One morning, a young child arrived at our pediatric hospital emergency room with abdominal pain and vomiting. I was going about my normal interview and physical, when the mother asked for some crackers for her two other children, as many parents with multiple kids in tow do while waiting for treatment. I gave them the crackers, and about an hour later she asked for cereal for her kids as well. I didn't think anything of it and gave them the cereal.
Just before the family was discharged, the mom said she wasn't very familiar with this part of town and asked if there were any food banks and shelters around. I was honestly floored. The family was so well dressed and put together, I never would have suspected they were homeless and hungry.
I was reminded of this encounter as the American Academy of Pediatrics (AAP) released its recent policy statement, "Promoting Food Security for All Children," which addresses the fact that one out of every five U.S. children lacks access to enough food. If this mom was not advocating for her children—and many families are reluctant or embarrassed to do that in the medical setting —they may have gone without shelter and food that night. Instead, we were able to connect them with both short- and long-term resources during the emergency department visit.
"The family was so well dressed and put together, I never would have suspected they were homeless and hungry."
As pediatricians, each day we screen, examine, assess, and plan care with every child and family we see, often in 15 minutes or less. We function within a health care system that offers an ever-increasing array of care and treatment options, but can sometimes prevent us from addressing some of the most basic issues influencing a child's growth and development.
Two Simple Questions
The good news is that we are collectively and rapidly producing innovative methods to help meet this daily challenge. Case in point: a simple but effective, routine gauge of "hunger vital signs" advocated by the AAP in the policy report. Unique among screening tools, the hunger vital signs are efficient, evidence-based, and may prove to be the most valuable questions we ask and address during our daily encounters with children and their families.
The AAP food security statement highlights the many reasons hunger vitals should become a regular part of medical visits. Children without adequate access to food get sick more often, recover more slowly, have worse overall health and are hospitalized more frequently, for example, and early childhood malnutrition is tied to conditions such as diabetes and cardiovascular disease later in life. We heard the importance of nutrition on children's health powerfully emphasized by AAP president Sandra Hassink, MD, FAAP, during her plenary address at this year's National Conference and Exhibition and previously here in this AAP
"Children without adequate access to food get sick more often, recover more slowly, have worse overall health and are hospitalized more frequently."
Heeding the Call
The AAP Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT)
FACE Poverty Campaign embraces the Academy's call to action on mobilizing against child hunger across the nation. We now challenge each other as trainees and all pediatric care providers to ask about the hunger vital signs everyday with every family through our "Hunger Vital Signs Challenge." We also encourage all pediatricians to become familiar with community resources available to patients and advocate for federal and local policies that support access to adequate, nutritious food.
Join us in our efforts as we take to Twitter, Facebook, and other on-line forums to broaden our challenge. We are urging care providers to ask the hunger vital signs and be bold enough to pose and post their picture with our sign:
FACE Poverty Hunger Vital Sign Challenge Sign on social media, challenging colleagues to also utilize the hunger vital signs.
Hunger Vital Signs
If the either are both of the following questions is thought of by children and families as "often true" or "sometimes true", the child and family are considered at risk for food insecurity.
"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."
Hager ER, Quigg AM, et al. Development and Validity of a 2-item Screening to Identify Children and Families at Risk for Food Insecurity.
Many pediatric practice settings have already incorporated the hunger vital signs into their daily practice. We celebrate their efforts through our FACE Poverty Campaign and Hunger Vital Signs Challenge. If your practice setting has yet to join the challenge, we would love to help you begin to address hunger every day with every family.
Whether attending, nurse practitioner, trainee, nurse, medical student, or any other care provider who cares for children and families, we can all start making inroads on child hunger together by challenging and supporting each other through the SOMSRFT FACE Poverty Hunger Vital Signs Challenge.
Christian D. Pulcini, MD, MEd, MPH, is a resident at Children's Hospital of Pittsburgh of UPMC. He is current Vice-Chair of the Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT). He can be contacted at Christian.email@example.com or on Twitter @cdpulcini.