Child Food Insecurity: What the Pediatrician Should Know

What is food insecurity? Food insecurity refers to limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.1 How many children in California are food insecure? The most recent estimates are that 27.3% - thats nearly a third of children in California are food insecure. Of these, nearly 2/3 are income-eligible for Federal food assistance programs.2 Why should it matter to Pediatricians? Food insecurity has been shown to impact child health even when controlling for other cofounders. Adverse effects occur before the appearance of readily identifiable clinical markers such as underweight. Infants and toddlers ages 036 months are especially vulnerable given the rapid physical growth and neurocognitive development at this stage.3 Food insecure children have been found to have higher rates of self-reported poor/fair health, hospitalizations, irondeficiency anemia, overweight and obesity, and developmental delays.4,5,6,7 How do I screen families for food insecurity? One way is to introduce the topic is to normalize the experience with a statement such as With the economy being so tough, I know a lot of families are having a hard time making ends meet. Then follow up with a question about food insecurity. Positive responses to the following two statements identify household-level food insecurity with a sensitivity and specificity of 97% and 83% respectively. Within the past 12 months we worried whether our food would run out before we got money to buy more. Within the past 12 months the food we bought just didn't last and we didn't have money to get more.8 Where do I send families in need? Many cities throughout California have free summer meal programs, but they are utilized far less than free/reduced price lunches during the school year. For a map of where families in California can access free breakfast and lunch, see: http://www.cde.ca.gov/ds/sh/sn/summersites12.asp Families can also call 1-8663-HUNGRY or 1-877-8-HAMBRE from 9 am 5 pm (EST), M-F and Sat 10 am -2 pm (EST) to get information on local food assistance like food banks and free meals. Applications for Calfresh in English and Spanish are available at the link below. Parents who are not documented but whose children are documented can still apply for food stamps on behalf of their children. Families can also apply on line at http://www.benefitscal.org/ http://www.calfresh.ca.gov/entres/forms/english/DFA285A1.PDF http://www.cdss.ca.gov/cdssweb/entres/forms/Spanish/DFA285_A1SP.pdf The Women, Infants and Children program provides food assistance for children up until age 5 and pregnant women up to 6 months or 1 year post-partum, depending on whether the mom is breastfeeding. To find a local WIC office, families can call: 1-888-942-9675 or go to http://www.apps.cdph.ca.gov/wic/resources/laSearch/search.asp.
Authored by Amy Whittle MD with research by Brett Simchowitz MS4, UCSF
1

Anderson, S.A. (ed.), Core Indicators of Nutritional State for Difficult-to-Sample Populations. J Nut, 1990; 120 (11S): 1557-1600. A report prepared by the Life Sciences Research Office, Federation of American Societies for Experimental Biology for the American Institute of Nutrition under Cooperative Agreement No. HPU880004-01-0, Nutritional Status Indicators of Low-income Populations, with the Office of Disease Prevention and Health Promotion, Department of Health and Human Services. 2 Feeding America. Map the Meal Gap: Child Food Insecurity 2011. http://feedingamerica.org/hunger-in-america/hunger-studies/map-the-meal-gap/map-executive-summary-child.aspx. Accessed February 18, 2012. 3 Feeding America. Child Food Insecurity: The Economic Impact on our Nation. http://feedingamerica.org/sitefiles/child-economy-study.pdf. Accessed 6/11/2012. 4 Zaslow, Bronte-Tinkew, Capps, Horowitz, Moore, and Weinstein (2008) Food Security During Infancy: Implications for Attachment and Mental Proficiency in Toddlerhood. Maternal and Child Health Journal, 13 (1), 66-80. 5 Kirkpatrick, McIntyre, and Potestio (2010) Child hunger and long-term adverse consequences for health. Archive of Pediatric Adolescent Medicine, 164 (8), 754-762. 6 Cook, J.T., Frank, D.A., Berkowitz, C., Black, M.M., Casey, P.H., Cutts, D.B., Meyers, A.F., Zaldivar, N., Skalicky, A., Levenson, S., Heeren, T., Nord, M. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr, 2004 Jun; 134(6):1432-8. 7 Casey, P.H., Szeto, K.L., Robbins, J.M., Stuff, J.E., Connel, C., Gossett, J.M., Simpson, O.M. Child Health-Related Quality of Life and Household Food Security. Arch Pediatr Adolesc Med, 2005; 159: 51-56. 8 Hager et al. Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics. 2010: 126e.