An Interview with Cecillia Sun, Registered Dietitian (RD)

FCSN Voices has recently initiated a series of interviews with Cecillia Sun, Registered Dietitian (RD), on the important topics related to nutrition for children with special needs. In this interview, Cecilia provides helpful tips to parents of picky eaters (ages 2-12).

What might be some common reasons behind picky eating? 

Picky eating is an issue of concern to many parents whether their children are autistic or not. It is noted that children with autism often have a harder time enjoying foods compared to their peers. Studies have indicated there are possible reasons behind picky eating among children with autism. It could be any of the following reasons:

1. Medical problem: gastrointestinal discomforts such as constipation, diarrhea, acid reflux etc. If food causes discomfort, the child will very likely refuse to eat it.

2. Oral motor skills: if the child has less muscle tone and poor motor coordination, the child may have chewing and/or swallowing difficulty. The child may eat only soft foods, and refuses to eat crunchy foods.

3. Sensory processing issues with food: the child may have particularly strong likes and dislikes in terms of smell, tastes and texture of certain food.

Are there any examples of creative food replacement for foods a picky eater will not eat?

Be creative with recipes. When introducing a new food to a child, you can combine it with foods that the child likes and is familiar with. For example, if your child likes macaroni and cheese, but dislikes carrots, you may try to introduce bite-sized pieces of carrots mixed in with macaroni and cheese. Later, when your child accepts carrots you may increase the size of the carrot pieces, and/or place the carrot separately.

Picky eaters often have deficiencies in certain nutrients because of their eating habits. What should parents look out for to make sure certain eating habits do not cause serious medical issues?

A “food journal” is one of the best tools to help parents and professional medical teams to assess if a child’s nutrition is adequate, or if a child’s diet is deficient in certain nutrients, vitamins and minerals. Keep a food journal to record the child’s likes and dislikes, food tolerance/intolerance, percentage of meal consumption (both solids and fluid) daily, and whether the child is eating balanced meals. A balanced meal comprises different food groups: protein, grains, vegetable, fruits, healthy fat, and water. When a parent notices a child’s picky eating behavior becomes more often and severe, parents may need to work with a pediatrician, a dietitian, and a behavior therapy to manage the child’s nutrition needs. As we know, prolonged nutrition inadequacy and imbalance may increase the risk of later chronic medical conditions.

Should parents buy supplements?

I would highly recommend parents consult with their pediatrician first prior to the initiation of any over-the-counter dietary supplements. Pediatricians might want to do blood work and run some lab tests on the child to assess if there is a nutrient deficiency, and then add supplements accordingly, if needed. Each child is different. I would not advise parents to buy supplements without consulting with a pediatrician first. 

Is there any other advice that you want to emphasize and share with parents of picky eaters? 

Here is some advice I would like to provide:

• Parents should make mealtimes relaxed, pleasant and positive. Make sure that your child is well rested before eating the meal. Try to minimize distractions, for example, turn off TV or iPad. 

• Be patient with your child and take baby steps. Even when a child rejects a food, you can circle back and try to offer the food later. 

• Praise your child when she or he tries a new food. For example: “Wow! Super job trying those carrot bites!”

• When a child is age appropriate, involve your child in meal preparation. Your child might be excited to participate in food preparation, and this participation may promote more adventurous eating. 

• Consider modifying the texture of the food your child avoids, such as chopping, blending or mixing with other foods. For example, instead of serving crunchy fresh tomatoes with pasta, cook the fresh tomato down to tomato sauce and serve on pasta. 

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Cecillia has been a RD for over 30 years, working in various medical fields and institutions. She has been a clinical dietitian in the Cardiac Rehab, ICU/ CCU, Obstetric/Pediatric, and surgical/oncology departments of various hospitals. She has assisted bariatric physicians, doctors who specialize in helping patients lose weight with surgical intervention. She was a dietitian consultant for Regional Center of East Bay (RCEB). Currently Cecillia is a level 3 renal dietitian at Davita Dialysis Center. Cecillia received her B.S. degree from University of Georgia and her M.S. degree in Nutrition Science from the University of New Haven.