Children’s Doctors Prescribe Good Food … and Enough of It

March 3, 2016

The American Academy of Pediatrics issued a policy statement on children and food security some months ago. Took me awhile to get to it, but better late than never, I think, because the statement is important for several reasons — and still timely, also for several reasons.

Voice of Authority

First off and most obvious, the AAP has unusual credibility — and in some quarters, influence — as a voice for children’s well-being. It’s the professional association for some 64,000 doctors who provide primary care and specialized services to children and young adults.

It’s nonpartisan, of course, and apparently free from the conflicts of interest that can shape research and policy, including support from corporations who’ll profit more — or less — from nutrition policies, guidelines and the like. (You who’ve been following the debate over school meal nutrition standards know why I mention them.)

Big Picture From Research

The policy statement pulls together findings from reliable research on how food insecurity affects children. Some are familiar to anyone who follows anti-hunger campaigns, even casually — poorer overall health, more hospital stays, high risks of obesity, learning problems, etc.

Others are perhaps less so. For example, the shame kids feel when they see their parents eating less so they can have enough. Also the fear they’ll be labeled “poor” and shunned by their peers.

Feelings like these probably stem from the all-too-common view that poverty reflects a failure of personal responsibility. Perhaps doctors — highly respected folks who’ve surely demonstrated personal responsibility — could lend their weight to a culture shift.

Call to Action

The AAP enjoins pediatricians to advocate for federal and local policies that help ensure food security for all children and their families. It notes specifically sufficient funding for SNAP (the food stamp program) and the Child Nutrition Act programs.

It also calls for advocacy to keep foods offered in these programs “high in nutrient quality,” according to “sound nutrition science.” Respected voices needed here.

Congress has already enabled schools to get temporary waivers from two school meal nutrition requirements — a switch to use of only whole-grain food products and a gradual reduction in the total amount of sodium in the breakfasts and lunches they serve.

Now the Senate Agriculture Committee has completed a revised CNA — one of those bipartisan compromises that gives schools some flexibility on the whole grains and sodium, but not a free pass.

But we may see further compromises in the “high nutrient quality” of the meals schools serve. A bill introduced by one of the Republican members of the House subcommittee responsible for the CNA would go further toward “reducing federal mandates,” as its title proclaims. No caps at all on calories or grains, for example.

So the call is especially timely. But it’s also forward-looking because USDA will presumably review the nutrition standards and related meal plans for daycare facilities, as well as school meals now that we have new Dietary Guidelines for Americans.

At the local level, pediatricians have several advocacy opportunities. They obviously could — and should — discourage schools districts from relaxing their efforts to serve meals as healthful as the current standards require.

They could also encourage more school districts to opt for community eligibility. Schools with relatively high percents of poor and near-poor students could then serve free meals to all, regardless of their family’s income.

This, among other things, has increased the number of students served two full, well-balanced meals a day — probably in part by removing fear of the free-meal stigma.

Broader Approach to Children’s Healthcare

The AAP statement reaches furthest, I think, in its recommendations for incorporating food insecurity into pediatrics training and practices. Children’s doctors would then not only understand how it affects their patients’ health, but actually do something about it.

The AAP recommends a routine screening, using a pared-down version of the survey used for USDA’s annual food security reports.

Pediatricians, like other doctors, need the information in part to understand what the source of their patients’ problems might be — anemia, for example, chronic anxiety, both overweight and underweight.

They also need it to make sure parents can follow instructions. Pills should be taken three times a day with food. Well, will there be food in the house?

Beyond this, however, the AAP wants pediatricians to become familiar with food assistance sources in the community so they can make referrals. It envisions the screening and readiness to link families in need as a regular part of medical education.

And beyond this, it alludes to specialized training that has led to partnerships between pediatrics clinics and both social workers and pro bono attorneys.

Attorneys supplied by law firms and legal aid societies have helped parents resolve diverse problems that directly and indirectly affect their children’s health, e.g., loss of benefits they’re entitled too, substandard housing, unmet needs for special education.

This broader approach to children’s health recalls the nonprofit I’ve blogged on that partners with hospitals and clinics to secure and fill “prescriptions” for more healthful and secure living conditions.

The AAP’s recommendation could, in the best of worlds, expand the project model to a major sector of our healthcare system, shifting its focus from care to health, as the project’s founder intends.

