FOOD INSECURITY
CHILD HUNGER: A Hidden Epidemic
V. Faye Jones, MD, PhD & Marian Morris, MD
V
ery rarely do children or their
parents come out and say, “We’re
hungry!” at a doctor’s visit. More
often, clues they are hungry lie
hidden in a medical complaint
or problem. These clues vary from obesity to
failure to thrive, from difficulty focusing in
school to toddler tantrums. Those who lack
consistent access to adequate food may choose affordable, high
caloric density & low nutritional content foods or consume less
than the adequate number of calories for the day. Both of these
options can have major impacts on children’s mental, physical
and developmental health. A parent’s relief may be palpable when
the physician realizes the family doesn’t have enough to eat (food
insecure) and helps them locate food assistance.
Food insecurity can be defined as “limited or uncertain avail-
ability to acquire food in socially acceptable ways.” 1 According to
Feeding America’s “Map the Meal Gap 2018,” which is derived from
2016 data, 15.5 percent of Kentucky residents are food insecure,
totaling over 685,000 people. 2 Specifically in Jefferson County, 15.8
percent of its residents are food insecure, with >120,000 residents
without consistent access to food. Fifty-three percent of Jefferson
County residents have household incomes <130 percent of the fed-
eral poverty level, which makes them eligible for Women, Infants &
Children (WIC), Special Supplemental Nutrition Program (SNAP)
and free school meals. 2
In 2015, the American Academy of Pediatrics (AAP) recom-
mended universal screenings of families for food insecurity and
assisting families in locating local resources. Quick screening can
be done in the office easily, utilizing the following two-question
screener developed by Hagel et al, where an affirmative answer on
either question results in a positive screen for food insecurity. 3
1) Within the past 12 months, we worried whether our food
would run out before we got money to buy more (yes or no)
2) Within the past 12 months, the food we bought just didn’t
last and we didn’t have money to get more (yes or no)
The consequences of food insecurity can be life-long. Often, the
most visible impact is alterations to the child’s growth parameters.
However, such visible changes are rarely seen amongst food-insecure
children in the US, though this does not preclude health impacts of
malnutrition. Some studies suggest that children ages six to 11 with
personal food insecurity are more likely to be obese, potentially as
result of consumption of affordable, high caloric density foods in
combination with chronic stress response. 4,5 Families of children
experiencing food insecurity are more likely to rate their children’s
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