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Sandra G Hassink, MD, MS, FAAP Immediate Past President AAP Director AAP Institute for Healthy Childhood Weight 1. Understand factors contributing to food insecurity and its effect on child health 2. Understand the impact of nutrition on


  1. Sandra G Hassink, MD, MS, FAAP Immediate Past President AAP Director AAP Institute for Healthy Childhood Weight

  2.  1. Understand factors contributing to food insecurity and its effect on child health  2. Understand the impact of nutrition on learning  3. Mobilize the pediatric health professional community to a convergence of thinking and action to improve child nutrition

  3. Sound nd, appropriate ate nutriti rition on  Health-promoting food intake, eating habits beginning with mother’s pre - conception nutritional status Stable, respons nsive ive envi viro ronmen nment t of relati tions onshi hips  Consistent, nurturing, protective interactions with adults that enhance learning, help develop adaptive capacities that promote well-regulated stress response systems Safe, support rtive ive physica ical, l, chemic ical al and built envir vironments onments  Provide places for children that are free from toxins, allow active, safe exploration without fear, offer families opportunities to exercise, make social connections developingchild.harvard.edu/files/5012/8706/2947/inb rief-health.gif

  4. Foundations undations of f Child ild He Heal alth th ar are Rooted oted in the Socio cioecologial ecologial Model del Communi nity y School physical activity Cultural/Religion Safety Advertising Injury prevention Family School nutrition Media Parental Health Recreational Intrauterine Environment Gender facilities Domestic Nutrition Child Age Social Race Violence Genetics School Connections Parenting Literacy SES Achievement Parent education Parent Lifestyle School Early care Access to healthy Nutrition Access to medical/dental care

  5. Ho How are w are the the ch chil ildr dren? en? 5

  6.  Die iet quali lity ty ◦ Children ages 2-17 who meet federal diet quality standards: 50% 50%  Obesi sity ty ◦ Children ages 6-17 who have obesity: 18% 18%  Activ ivity ity li limit itat ation ion ◦ Children 5-17 with activity limitation resulting from one or more chronic health conditions 9% 9%  Food Insecur curity ity ◦ Children 6-10 living in food insecure homes: 21% 1%

  7.  “an adequate diet for children…one that contains ains an approp ropri riate ate dens nsity ity of nutri trients, ents, is suffic ficiently ently dive verse rse that t it suppli plies es adequate equate but not excessive ssive amoun unts ts of nutri triti tion, on, is palatab atable e and culturall urally acceptab table, e, afford rdable able and ava vailable able year ar roun und d and d ove verall all suppo pports rts normal al gr growt wth h and development.”  Allen L, Causes of Nutrition Related Public Health Problems of Children : Available Diet J Ped Gastr Nutr 2006 43 S8-S12

  8. 8

  9.  "the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways."  "Very low food security," the most severe level measured by the survey, is characterized by irregular meals and inadequate food intake, as determined by caregivers  U.S. Department of Agriculture http://www.childtrends.org/?indicators=food- insecurity#sthash.VXI2ws3z.dpuf

  10.  2013, 21% (> 1 in 5) U.S. children lived in households that were food-insecure at some point during the year  1% experienced the most severe level of need, where food intake is reduced and regular eating patterns are disrupted  Coleman-Jensen A, Gregory C, Singh A, Household Food Security in the United Sate in 2013. Pub no. ERR- 173. Washington DC, USDA , Economic Research Service Sept 2014  http://www.childtrends.org/?indicators=food- nsecurity#sthash.VXI2ws3z.dpuf

  11. http://www.feedingamerica.org/hunger-in-america/our-research/map-the-meal-gap/2012/2012-mapthemealgap-exec-

  12. Annual cost burden of hunger in the US $167.5 billion. Costs associated with charity, chronic illness, psychosocial dysfunction, diminished learning and economic productivity Shepard D et al Hunger in America Suffering we all pay for 2011www.americanprogress.org/wpcont ent/uploads/issues 2011/10/pdf/hungerpaper.pdf http://www.feedingamerica.org/hunger-in-america/our-research/map-the-meal-gap/2012/2012-mapthemealgap- exec-summary.pdf

  13. States that appeared on the States that appeared on the States that appeared on all bottom 15 list of for obesity food insecurity and poverty three lists and either food insecurity or list - but not the obesity poverty list

  14. http://aftnj.org/wp- content/uploads/2014/02/Children- Poverty-MAPS-REV2.png 14

  15. Coleman-Jensen et al Household Food Security in the United States in 2011 ERR-141 USDA Economic Research Service, 9/12.