There’d be ripple effects beyond the immediate health of children. Better health and better economic prospects for them as adults. Better health for their parents too.

Still not the be-all and end-all. The food insecurity pediatricians would identify, the further needs social workers would surface and make referrals for, the problems attorneys would tackle are all rooted in poverty — the “causes of causes,” as we’re told epidemiologists refer to it.

We’re not going to cure poverty by ensuring that malnourished children have enough of the right kinds of things to eat and a warm, mold-free place to live. But having many thousands more widely respected, vocal champions could make a difference.

 


DC Child Welfare Agency Will Treat “Traumas” of Child Poverty

November 19, 2012

Policy consultant and blogger Susie Cambria calls our attention to a grant the District of Columbia’s Child and Family Services Agency recently received.

The grant, says CFSA, will help it “make trauma-informed treatment the foundation of serving children and youth in the District [sic] child welfare system.”

The approach sounds like a good thing, but it’s far beyond my capacity to assess.

The reason I write about it is rather what Mindy Good, CFSA’s public information officer, told Cambria about the traumatic events children have experienced by the time they become part of the agency’s caseload.

Some are cases we could confidently classify as abuse, e.g., severe physical punishment, molesting.

Others bespeak neglect that could call for at least a temporary rescue, e.g., having to rely on a parent or other caretaker whose behavior is “erratic” due to substance abuse or untreated mental illness.

But many are simply consequences of living in a family that’s desperately poor, e.g., “not knowing where the next meal is coming from,” “being homeless or moving a great deal.”

Good alludes to getting the child to safety as a first step. This seems to mean, in most cases, removing children from their parents or other caretakers — itself a traumatic experience, as she notes.

Perhaps even the first traumatic experience they have. It’s by no means clear, for example, that the mere fact of living doubled up with first one family and then another induces emotional and/or behavioral problems.

Last year, CFSA confirmed about 873 cases of child neglect — 58% of all the incidents it substantiated. In 2010, neglect (unspecified) was the primary reason it put 395 children into foster care.

One can’t help wondering how many of them weren’t really neglected at all — children in food insecure families, for example, or in homeless families the District wouldn’t shelter.

Or children being cared for by strangers or tasked with caring for younger sibs — two other “traumatic events” Good cites.

There’s a ready remedy for these “traumas.” And it’s not being put into foster care.

If children justifiably fear hunger, their parents or guardians obviously need food stamps — or if they’re not eligible, assurance that their children often are.

Perhaps they also need cash assistance, since we know that food stamps often don’t cover the costs of even the U.S. Department of Agriculture’s cheapest meal plan.

If children are homeless, their families need affordable housing. Same if the family moves frequently because it has to rely on the hospitality of friends and relatives.

If children get parked with strangers or have to shoulder inappropriate child care responsibilities, perhaps the family needs a voucher to pay for daycare — and access to a provider who’ll care for kids early, late and on unpredicable schedules.

CFSA can advise families how to seek these kinds of help. And it may now be doing so, since it reports a new response model, which, in some cases, “leads to service options the family can choose to accept.”

But, of course, seeking isn’t receiving.

As recently as 2010, CFSA cited “inadequate housing” as the primary reason it put some children into foster care. Telling their parents they could apply for housing assistance would be futile, since they’d merely join the many thousands of households on the waiting list.

Though parents might enroll in the Temporary Assistance for Needy Family’s program, the cash benefits would leave them in dire poverty — perhaps still unable to stretch their food budgets till the end of the month.

They’d be eligible for child care assistance, but they might not be able to find it because the District’s provider reimbursement rates have led to a severe shortage of available slots, especially for very young children and those with disabilities.

CFSA’s new treatment approach may help children overcome whatever traumas they’ve experienced because their parents can’t afford to provide them with safe, stable housing, regular meals and the like. But it’s a second-best solution.

Perhaps the best CFSA can do, however, because our system defines “child welfare” as protection from abuse and neglect.

It’s up to other agencies — and ultimately to our elected officials — to ensure that the poor children in our community have what they need to fare well.

Or rather, it’s ultimately up to us since we’re the ones who elected them. Don’t think as many of us as could are doing as much as we might, though some are giving their all and more.


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