September is National Childhood Obesity Awareness Month. Food insecurity is a critical child health issue that impacts millions of children and families in all communities across the United States. 1 in 7 U.S. children lives in a household struggling against food insecurity. Pediatricians can help keep children healthy by ensuring they have enough to eat and access to nutritious meals.

To elevate the role of pediatricians in addressing food insecurity, The Food Research & Action Center (FRAC) teamed up with the American Academy of Pediatrics (AAP) to create Screen & Intervene: A Toolkit for Pediatricians to Address Food Insecurity.

In this three-part blog series, FRAC interviewed practicing pediatricians about their work to fight childhood hunger.

Interview One:
Sarah Adams, MD, FAAP

Why is it important for pediatricians to address food insecurity?
It is important, now more than ever, to become educated, screen and intervene for food insecurity.  Prior to the Food Insecurity webinar, I was naive to the fact that one in seven children suffer from food insecurity and hunger.  As pediatricians, we have the opportunity to see families on a regular basis, identify their needs, and provide resources.  This is, in my mind, a significant health crisis and not one that typically comes up in a well child visit unless we screen for it.  The impact of food insecurity goes beyond the nutritional deficiencies, and it also has a significant toll on mental health and learning.  We have to keep in mind that even if they are already participating in a program, food could run out.  It is important for pediatricians to understand all of the challenges, address them with empathy, and follow up to ensure their needs are met.

How does the AAP/FRAC toolkit support this work?
This is an overwhelming concern among children and families. With the help of the AAP/FRAC toolkit, I was able to get step-by-step guidance on how to screen and intervene.  The toolkit is very informative and starts with what we need to know, how to prepare for screening, documenting the medical records as well as coding, information on federal nutrition programs and connecting families to the appropriate resources as well as resources for advocacy.  I have developed a strategic plan and have the confidence to help families in an efficient and sensitive way.

How does your practice screens patients for food insecurity and intervene (e.g., connect patients to federal nutrition programs and other resources)?
Each family that presents for a Well Child visit is given a questionnaire from the front office staff at check-in to assess Social Determinants – the two questions from Hunger Vital Sign is included.  We also give some space on the form for families to add additional comments.  The answers to these questions are entered into the EMR by the medical assistant and if a child is at risk for food insecurity, there is a warning that pops up on EMR when you open the chart.  Included in this pop-up window is a Smartset you can click on that will allow you to add the diagnosis, provide educational material and links to resources that will help the family.  The RN, Hunger Champion, connect the family, go over the resources, and follow up as well as provide additional interventions if needed.  They will be given the information directly or referred to a community partner.

Why is the Supplemental Nutrition Assistance Program (SNAP) important to families?  Would you support increasing the SNAP benefit allotment?
SNAP is important to families because it helps them purchase healthy foods on their own that they would not be able to do on their own budget.  It has proven to be one of the most effective programs to provide health benefits and reduce hunger.  I would support increasing the SNAP benefit allotment because many families run out of benefits before they are eligible at the end of the month.

Interview 2 :
Chris Peltier, MD, FAAP

Why is it important for pediatricians to address food insecurity? 
As pediatricians, we are a trusted source of knowledge for our families and see families at frequent, regular intervals in the office.   It is important for pediatricians to address food insecurity due to the effect that it has on the health and well-being of the children we take care of.  Food insecurity in children is associated with poorer health status, developmental risks, mental health problems, and poor educational outcomes.

How does the AAP/FRAC toolkit support this work? 
It provides pediatricians with the education and tools to effectively and easily screen for food insecurity, as well the resources to intervene and provide appropriate medical interventions. Additionally, the toolkit helps doctors connect patients to local and federal nutrition programs to help provide food, and know how to advocate and address food insecurity at its root causes (poverty, housing insecurity and structural racism).

How does your practice screens patients for food insecurity and intervene (e.g., connect patients to federal nutrition programs and other resources)?
We use a validated two-question screener at all of our well child visits.  We have provided a list of resources to help connect families to local food banks, school nutrition programs, WIC offices and the SNAP program.

Why is the Supplemental Nutrition Assistance Program (SNAP) important to families?  Would you support increasing the SNAP benefit allotment?
SNAP is essential in combating food insecurity as it aids low-income families in buying food which also begins to raise them out of poverty.  By doing so, it supports the physical and mental health of children.  As SNAP benefits help the most vulnerable of families, I would definitely support increasing the SNAP benefit allotment.

Interview 3:
Mercy Brew, MD, FAAP

Why is it important for pediatricians to address food insecurity? 
It’s so important for pediatricians to address food insecurity because it’s basic human need. There is no way you can have a healthy child who does not have enough to eat.

How does the AAP/FRAC toolkit support this work? 
The toolkit is amazing and the lecture we had also was really eye-opening. Of my patients, 90 percent utilize WIC and the Supplemental Nutrition Assistance Program (SNAP) but I did not know that [benefit allotments were] insufficient. Also, after the kids no longer take formula, most parents stop getting assistance. [Pediatricians] need to ask appropriate questions. I was hesitant because it’s extra work, extra time but now I know I can do Telehealth and bill for it and that is so awesome.

How does your practice screens patients for food insecurity and intervene (e.g., connect patients to federal nutrition programs and other resources)?
I have been using injury screen from Ohio AAP, which has the food insecurity questions for children up to five years old. Now my organization, the Healthcare Connection, has a grant from Humana Insurance to address food insecurity; since April, we’ve given out screening tools to all patients, adults and kids. If anyone is not already signed up for federal nutrition program benefits, our resource advocates sign them up. We also give a resource of all available food banks in the neighborhood to all patients. This resource is in all examining rooms.