Parents cross the line into the child’s role.

• They pressure the child to eat a certain amount or try a specific food.
• The child resists, leading to stress and power struggles.

❌ Children cross into the parent’s role.

• They demand specific foods or dictate the structure of meals.
• Parents feel stuck in a short-order cooking cycle.

The key takeaway?

When children have control over their own eating decisions within a structured mealtime, they are more likely to develop positive relationships with food. In the Circles to Feeding™ model, this balance supports a child’s comfort—helping them feel safe and confident at mealtimes.

Autonomy & Pressure in Feeding

Pressure is what happens when a child loses autonomy over their eating experience—whether real or perceived.

It’s easy to see how this happens:

• A parent tells a child to "take another bite."
• A therapist repeatedly encourages a child to interact with food, even when they hesitate.

On the surface, these might seem like small things. But to the child, it feels like their control is being taken away.

What happens when autonomy is lost?

📌 A parent tells a child to “take another bite.”

• The child experiences pressure and a loss of control.
• They may refuse to take another bite or become more frustrated.

📌 A therapist encourages a child to touch a food repeatedly in play.

• The child may feel uncomfortable with the expectation to touch the food.
• They experience pressure and loss of autonomy.
• They either resist or reluctantly engage, but may lose trust in the therapist.

What can we do instead?

• Create an environment where ‘no’ is respected—verbally or non-verbally.
• Support curiosity, but don’t push a child beyond their comfort zone.
• Model interactions with food without expectations.

When a child feels safe and in control, they are more likely to engage with food on their own terms. This is why autonomy is a foundational piece of the Circles to Feeding™ approach—it helps children feel safe enough to explore food at their own pace.

Autonomy & Separation-Individuation

We can’t talk about autonomy in feeding without considering a child’s developmental stage. This is where Separation-Individuation comes in.

What is Separation-Individuation?

This is the psychological process where infants and toddlers begin to understand themselves as separate individuals from their caregivers.

It typically begins around 6-12 months and continues into toddlerhood. During this stage, children naturally seek more control over their actions—including feeding.

What does this look like in feeding?

📌 A typically developing 10-month-old suddenly refuses spoon-feeding.

• Parents become concerned and try harder to feed the child.
• The child resists even more (because they are trying to assert autonomy).

What can we do instead?

• Give the child their own pre-loaded spoon and let them attempt to feed themselves.
• Offer opportunities for self-feeding with soft finger foods.
• Respect their refusal and adjust strategies accordingly.

This simple shift honors autonomy, supports a child’s developmental drive for independence, and fosters positive experiences around food.

How to Support Autonomy in Feeding Therapy

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Supporting autonomy doesn’t mean letting children “do whatever they want” with food. It means guiding them in a way that builds trust, curiosity, and confidence.

Practical Strategies to Encourage Autonomy

• Respect refusals—If a child turns their head away from a food or says, “I don’t want to try that,” acknowledge and honor their choice.
• Avoid pressure—Even subtle forms of pressure, like praise (“Mmm, yummy!”), rewards, or repeatedly encouraging food interaction, can undermine autonomy.
• Allow children to engage with food on their own terms—Provide opportunities for playful exploration without expectations.
• Adjust support based on the child’s needs—Some children need extra sensory or motor support, but that doesn’t mean we should override their control.

Final Thoughts

By empowering children instead of overriding them, we set them up for long-term feeding success. Feeding Freedom happens when children feel safe, respected, and supported in their feeding journey.

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