Screening for Food Insecurity Can Get Kids Help Earlier

When you think of common sources of stress for children, it could be trouble at home, a hard time keeping up in class, or difficulty making friends. But what about something as basic as food insecurity?

Millions of U.S. children live in homes where they're unsure of where their next meal will come from. Some primarily get food from child care centers or in school. Kids who don't have adequate nutrition face an uphill battle when it comes to their health, now and into adulthood.

It's no surprise, then, that pediatricians have historically been strong advocates for increasing access to nutritious food through federal, state, and local assistance programs. In October, the American Academy of Pediatrics (AAP) released a report about children living in food-insecure homes and urged pediatricians to screen all children. The AAP's hope is that, by screening families, pediatricians can help connect those patients to resources to address related health problems early.

The Problem

The United States Department of Agriculture (USDA) defines food insecurity as occurring in households in which "access to adequate food is limited by a lack of money and other resources." These households aren't limited just to people living in poverty. The problem is more widespread, and many people with lower incomes -- but not low enough to qualify for assistance -- still struggle to afford enough healthy food for their families. You may not be able to tell just by looking which patients are dealing with hunger.

According to the AAP's report, about 60 percent of food-insecure households had incomes below the qualifying level for food assistance programs ($44,093 for a family of four). About 30 percent of families above that income level still faced trouble with access to enough quality food.

Environment is also a factor: People who live in poorer communities tend to have fewer full-service grocery stores and a lot more fast-food restaurants. Food pantries and other food services strive to offer people healthier options, but they are limited by donations and money.

Health Problems

Because of those challenges children from food-insecure homes are more at risk for health problems. According to the AAP's report, these include:

• Poorer overall health.
• More hospitalizations.
• Iron deficiency.
• Lower bone density in preadolescent boys.
• Higher risk of obesity.
• Dysregulated behavior.
• Emotional distress.
• Lower academic achievement.
• Malnutrition that leads to health problems in adulthood.

The Pediatrician's Role

The pediatrician's role has expanded over the years, moving beyond just keeping a child free from disease. The Institute of Medicine in a 2004 report defined children's health as "the extent to which individual children or groups of children are enabled to (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities to allow them to interact successfully with their biological, physical, and social environments."

The AAP and other groups view pediatricians as clinician-advocates. An article in the American Journal of Public Health argued that "advocacy to ensure environmental health and to protect from the biological embedding of toxic stress has become a fundamental part of pediatrics."

Those authors, as well as the AAP, suggest that physicians need to be more comfortable asking parents about obesity, breastfeeding, nutrition, and environmental and mental health. That includes asking all patients whether they have enough food.

Recommendations

The AAP provides recommendations on how you can screen for food insecurity and what to do next:

• Use a screening tool. The USDA has an 18-item screening tool that you can use in the office. However, the AAP recommends a condensed tool with two statements that patients can answer with a simple yes or no: "Within the past 12 months, we worried whether our food would run out before we got money to buy more," and "Within the past 12 months, the food we bought just didn't last, and we didn't have money to get more."
• Refer families who screen positive to resources. Have a general understanding of supplemental food programs such as SNAP, WIC, summer feeding programs, and school nutrition programs. Also, learn about food banks or service organizations nearby that provide food to children and families. The USDA offers a list of resources for how to find local food banks, enroll in assistance programs, and take advantage of other organizations.
• Address health factors related to food insecurity at checkups. Although you aren't able to solve their food problem, you can be prepared to address health problems early. This may mean helping families better understand nutrition and develop strategies to avoid unhealthy options, such as fast food, that tend to pervade low-income communities. Share USDA tips on eating healthy with SNAP benefits, among other resources.
• Advocate for increased access to nutrition assistance programs. Also, advocate for keeping foods in school lunch and other food programs as healthy as possible.

Food insecurity is a complex issue affected by numerous social factors. Pediatricians play a critical role in recognizing the problem and the health implications, as well as advocating for improvements.