Immediate Past President AAP Director AAP Institute for Healthy - - PowerPoint PPT Presentation
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
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
learning
3. Mobilize the pediatric health professional
community to a convergence of thinking and action to improve child nutrition
Sound nd, appropriate ate nutriti rition
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
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
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
Child Intrauterine Environment Family SES Parental Health Communi nity y Nutrition Gender Age Race Parent Lifestyle Safety Parenting Parent education School nutrition School physical activity Social Connections Early care Access to medical/dental care Media Domestic Violence Injury prevention Literacy Recreational facilities Access to healthy Nutrition Cultural/Religion Advertising
Foundations undations of f Child ild He Heal alth th ar are Rooted
the Socio cioecologial ecologial Model del
School School Achievement Genetics
5
Die
iet quali lity ty
standards: 50% 50%
Obesi
sity ty
18%
Activ
ivity ity li limit itat ation ion
resulting from one or more chronic health conditions 9% 9%
Food Insecur
curity ity
1%
“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,
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
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"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
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-
Service Sept 2014 http://www.childtrends.org/?indicators=food- nsecurity#sthash.VXI2ws3z.dpuf
http://www.feedingamerica.org/hunger-in-america/our-research/map-the-meal-gap/2012/2012-mapthemealgap-exec-
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
States that appeared on the bottom 15 list of for obesity and either food insecurity or poverty States that appeared on all three lists States that appeared on the food insecurity and poverty list - but not the obesity list
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http://aftnj.org/wp- content/uploads/2014/02/Children- Poverty-MAPS-REV2.png
Coleman-Jensen et al Household Food Security in the United States in 2011 ERR-141 USDA Economic Research Service, 9/12.
Coleman-Jensen et al Household Food Security in the United States in 2011 ERR-141 USDA Economic Research Service, 9/12.
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
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
insecurity can assist in understand its effect on their wellbeing. J Nutr 2005;135(7)1684-1690 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
Lower levels of physical
activity
To QG, Frongillo EA, Gallegos D, Moore JB. Household food insecurity is associated with less physical activity among children and adults in the U.S. population. J Nutr. 2014; 144(11):1797–802
Children and adolescents more
likely to be iron deficient
Eicher-Miller HA, Mason AC Weaver M, McCabe Boushey CJ. Food insecurity is associated with I deficiency anemia in US adolescents. Am J Clin 2009;90(5) ;1358-1371
Cook JT, DA. Child food insecurity and iron deficiency anemia Skalicky A, Meyers AF, Adams WG, Yang Z, income infants and toddlers in the US. Matern ChildJ. 2006;10(2) 177-185
Adolescent are more likely to experience dysthymia and suicidal ideation
Alaimo K, Olson CM, Frongillo EA. Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. J Nutr 2002;
132(4);719-725.
Adolescents with household
food insecurity have increased risk of emotional, conduct and peer problems and less optimal pro-social behavior More than a 2 fold increase risk
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
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.
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.
Children who live in food insecure
households
math, and science
Jyoti DF, Frongillo EA, Jones SJ. Food insecurity affects school children’s academic performance, weight gain, and social skills. J Nutr. 2005;135(12):2831–9. Alaimo K, Olson CM, Frongillo EA Jr. Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics. 2001;108(1):44– 53. Murphy JM, Wehler CA, Pagano ME, Little M, Kleinman RE, Jellinek MS. Relationship between hunger and psychosocial functioning in lowincome American children. J Am Acad Child Adolesc Psychiatry. 1998; 37(2):163–70 Ashiabi G. Household food insecurity and children’s school engagement. J Child Poverty. 2005;11(1): 3–17 Tolbert Kimbro and Justin T. DenneyTransitions Into Food Insecurity Associated With Behavioral Problems And Worse Health Affairs, 34, no.11 (2015):1949-1955
Higher rates of externalizing behaviors, such as
aggression
Internalizing behaviors, such as depression and
anxiety
Hyperactivity and inattention problems.
