"Did you ask if she ate today?" That was my nurse, and it was one of my first weeks as an attending at a city-run health center. I had just ordered the due and overdue immunizations for a 16-year-old girl who had come in on her own for her well child check. It was 2 pm.
The girl wasn't underweight, she hadn't expressed body images concerns, and no, I hadn't asked if she had eaten.
"You don't want her passing out on us with her shots; you should always ask," she gently admonished while scrounging up some crackers to give her. It was summer break, and as the girl disclosed to the nurse, there wasn't much food around at the house this time of the month.
You don't know if you don't ask. If you don't know, you can't help. One in six children in the United States lives with food insecurity, defined as limited or uncertain access to enough food. Identifying children at risk isn't complicated.
"The AAP recommends that all pediatricians use the "Hunger Vital Sign," a simple, two-question screening tool."
The American Academy of Pediatrics (AAP) and the Food Research & Action Center recently made it easier by creating a new resource, Addressing Food Insecurity: A Toolkit for Pediatricians. The toolkit offers provides information to help pediatricians screen for food insecurity in a practical and sensitive manner and connect families with needed resources.
The AAP recommends that all pediatricians use the "Hunger Vital Sign," a simple, two-question screening tool. Responses to two statements--"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"--with "often true" or "sometimes true" to either or both means a positive result for food insecurity. Healthcare providers can easily integrate this screening into the normal office workflow or as part of the forms patients fill out when they arrive.
We located a summer food site not too far from my patient's house (well, she did, actually). The U.S. Department of Agriculture has a
website that lets you enter an address and get a list of nearby resources, so she pulled the list for herself on the exam room computer while I finished up her school physical form. She already knew about her school breakfast and lunch programs when school was back in session.
" Food insecurity can be tough to discuss. Even when a family has told me there is enough food at home, I'll notice when I return to exam room that one of the tear-offs on the flyer about SNAP is missing."
Study after study suggests the value of these programs, showing that children in food-insecure households are likely to get sick more often and be hospitalized more frequently than their peers, for example. Hunger also can lead to developmental delays and behavioral problems that can affect academic performance and job preparedness. Obesity is another less obvious problem tied to food insecurity.
Recently, I was having one of the many daily conversations with a parent of an overweight preschooler about changes to promote healthy eating. Mom leveled with me: she knew that she should be giving him more vegetables and making healthier dinners, but when she did, he wouldn't eat them. Yes, she knew it took multiple exposures, but that meant repeatedly spending money on food he didn't eat. "I can't keep buying food to throw it away," she said, "so I just make him what I know he will eat."
As pediatricians, we get it. We know there are ways to make it work economically, but we also hear the worry and stress food insecurity puts on our families. In addition to local food pantries, physicians can refer patients to federal programs like the Supplemental Nutrition Assistance Program (SNAP).
Food insecurity can be tough to discuss. Even when a family has told me there is enough food at home, I'll notice when I return to exam room that one of the tear-offs on the flyer about SNAP is missing. I hope that means they connected with resources, even if they weren't ready to let me know.
These programs matter, and we must continue to advocate for adequate funding. When we realize that our patient may not have eaten today, they must have places to turn to make sure they can eat for many tomorrows.
Erin Teresa Kelly, MD, FAAP, is an AAP LIFE fellow and a primary care internal medicine-pediatric physician at the City of Philadelphia Health Centers #4 and #5. Dr. Kelly completed her residency in Medicine and Pediatrics at Strong Memorial Hospital at University of Rochester in 2015. She received her medical school training at the Alpert Medical School of Brown University.