  16. Coleman-Jensen et al Household Food Security in the United States in 2011 ERR-141 USDA Economic Research Service, 9/12.

  17.  School age children are aware and distressed May develop their own strategies for reducing food intake including choosing to eat less that they want Fram MS, Frongillo EA, Jones SJ. Et al. Children are aware of food insecurity and take responsibility for managing food resources. J Nutr 2011;141(6) 114-119.  Teens express worry, anxiety or sadness, shame or fear of being labeled poor, feeling of having no choice Connell CL, Lofton KL, Yadrick K, Rehner TA. Children’s experiences of food insecurity can assist in understand its effect on their wellbeing. J Nutr 2005;135(7)1684-1690 18

  18. Parent-reported poorer health and developmental risk  More frequent stomach aches, headaches, colds, hospitalizations, anemia and chronic conditions  More anxiety, depression, school difficulties Nord M, Food insecurity in households  with children: Prevalence, severity, and household characteristics.2009 USDA, Economic Research Service www.ers.usda.gov/Pulbications/EIB56/  More difficulty with interpersonal skills, self control, attentiveness, flexibility and persistence Howard LL, Does food insecurity at  home affect non cognitive performance at school? A longitudinal analysis of elementary school classroom behavior. 2010 Economics of Education Review 20, 157-176  Infants more likely to have insecure attachments and perform more poorly on cognitive assessments Zaslow M et al Food security during  infancy; Implications for attachment and mental proficiency in toddlerhood. 2009 Maternal and Child Health Journal 13(1) 66-80

  19. Adolescent are more likely to  Lower levels of physical  experience dysthymia and activity suicidal ideation To QG, Frongillo EA, Gallegos D, Moore JB. Household food  Alaimo K, Olson CM, Frongillo EA. Family food insecurity is associated with less physical activity among insufficiency, but not low family income, is children and adults in the U.S. population. J Nutr. 2014; positively associated with dysthymia and 144(11): 1797 – 802 suicide symptoms in adolescents. J Nutr 2002; 132(4);719-725.  Adolescents with household  Children and adolescents more food insecurity have increased likely to be iron deficient risk of emotional, conduct and Eicher-Miller HA, Mason AC Weaver M, McCabe peer problems and less optimal Boushey CJ. Food insecurity is associated with I pro-social behavior deficiency anemia in US adolescents. Am J Clin 2009;90(5) ;1358-1371 More than a 2 fold increase risk Cook JT, DA. Child food insecurity and iron deficiency anemia Skalicky A, Meyers AF, Adams WG, Yang Z, of parent reported mental income infants and toddlers in the US. Matern ChildJ. 2006;10(2) 177-185 health problems Poole-DiSalvo E, Silver E, Stein R. Household Food Insecurity and Mental Health Problems Among Adolescents: What Do Parents Report? Acad Peds Vo 16 (1) Jan-Feb 2016 90-96

  20.  Children who experienced hunger more likely to have poorer health  Repeated episodes of hunger are particularly toxic  Multiple episodes of hunger associated with a higher likelihood of chronic conditions and of asthma  The number of episodes of hunger that children experience is related to their health as they grow older Kirkpatrick SI, McIntyre L, Potestio ML. Child hunger and long-term adverse  consequences for health. Arch Pediatr Adolesc Med 2010;164:754-62.

  21.  Short-term hunger can adversely affect attention and interest Levinger B. Nutrition, health and education for all.  Education and Development Centre. Newton MA: Education and Development Center, Inc, 1996.  Overnight and morning fasting (e.g. skipping breakfast) has been shown to adversely affect performance on cognitive tasks, particularly for children who are nutritionally at risk Pollitt E. Does breakfast make a difference in school?.  Journal of the American Dietetic Association 1995;95(10):1134.

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