Teachers reported generally worse scores for
interpersonal skills and self-control
Murphy JM, Wehler CA, Pagano ME, Little M, Kleinman RE, Jellinek MS. Relationship between hunger and psychosocial functioning in lowincome American children. J Am Acad Child Adolesc Psychiatry. 1998; 37(2):163–70. Kleinman RE, Murphy JM, Little M, Pagano M, Wehler CA, Regal K, et al. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics. 1998;101(1):E3. Whitaker RC, Phillips SM, Orzol SM. Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics. 2006;118(3):e859–68. Alaimo K, Olson CM, Frongillo EA. Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. J Nutr. 2002;132(4):719–25 Tolbert Kimbro and Justin T. DenneyTransitions Into Food Insecurity Associated With Behavioral Problems And Worse Health Affairs, 34, no.11 (2015):1949-1955
2X as likely to experience persistent symptoms of
hyperactivity/ inattention
Have diets that are high in refined sugars and low in iron,
which can have behavioral consequences including hyperkinesia, inattention and poor memory
Controversy surrounding the reported link between food
insecurity and hyperactivity/inattention
Recent intervention trials reported improvement in
symptoms of attention deficit hyperactivity disorder (ADHD) in some children after the introduction of a healthy diet
Belsky DW, Moffitt TE, Arseneault L, Melchior M, Caspi A. Context and sequelae of food insecurity in children’s development. Am J Epidemiology 2010;172:809-18. Melchior M, Chastang JF, Falissard B, et al. Food insecurity and children’s mental health: A prospective birth cohort study. PLoS One 2012;7:e52615. McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9- year-old children in the community: A randomized, double-blinded, placebo-controlled trial. Lancet 2007;370:1560-7. Pelsser LM, Frankena K, Toorman J, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): A randomized controlled trial. Lancet 2011;377:494-503.
Child hunger predictor of depression and suicidal
ideation during late adolescence and young adulthood
Food insecurity linked with higher rates of
adolescent mood, behavior and substance abuse disorders
Food insecurity early in life can weaken infants’
attachments to parents, which may negatively affect children’s mental health later in life
McIntyre L, Williams JVA, Lavorato DH, Patten S. Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger. J Affect Disord 2013;150:123-9 McLaughlin KA, Green JG, Alegría M, et al. Food insecurity and mental disorders in a national sample of U.S. adolescents. J Am Acad Child Adolesc Psychiatry 2012;51:1293-303 Zaslow M, Bronte-Tinkew J, Capps R, et al. Food security during infancy: Implications for attachment and mental proficiency in
2009, 50% of U.S. infants participated in WIC,
and about 25% of pregnant women, postpartum women, and children ages 1–4
Oliveira, Victor; Frazao, Elizabeth. The WIC Program: Background, Trends and Economic Issues, 2009 Edition. USDA Economic Research Service Report. 2009; 73 Jackson MI. Early childhood WIC participation, cognitive development and academic achievement.Soc Sci Med. 2015 Feb;126:145-53. doi: 10.1016/j.socscimed.2014.12.018. Epub 2014 Dec 15
WIC overlaps with critical and sensitive
periods of developmental plasticity when intervention is crucial for brain development
Gluckman, Petter; Mark, Hanson. The Developmental Origins of Health and Disease: The Breadth and Importance of the Concept. Advances in Experimental Medicine and Biology. 2006; 573(1):1–7.
Study of children with and without WIC
participation and early cognitive development and success in school.
Age 2 Bayley Short Form-Research Edition (BSF-R) Age 11 Woodcock-Johnson Revised reading and math achievement tests
Could account for +/- prenatal WIC but couldn’t
tell if all children with prenatal WIC had early childhood WIC although evidence suggests most of them do participate in early childhood.
