Food Insecurity as a reason for feeding difficulty

In this post, I would like to discuss the delicate issue of food insecurity. Food insecurity is defined  as “the state of being without reliable access to a sufficient quantity of affordable, nutritious food”. Specially, I want to address how not having enough food can affect a child’s oral motor function, weight gain, nutrient intake, eating behavior, and health. And how food insecurity can sometimes end up as a referral to a speech pathologist or occupational therapist for a feeding eval.

 

I first heard this term at a feeding conference in a presentation about the relationship of feeding problems for some children and not having enough food. Before that conference, I admit, it was not on my radar and I had not actively connected the relationship. However, when I started to pay closer attention to this, I realized I had seen clients and am seeing children for whom this is true. How might it manifest and how do we identify families in need?

• a family who didn’t bring food for their child’s feeding eval and when food was provided, the family asked for some too.
• a child who is underweight with reported poor intake, but when given food during an eval eats everything and asks for more.
• a caregiver who mentions running out of food or the cost of food preventing the ability to provide enough or healthy options.
• poor intake due to oral motor delay and inability for family to provide purees (most food assistance agencies stop providing baby food and purees at age 1).
• a family waters down milk or formula or purchases inexpensive food.

When a child is malnourished it not only affects their weight gain and growth but also can result in poor nutrient intake. This can lead to poor attention and focus, fatigue, and further health problems.

“Not having enough healthy food can have serious implications for a child’s physical and mental health, academic achievement and future economic prosperity. Research shows an association between food insecurity and delayed development in young children; risk of chronic illnesses like asthma and anemia; and behavioral problems like hyperactivity, anxiety and aggression in school-age children.” (http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/)

The feeding team I work with now asks this question on our intake form of all new patients:

Food Availability. In the last six month, were there times when it was not possible to feed your family a healthy meal (including formula) because there was not enough money? 

Yes

No

This question is helping us identify families in need in a discreet way so that we might be able to provide assistance or connect them with resources to help.

When a child presents with failure to thrive or malnourishment, our feeding team addresses the caloric and nutrient needs of the child. Nutrition comes first. Some of these children will end up drinking a supplement to provide the calories and nutrients they need. I have wondered if some of these children are being provided with a supplement primarily or secondarily due to food insecurity? And what impact will that have on their eating behavior? While this might be the correct intervention for catch up growth and/ or meeting imminent nutritional needs, it potentially introduces other issues that may need to be addressed down the road .

• replacing meals or snacks with a sweet supplement that might be more motivating than a balanced meal or healthy snack.
• drinking calories vs chewing and using oral motor manipulation of a food.
• lower motivation for a caregiver to move a child off of supplement that is provided and assists with the struggle to provide food.

Being more aware of food insecurity has prompted our feeding team to not only ask the question but also to connect with local and state resources and social workers that can help our families. We have brainstormed about creating a food bank or writing a grant to provide grocery store money cards. We have partnered with a company to provide free and discounted blenders for our clients that need purees for a pronged period due to oral motor delays. We accept donated formula and make sure it is given to children who need it.

I would love to hear from other clinicians who have ideas on how we as feeding professionals can address this issue and help our clients and families who struggle with food insecurity.

* This post is meant for informational and discussion purposes and is presented without judgement and solely in the spirit of helping families and our clients thrive .