COVID-19 and meals for low income children

The coronavirus has become a hot topic. No breaking news there. Everyone is doing their best to protect the overall population health, I have no doubt. A lot of times when we make broad sweeping changes, however, we forget about the unintentional consequences. I heard today that a local school district is cancelling classes for at least a week. At first glance, this falls in line with every other major institutions’ decisions the past week. We most likely forget, however, that a large proportion of our school-aged children rely on school attendance to receive 2 meals per day.

Thankfully there have been proposals to aid during this difficult time to feed children who are reliant on the school system for meals. States can request waivers from the USDA to continue providing meals, with Texas recently drafting its own. I recommend to local pediatricians to advise families to contact their local school districts to inquire about meal assistance programs. I also recommend contacting your Congressional House of Representatives member asking to expand the SNAP food assistance program during this difficult time.

Zachary Stone, MD


New “Public Charge” Rule: How does it affect our patients’ families?

Texas is home to approximately 4.7 million immigrants (an estimated 17% of the state population), including approximately 317,000 immigrant children1. Of these immigrants, approximately 1.7 million are naturalized US citizens, nearly 1 million are eligible to become naturalized US citizens, and nearly 2 million are undocumented immigrants1,2. The number of US-born children in Texas who live with an undocumented family member is reported to be approximately 1 million, with approximately 500,000 children with an undocumented parent1,3. Obtaining permanent residency status is a lengthy process and a source of anxiety for many immigrants. Recent changes to the US Department of Homeland Security (DHS) rules regarding which public benefits count negatively towards obtaining permanent residency may impact these families and children. Pediatric healthcare providers should be prepared to help immigrant families understand how the use of public benefits could impact changing their immigration status.


The New Food Label Delay and the Importance of Added Sugars

It is important for pediatricians to show parents how to recognize added sugars in their children’s diet and stress the importance of limiting them. New and improved food labels could facilitate this kind of nutrition counseling. In May 2016, the FDA issued a rule changing what needed to be included in nutrition food labels. Originally, companies were expected to be in compliance by July 2018, just last month.1 However, many groups rallied against the new food labels, including the Sugar Association, the American Beverage Association, the Corn Refiners Association, and the American Bakers Association, to name a few.2 One part of the nutrition label that was criticized by these groups was a new section underneath “Total Carbohydrates.” This section will inform consumers about the quantity of added sugars in each product. However, the deadline has now been pushed back until January 2020 for food companies with revenue greater than 10 million dollars in food sales and until January 2021 for those with revenue less than 10 million dollars in food sales. Many of the public comments under the bill proposing the new food label came from industry groups who pointed to a lack of scientific research demonstrating intrinsically harmful effects of sugar.3 (more…)

Food Insecurity and the Pediatrician’s Role in Fighting Hunger


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. (more…)

Call for comments to help FDA with providing nutrition facts to consumers.

An average American is approximately 15 pounds heavier compared to 20 years ago. Height, however, has stayed relatively constant, meaning that our BMI’s are increasing. Unfortunately, children are not immune to this observation. An average 11 year old female has gained more than 11 pounds, and an average 11 year old male has gained more than 13.5 pounds over the past 20 years, leading to the “childhood obesity epidemic” we often hear about in the media. To combat the skyrocketing weight trend, we should write comments to help pass regulations which will increase consumer awareness of various foods’ nutritional values. (more…)

How Much Salt is Too Much?

Doctors continue to endorse eating a low salt diet but patients remain confused on what exactly this means. Even experts cannot seem to agree on how much salt is too much; the American Heart Association, the Dietary Guidelines for Americans, and individual research groups all propose different recommendations for daily sodium intake. Furthermore, the American Academy of Pediatrics recommends to “use small amounts of sugar, salt, fats, and oils with highly nutritious foods to enhance enjoyment and consumption,” but the AAP does not quantify these amounts. It is difficult for patients to implement these recommendations without knowing exactly what they are. Regardless of the varying recommendations, the majority of research endorses that high sodium intake in children is a cause for concern. Thus, pediatricians should provide patient education for lowering sodium intake early in life, as research shows that preference for sodium is shaped by dietary exposure.