Jackson MI, Early Childhood WIC Participation, Cognitive Development and Academic Achievement.Soc Sci Med. 2015 February ; 126: 145–153. doi:10.1016/j.socscimed.2014.12.018
Associated with significantly stronger cognitive development
0.062 SD higher on the Bayley Mental Development assessment than their similar peers who do not receive exposure in utero. Magnitude is comparable in size to the relationship between breastfeeding and cognitive development.
1/4 the size of race/ethnic and maternal education gaps in early cognitive development
Perform significantly better on reading
assessments measured by passage comprehension
0.3 of a standard deviation.
Jackson MI, Early Childhood WIC Participation, Cognitive Development and Academic Achievement.Soc Sci Med. 2015 February ; 126: 145–153. doi:10.1016/j.socscimed.2014.12.018
WIC participants (pregnant women, young
children)have higher nutrient intake than those who do not participate
Fox, MK.; Hamilton, W.; Lin, B. National School Lunch Program. In: Anonymous. , editor. Effects
Nutrition education Links to other health services Longer pregnancies Fewer premature births Fewer infant deaths Savings in health care costs,
Available data do not yet permit a benefit-cost
analysis of WIC over the life cycle
Head Start and the Perry Preschool project, average
impact on teenage outcomes is 0.26 standard deviations
Deming, David. Early Childhood Intervention and Life-Cycle Skill Development: Evidence from Head Start. American Economic Journal: Applied
This study for school-age outcomes (mean age of
10.5) range from 0.09 to 0.26 SD.
Jackson MI, Early Childhood WIC Participation, Cognitive Development and Academic Achievement.Soc Sci Med. 2015 February ; 126: 145–153. doi:10.1016/j.socscimed.2014.12.018
Costs of WIC are smaller than those of other early
childhood intervention programs,( $49/month per participant)
Promoting healthy infant and child feeding
behavior
Helping families build self efficacy around
nutrition
Strengthening nutritional environments at
home
Promoting nurturing parent relationships
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School meals are most effective for those
most in need
testing
Kristjansson B, Petticrew M, MacDonald B, et al. School feeding for improving the physical and psychosocial health of disadvantaged students (Review). Cochrane Database Syst Rev 2007;(1):CD004676. doi:10.1002/14651858.CD004676.pub2
The Keeping Infants Nourished and Developing (KIND) program
infant formula, tailored education, and connection to clinic and community resources
An on-site physician, social worker, and dietician collaborated to
define KIND eligibility criteria.
Families receiving KIND were significantly more likely to report risks
relating to parental mental health, housing, benefits, and domestic violence, (highest-risk patients).
KIND may have served as a “connector” between these high-risk households and primary care
lead, developmental screening) and 5+ well-infant visits in the first 14 months. more likely to be linked to interventions poised to address multiple and potentially interrelated concerns (eg, social work)
Forging a Pediatric Primary Care–Community Partnership to Support Food-Insecure Families Andrew F. Beck, Adrienne W. Henize, Robert S. Kahn, Kurt L. Reiber, John J. Young, and Melissa D. KleinPediatrics 2014; 134:2 e564-e571; published ahead of print July 21, 2014, doi:10.1542/peds.2013-3845
Know your communities resources
for food, housing, literacy, early education etc.
Ask about food insecurity
whether our food would run out before we got money to buy more”
we bought just didn’t last and we didn't have money to get more.”
Hager E et.al. Development and validity y of a 2-item screen to identify families at risk for food Pediatrics. 2010 Jul;126(1):e26-32. doi: 10.1542/peds.2009-3146
Screen for key poverty related
health conditions
injuries, mental health diagnosis, HIV infections, and tobacco exposure etc.
Advocate for protecting and
increasing access to and funding for SNAP, WIC, school nutrition programs and summer feeding programs.
(Food Security Policy released Oct 2015) ww.pediatrics.org/cgi/doi/10.1542/peds.2015-3301 DOI: 10.1542/peds.2015-3301)