Q&A: How pediatricians can screen for food insecurity
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Key takeaways:
- The AAP recommends that pediatricians screen for food insecurity at all health maintenance visits.
- The idea that every family with food insecurity receives food stamps is a misconception.
In a recent “Patient Page” in JAMA Pediatrics, physicians discussed how families and pediatricians can address food insecurity in children.
“Providing for children has always been a challenge, but parents have had to struggle more to obtain food since the COVID-19 pandemic,” the physicians wrote.
We spoke with one of them, Leila H. DeWitt, DO, MA, an assistant professor of pediatrics at Wake Forest University School of Medicine and pediatric hospitalist at Brenner Children’s, about food insecurity and how pediatricians can screen for it.
Healio: Can you define food insecurity?
DeWitt: Most simply, food insecurity is a lack of consistent access to food in the household. These are families who don't have access to enough food for everyone in the house to be healthy. The reasons for having food insecurity can vary, but not having enough food for everyone in the house is what makes them food insecure.
Healio: Are there any common misconceptions about it?
DeWitt: The first misconception is that everyone with food insecurity gets food stamps, or government access to food, when in reality, many households defined as food insecure actually don't qualify for the nutritional programs, including The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or the Supplemental Nutrition Assistance Program (SNAP), and do often need to rely on community pantries or food drives or soup kitchens to provide food for them and their families.
The other big misconception that I'm very partial to is that food insecurity is an adult problem. We know that about 34 million Americans are food insecure, but 9 million of those are children. With 9 million children in the United States being food insecure, we as pediatricians have a responsibility to identify it and address it to make sure that kids receive the nutrition they need to grow and develop and just overall thrive.
Healio: How can pediatricians screen for food insecurity?
DeWitt: The Hunger Vital Sign tool is the tool that's most frequently used by pediatricians to screen for food insecurity. It's also identified as the gold standard for food insecurity screening. Because it's only two items, it can be done quickly and really easily in the clinical setting. Those two items are, “Within 12 months, we worried if our food would run out before we could get money to buy more;” or, “Within the last 12 months, we bought food that didn't last and we didn't have money to get more.” So, that screening tool with those two items, that's really the most ideal screening tool for us to use.
The AAP does have a formal recommendation that all pediatricians screen and intervene at all health maintenance visits. That means at well-child checks, or routine scheduled appointments for kids, they want pediatricians screening for food insecurity, and they want us to use a validated tool. That's their formal recommendation so that every kid at a well check gets screened, gets referrals to benefit programs and, if needed, care coordinators who can help follow them. A great was produced jointly by the AAP and the Food Research and Action Center, which outlines really nicely how to start screening, how to intervene, and also how to advocate for patients with food insecurity.
Healio: What food assistance programs are available to prevent food insecurity, and what is their status?
DeWitt: The two most important ones are WIC and SNAP. WIC is a federal grant funded through Congress each year, and that is active for families with children aged 5 years and younger. Another big federal nutrition program is SNAP, which is most commonly known as food stamps. SNAP provides electronic benefit transfer cards as vouchers every month that can be used to buy food items for families listed as eligible by the program. Both of those programs are quite strong. There are various ways to check one’s eligibility for WIC and SNAP, but certainly, any health care provider — especially pediatricians — should be able to assist with referral to those programs to help answer if families are eligible.
The third big food assistance program I think people need to know about are the school programs for kids who are eligible for free breakfast and free lunch at school. Those meal programs are great for families with food insecurity, making sure that those kids get fed. What's really wonderful is we've seen those school programs, especially in the height of the pandemic, continue to provide meals through the summer so that when schools are out, those kids with food insecurity still have access to healthy meals for breakfast, lunch and dinner throughout the summertime.
We as providers typically think about food insecurity in the clinic settings. When patients come in for a visit, screen them by asking whether or not they have enough food at home. I'm a hospitalist and I don't see patients in the outpatient clinical setting. What I think people need to understand is that no matter where you're seeing patients, whether it's in a clinic or in a hospital, we should be asking about this because food security is essential to health.
Here at Brenner Children's, my research has focused on looking at food insecurity, specifically in the inpatient setting. We've seen that families — especially parents, and caregivers of kids who are sick and admitted to the hospital — have a really difficult time taking care of their sick child in the hospital, if they can't be taken care of themselves. If you think about a parent or caregiver who's hungry in the hospital and hasn't eaten for a couple of days, it's very hard to expect them to participate in rounding with the medical team and taking care of their child. We're starting to pay a lot more attention, and that's really what my research focuses on: making sure that families in the hospital have the food that they need to stay well, and be able to care for their kids and themselves. Because, really, that’s our shared goal: taking the best possible care of children.
References:
Children’s Health Watch. Hunger Vital Sign. https://childrenshealthwatch.org/public-policy/hunger-vital-sign/. Accessed Oct. 3, 2023.
DeWitt LH, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.3640.
Food Research & Action Center. Screen and intervene: A toolkit for pediatricians to address food insecurity. https://frac.org/aaptoolkit. Accessed Oct. 3, 2023.
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