Problem:

In the United States hunger remains a problem with far reaching consequences especially when it affects our youngest members of society. Though many would argue that food is one of our most basic human needs, it is something many United States families at times must go without.

According to the USDA, food insecurity is when a household’s access to adequate food is limited by a lack of money and other resources. In 2016 it is estimated that 15.6 million US households (12.3 percent) were food insecure, which is stable from the previous year and down from a high of 14.9 percent in 2011. From 2014 to 2016, the prevalence of food insecurity in Texas was above the national average at 14.3 percent of households. Often in food insecure household adults will go without food to spare children from hunger but in 3.1 million households (8.0 percent of households with children) both adults and children were considered food insecure.

Hunger is a huge problem, especially among children, because the effects of this problem are not limited to the physical sensation of hunger. There are physical, cognitive, and psychological consequences of food insecurity among children. When compared to children in food secure households, children in food insecure households are more likely to:

• have poorer overall health and be hospitalized
• be iron deficient
• have developmental or behavioral problems
• have reduced academic achievement in reading and math

A common misconception is that hunger and obesity exist at opposite ends of a continuum, but in reality hunger and obesity go hand in hand. Children in food insecure households are more likely to be obese as their access to high-quality foods, especially fresh produce, is limited. Often the food that is available to these food insecure families is high in starches and sugars.

 

How Can Pediatricians help?

The first step is to recognize when a child is suffering from food insecurity. The USDA uses an 18-item screening tool to measure food insecurity. A more practical 2-item screening, developed by Hager et al, has a sensitivity of 97% and specificity of 83% when compared to the 18-item questionnaire. This validated 2-question screening tool is recommended for use during routine health maintenance visits and includes the following questions:

• Within the past 12 months, we worried whether our food would run out before we got money to buy more (Yes or No)
• Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more. (Yes or No)

 

Resources for Food Insecure Families

It is important for pediatricians to be familiar with resources available to these families so that when they recognize children in food insecure households, they are able to provide appropriate guidance.

• WIC- Special Supplemental Nutrition Program for Women, Infants, and Children serves pregnant women, breastfeeding women (up to 1 year postpartum), non-breastfeeding women (up to 6 months postpartum), infants (up to 1 year of age), and children (up to 5 years old).
• SNAP- Supplemental Nutrition Assistance Program. Families can qualify for this program based on monthly income.
• National School Lunch and National School Breakfast Program- Provides nutritious meals to students who qualify. In 2010 the Healthy, Hunger-Free Kids Act established the Community Eligibility Provision, which allows schools with more than 40% identified students to provide meals to all students. Identified students are students who qualify for the program because they receive assistance through SNAP, TANF, or FDPIR or students who are in foster care, Head Start, homeless, runaway, or migrant.
• Summer Food Service Program- Provides nutritious meals to children when school is not in session as many students depend on these meals.

Stephanie Trenkner, MD

References

“Promoting Food Security for All Children.” Council on Community Pediatrics, Committee on Nutrition. Pediatrics, vol. 136, no. 5, Nov. 2015, doi:10.1542/peds.2015-3301.

https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/ChildNutrition.aspx

https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/SchoolNutrition.aspx

https://www.ers.usda.gov/webdocs/publications/84973/err-237.pdf?v=42979

https://yourtexasbenefits.hhsc.texas.gov/programs/snap