As pediatric providers we are dedicated to helping children have optimal health. And what could be more basic to health than having enough food? Yet, even in one of the richest countries on the planet, as much as 25% of US families are reported to have “food insecurity.”
What does this mean? The US Department of Agriculture (USDA), the agency tracking and addressing food issues, defines food security as “marginal” when there are one or two indications, typically anxiety over food sufficiency or shortage of food even with little or no alteration of diet or intake. “Low” includes reduced quality, variety, or desirability of the diet but little or no reduced intake. When eating patterns are disrupted and intake is reduced, this is considered “very low food security.” “Hunger” refers to an individual’s physiological state when prolonged, involuntary lack of food results in discomfort, illness, weakness, or pain beyond the usual uneasy sensation. Pediatric researchers include in the definition lack of access to enough food for an active and healthy life. I will use the common term “food insecurity” here.
Children under 3 years old in homes with food insecurity have been found to be sick more often, recover more slowly from illness, and be hospitalized more frequently. Deficiencies in nutrition vary by age, with children under 6 having low vegetable intake and low iron, ages 6-11 excess sugary food intake and lower bone density in boys, and adolescents, although harder to measure, had low iron.
Physical and Mental Effects of Food Insecurity
Associated with food insecurity in the home are more developmental delays in children 4-36 months old. Beyond that, children of all ages have lower cognitive indicators, dysregulated behavior, and emotional distress than those in homes with secure food access. These are persisting deficits: kindergarten children with food insecurity have lower math and reading abilities over at least 4 years.
Dr. Barbara J. Howard
Mental health is also affected by food insecurity. Reviews of multiple studies of children from preschool through adolescence show more child hyperactivity, emotional dysregulation, anxiety, depression, and stress beyond those attributable to their mother’s depression and anxiety. Food insecurity in the early years is associated with mental health issues even into adolescence. School aged children and youth are well aware of the family’s struggle with food access, even when their parents do not realize this. In addition to the anxiety and depression, they may feel shame or be socially ostracized. They may eat less, or choose low-quality foods to cope. Adolescents experiencing food insecurity report greater dysthymia and suicidal ideation. It is unknown whether these mental health difficulties are due to the stress, shame, or decreased intake of macronutrients important to emotional regulation or all of these. One implication is that pediatric providers should also screen for food insecurity as well as other social drivers of health (SDOH) when addressing developmental, behavioral, or mental health issues, not just at well visits.
While we worry about effects for the child, impact of food insecurity on caregivers is significant for parenting as well as adult well-being beginning prenatally. First trimester food insecurity is associated with increased maternal stress at 2 months postpartum and lower bonding scores at 6 months, although this is moderated by social support. The stress of food insecurity and other SDoH present are associated with parental depression, anxiety, and toxic stress, making optimal parenting difficult. Caregivers experiencing insecure food access worry most about their children and may reduce their own eating and food quality to spare the child. More than 30% of families indicated that they had to choose between paying for food and paying for medicine or medical care, jeopardizing their health, making this an important point of discussion for us as well.