December brings so many family traditions and celebrations, many of which center around food and meals. These celebrations and traditions can be burdensome financially, especially for families with limited income. One in six children in the United States live in a household with food insecurity. According to Feeding America, approximately 16% of children in Illinois face food insecurity. For these children and families, the holiday season may be a difficult time to navigate given the added demands that may impact food insecurity. Parents may face increasing pressures to provide for their children during the holidays, increasing risk for their own anxiety, depression or toxic stress.
The American Academy of Pediatrics and the Food Research and Action Center have a toolkit for addressing food insecurity in the pediatric practice. Screening is key to identifying these families, as it is difficult to determine if a family or child is hungry through observation alone. There are some risk factors in families that contribute to the likelihood of food insecurity that include:
- Rates for African-American and Hispanic families are above the national average for food insecurity
- Rural areas have higher rates of food insecurity in comparison to more urban areas
- Unemployment and underemployment are related to food insecurity
- Large families, divorce or separated families, immigrant families and families headed by single women are more likely to face food insecurity
Food insecurity can have a significant impact on children and adolescents. It has been linked to developmental, behavioral and mental health issues. Food insecurity impacts children throughout their growth and development. Children three and younger who face food insecurity have higher risks of developmental delays than their food secure peers. Food insecurity in kindergarten children was found to impact future academic achievement. In adolescence, food insecurity has been associated with dysthymia and suicidal ideation. Finally, food insecurity throughout childhood has been found to impact adulthood, including risk of diabetes and cardiovascular disease.
Discussing food insecurity may be a difficult subject as parents or caregivers can experience shame, embarrassment and most likely try to shield their children from the family’s struggles. It may be beneficial to screen the parent or caregiver outside of the presence of the child. Children’s Health Watch developed a two item screening tool, Hunger Vital Sign, that can be used with ease in the pediatric office.* The tool is free and has been validated for use with youth, adolescents and adults.
Once food insecurity has been identified in a family, there are things that can be done to help. Assistance programs are available such as the Supplemental Nutrition Assistance Program (SNAP) and the National School Lunch Program. Normalizing the family’s situation by saying that most people throughout Illinois and the county need help at some point may reduce the stigma associated with these programs. There are posters available that can be hung in offices and waiting rooms to help provide information and education to families. The FRAC Toolkit also has additional information about how to institute screening and intervention for food insecurity in your practice as well as suggestions on how to talk to families, providing information about food bank resources or even setting up a food pantry in the office. While there is an increasing burden on primary care providers to complete multiple screens during limited time for patients, Illinois DocAssist can assist providers in prioritizing the need for their patients and families through consultation.
*Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.