Miriam E. Tucker

October 26, 2015

WASHINGTON, DC — Pediatricians should assess all patients for consistent access to adequate nutritious food, according to a policy statement released here at the American Academy of Pediatrics (AAP) 2015 National Conference, and published online in Pediatrics.

"We know that despite the advances that we've made over the past several years, there are still more than 15 million children suffering from food insecurity here in the United States," said Julie Linton, MD, from the Wake Forest University School of Medicine in Winston-Salem, North Carolina, who helped develop the plan.

Inadequate access to food can deprive children of nutrition, add to family stress, and lead to depression, anxiety, behavior problems, poorer overall health, and reduced academic achievement, according to the policy statement. Food insecurity is also associated with obesity, because poorer families often buy inexpensive foods, which tend to be energy dense but nutrient poor.

Many pediatricians already address this issue with some people, but the recommendation in the policy is that this be applied to all families.

"Although we know there are very clear risk factors" — such as poverty, single-parent households, low parental education, immigrant families, and unemployment or underemployment — "we know that we're still missing many," Dr Linton told Medscape Medical News.

"Very tiny changes or shifts in income or employment status can lead a family that was previously food secure to suddenly not having consistent access to adequate and nutritious food," she explained. "And because that very minimal income shift can lead somebody to have to choose between food and medications, we don't feel comfortable using demographics alone when looking at the data."

There are still more than 15 million children suffering from food insecurity here in the United States.

In the United States, 30% of families who identified as being food insecure in 2009 reported having to choose between paying for food and paying for medication or medical care, the Hunger in America 2010 study showed.

The policy statement recommends the use of a two-item validated screening tool to assess food insecurity.


Parents should be asked two questions about their situation in the previous 12 months: had they worried that their food would run out before they got money to buy more; and had they worried that the food they bought wouldn't last and they wouldn't have the money to buy more.

If the answer to either question is yes, pediatricians are advised to refer families to appropriate federally funded resources — such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the Supplemental Nutrition Assistance Program (SNAP); the National School Lunch and National School Breakfast programs; the Child and Adult Care Food Program; and the Summer Food Service Program — and, when necessary, to food pantries or soup kitchens.

The statement describes each of these resources, and advises pediatricians to familiarize themselves with local contacts and with any other food resources available in their local communities. Local WIC offices will often have a listing of active food pantries, Dr Linton pointed out.

Pediatricians are also asked to advocate for continued funding for WIC, SNAP, and school nutrition programs at the national, state, and local levels. According to the statement, the AAP anticipates that Congress will attempt to weaken nutritional standards in some of these programs at the federal level.

A Lack of Resources

The statement was welcomed by Blaine Sayre, MD, clinical professor of pediatrics at Washington University in St. Louis, Missouri.

"I have an inner-city practice," he told Medscape Medical News. "There are a significant number of families where it's obvious that basic food is an issue."

Dr Sayre said he currently assesses food insecurity selectively. "We know our patient base," he explained.

There is, however, a lack of resources for families in need. He said he routinely refers patients to WIC, for example, but that only covers children up to the age of 5. "We're familiar with all the standard programs. The problem is those who fall between the cracks. No matter how many programs are in effect, there are always gaps in coverage."

The list of resources in the statement will be helpful, he said, adding that "if we had more resources, we'd probably ask more people about food insecurity."

Families want to feed their kids.

"Families want to feed their kids. The families we care for want to provide the best for their children, and they want the tools to do so," Dr Linton told Medscape Medical News.

"Partnering with our communities and with our advocacy organizations to help families do that is the key," she said. "If we don't ask the questions, we can't link them to the resources they need."

Dr Linton and Dr Sayre have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2015 National Conference. Presented October 23, 2015


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