 The American Heart Association (AHA) recommends a maximum amount of 1,500 mg of sodium a day for all people regardless of age. However, the average child ages 2 through 19 eats more than 3,100 mg of sodium per day, more than twice the daily recommendation, according to the AHA. School-aged children consume most of their sodium at lunch and dinnertime, and processed and restaurant foods make up 83% of the sodium kids eat. The sodium is already contained in the foods kids are eating: it is not being added from the kitchen salt shaker. This is frightening because it presents a challenge to parents who may not pay attention to the sodium content of foods and who cannot take it out of the processed foods which they purchase.

High sodium intake is associated with high blood pressure which is a major risk factor for heart disease. High blood pressure also increases the risk of heart attacks, strokes, and heart failure. Heart disease is considered the leading cause of death worldwide, according to the AHA. Some research suggests that reducing sodium intake may lower blood pressure in some individuals while actually increasing blood pressure in others. In addition, this research tends to shift the blame from sodium to sugar as the true culprit behind heart disease. The AHA continues to endorse that the connection between sodium consumption and health adversities, and it recommends that Americans should lower sodium consumption for better health outcomes.

Pediatricians should provide resources and guidance to parents about monitoring and reducing as necessary a child’s consumption of sodium. The AHA’s How to Reduce Sodium article and the CDC’s section on salt ( provide further information on how to decrease the amount of sodium in food consumption.

Additionally, pediatricians should take action to encourage food companies to reduce the sodium content in their products, because more than 80% of sodium intake comes from the consumption of pre-packaged and restaurant foods. The Food and Drug Administration (FDA) has announced a draft voluntary guidance, “Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations in Commercially Processed, Packaged, and Prepared Foods,” and the agency is asking for public comments for it. The guidance will offer voluntary goals to reduce the amount of sodium in certain categories of processed and other foods. Electronic or written comments for the guidance must be submitted by August 31, 2016 for four issues and by October 31, 2016 for four other issues, all listed as questions in the announcement in the Federal Register. You can access the draft guidance through the FDA’s website here.

Rija Siddiqui, MD


“AAP Recommends Whole Diet Approach to Children’s Nutrition.” American Academy of Pediatrics. February 23rd, 2015.

“High Sodium Intake in Children and Adolescents: Cause for Concern.” Center for Disease Control and Prevention. March 2013.

“Sodium and Kids.” American Heart Association. 2016.

“Sugar Versus Salt: Which Has the Greater Impact on Your Heart Health?” Forbes. March 2015.

September is AAP’s National Obesity Awareness Month — Get Involved!

September serves as the AAP’s National Obesity Awareness Month—an appropriate occasion for pediatricians to take a more active role in combating childhood obesity. Pediatric obesity has increased two to three fold over the past several decades in the US (more…)

Help Update Nutritious Meal Pattern Requirements for Young Children

A proposed federal rule accepting comments until April 15, 2015 proposes changes to meal pattern requirements for young children served by the Child and Adult Care Food Program (CACFP) to better align with updated nutrition guidelines. Several proposed revisions would extend to affect the National School Lunch Program, School Breakfast Program, and Special Milk Program to be more consistent across all Child Nutrition programs, as well as move toward more nutritious meals for children in day care.  (more…)

Breast is Best!

Breast feeding is the best thing mothers can do for their babies at the beginning of life. However, many mothers cannot breast feed for long as they must return to work to support their families. Let’s provide all mothers with breast feeding education, lactation support and equipment so that our kids will be healthy. (more…)

Update: Protect Key Programs Critical to Child Nutrition

In a previous post on June 23, 2014, Dr. Michelle Ting highlighted H.R. 4800 (Sec. 739), the U.S. House bill concerning the Agriculture Department’s 2015 FY budget. Dr. Ting explained that the bill threatens to weaken federal child nutrition programs by creating a waiver from compliance with current nutrition requirements for schools that are able to demonstrate a net loss, for at least six months, from operating a food service program. With many children receiving as much as 50% of their daily caloric intake from meals at school, school nutrition standards play a large role in reducing the rate of pediatric obesity. (more…)