Household food insecurity, "meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food" (Coleman-Jensen et al., 2014, p. i) remains a consistent social problem that has been exacerbated by the Covid-19 pandemic. Households with children are nearly twice as likely to be food insecure as households without children (American Academy of Pediatrics [AAP], 2015). Childhood food insecurity is especially prevalent among low-income families; rates are now at their highest since 2001 (Galvin, 2020). In April 2020, ~41% of mothers with children <13 years reported problems with accessing food. The nonprofit Feeding American project expects >18 million children could be food insecure (Galvin).
Recent research has found that food insecurity was significantly related to: poorer general health outcomes, some acute and chronic health problems such as asthma and depression, decreased health care access, and increased emergency room utilization (Thomas et al., 2019). Children with limited access to adequate nutrition are predisposed to lower cognitive indicators, dysregulated behavior, emotional distress, developmental delays, and poor school performance as well as later adult onset of diabetes, hyperlipidemia, and cardiovascular disease (AAP, 2015).
Historically, there have been many federally funded programs to address childhood food insecurity established as early as the 1960s. These include the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the Supplemental Nutrition Support Program (SNAP); the United States Department of Agriculture (USDA) National School Lunch Program; the School Breakfast Program; the USDA Child and Adult Care Food Program, which provides cash assistance to states; and the Special Food Service Program, serving children during the summer and in child care. In 2010, the Healthy, Hunger-Free Kids Act established the Community Eligibility Provision, which allows schools in high poverty areas to offer two free meals a day to all students, thereby eliminating stigma associated with food insecurity. Local communities offer food pantries and soup kitchens that are funded in cooperation with the government and with philanthropic organizations and faith-based communities (AAP, 2015).
In fiscal year 2018, ~29.7 million low-income children participated in these school programs, yet less than 14% received this benefit over the summer. It is estimated that in May 2020, only 15% of eligible children received any of these benefits. In March 2020, Congress created the Pandemic Electronic Benefit Transfer or P-EBT program for households with children eligible for these school-based programs to receive cash value of those meals. Families receive a total of $5.70 a day per child or $114.00 per month per child. Early in the pandemic, some school districts organized grab-and-go stations for families. Congress also expanded the SNAP program and continues to propose legislation to alleviate childhood food insecurity. Experts anticipate that even with sufficient funding, the Covid-19 pandemic will have long-term and lasting health and behavioral effects on children (Galvin, 2020).
Nurses and other pediatric providers should be aware of what community resources are available for their patients and families. They can assess the stress of food insecurity in individual families by incorporating the USDA 18-item Household Food Security Scale, or a 2-item screening tool that uses a subset of 2 questions from the Household Food Security Scale. Affirmative answers to either of these 2 questions identified food insecurity with a sensitivity of 97% and a specificity of 83% (AAP, 2015). Nurses and other pediatric providers should participate in advocacy efforts at the federal, state, and community levels.
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