Dr. Lucy Qiao is a retired physician who received her MD degree from Beijing Medical College. Shortly after moving to the United States, she began to explore the field of neuroscience in order to achieve a deeper understanding of her child’s autism. She obtained a PhD degree in Neuroscience at the Baylor College of Medicine and has remained an active participant of the FCSN community to this day. 

In this interview, Dr. Qiao discusses her personal journey as a mother of a child with autism. She shares her insight on the importance of nutrition, as well as her experiences with establishing healthy eating habits and providing a balanced diet for her child. She also offers valuable advice and strategies for other parents facing similar challenges.

*Note: Dr. Qiao’s insights are solely based on her experiences as a parent of a child with special needs; she is not a certified expert in child nutrition.

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What is nutrition? Why is it important, especially for children?

Nutrition plays a vital role in supporting the growth, functioning, and repair of the body. Dr. Qiao explains, “As humans, we have this human body, and it is quite a complex body. There are so many different kinds of organs, tissues and cells. They all need their nutrition to stay healthy, and the body first needs to work constantly, even during our sleep.” In addition, due to programmed cell death and tissue damage from pathogens, body cells must be constantly renewed. “These are all the reasons we need to eat,” Dr. Qiao said. “We need to bring in substance, which is different kinds of food, to provide [for] our energy, [and] to provide the stuff to renew, rebuild, and repair our body…For younger people like a kid or infant, then they will need additional stuff to grow because their body is growing. That’s why youngsters’ nutrition is even more important.”

According to Dr. Qiao, the key to a healthy diet is balance and diversity. “It is really necessary to have a balanced food intake to be able to maintain our physical and mental health. We need to have good food, and…the key emphasis would be ‘balanced’ and ‘diverse,’ so not emphasizing one category versus the other. The more diverse, and our [bodies] can pick up what they need. If you don’t have one category of food, you can get sick.”

Picky Eating and Overeating

Having worked with both picky eating and overeating, Dr. Qiao has substantial experience working with the two extremes of the eating spectrum. Her son grew up as a picky eater, but he now struggles with overeating. “For our normal kids, you can reason and talk to them and persuade them to try new foods…[also,] they won’t eat too much. They try to stay in good figure because they have self-awareness. However…a lot of [kids with special needs] may not have that kind of awareness, and it will be more challenging to teach them what is essential. They don’t understand the rationale behind it.” To encourage healthy eating habits, she recommends reinforcing simple statements such as “This is not good. You can get sick” or “That’s not healthy. Do not drink that.” Dr. Qiao also finds that placing daily intake restrictions on unhealthy foods or drinks can be helpful. Her son loves sugary sodas, so Dr. Qiao gradually helped him eliminate them from his diet in order to reduce his daily sugar intake.

Whether dealing with picky eating or overeating, Dr. Qiao encourages parents to break goals up into small steps until the child accepts them little by little. For picky eating, “the first thing you want to do is encourage [your child],” Dr. Qiao said. “Just maybe [the] tip of the chopstick or spoon, put [food] on his tongue, and then, ‘Oh, that tastes good,’ and then reward him.” Dr. Qiao also recommends cutting food up into small pieces until the child can no longer recognize it as a food they dislike, as well as pairing unfamiliar foods with their favorite food.

For overeating, it may help to teach your child fullness cues by asking them if they are full after a large meal. “I will ask, ‘[Did] you have enough food?’” Dr. Qiao said. “You repeatedly [ask] him…so now he will say, ‘No more.’ So it’s very important to…know not only [a] good, positive relationship with food, but also know when to stop.”

Another important consideration is that many children with special needs have gene mutations associated with food allergies or intolerances. Dr. Qiao recommends finding a way to regulate the condition or consuming food alternatives that provide the same nutrients. For example, a child who is lactose intolerant can receive calcium and protein from other types of milk, such as soy milk or oat milk. Alternatively, there are liquids designed to break down lactose in milk and over-the-counter tablets that help suppress symptoms of lactose intolerance.

Hunger Cues

Recognizing hunger cues can be difficult for children with special needs. They often experience “trouble [describing] their own feelings,” according to Dr. Qiao, which includes “not just hunger or fullness, but also pain.” Similar to overeating, Dr. Qiao trained her son to recognize hunger by asking him if he was hungry when she knew his stomach was empty. “[For] autistic kids, a lot of the time, you really have to give the word or give them the concept into their mouth for them to accept [it],” she said. 

Moderating the timing of hunger cues can also improve hunger recognition. Dr. Qiao explains that pairing signals together in conditioning, such as ringing a bell before mealtimes, can stimulate hunger. “After training [for] a long time, you ring the bell, and the GI [starts] secreting all those digestive enzymes…your mouth [starts] watering. You say, ‘I’m hungry.’ That’s conditioning training.” In addition, establishing a regular eating schedule is a very healthy habit, according to Dr. Qiao. “It is not healthy if you [do] not eat for a long time and become so hungry, and then eat a big portion. That’s unhealthy as well. You’re stretching your body’s ability to digest food…because your body signal in the brain has not gotten there yet. Your brain [is] still sensing [hunger], so that actually will disrupt normal…After [a] long time, if you keep doing that, you can get [sicknesses] such as diabetes.” 

In summary, it is possible to help children with special needs to establish and recognize appropriate hunger and fullness cues. Parents can reinforce these concepts through questioning, setting designated meal times, and pairing signals with hunger. For children who are picky eaters, parents can make new food experiences more manageable by cutting foods into smaller portions or combining them with their favorite foods. Implementing these strategies will not only promote a positive relationship with food, but will also prevent illnesses caused by unhealthy eating habits. 

“It is challenging long-term, but I think we just have to keep working and helping the special kids…to make sure they are healthy,” Dr. Qiao said. “Each individual is different. [There is] not a recipe or protocol that works for all special needs kids. We will have to find out what works for our kids.”