Food Insecurity and Child Malnutrition in the United States

Children and the elderly are at increased risk for malnutrition, an affliction that takes place when a patient's body is deprived of the vitamins, minerals and other nutrients needed to sustain healthy tissue and organ function. Unfortunately, millions of children in the United States reside in households where food insecurity is a constant issue. The problem of food insecurity has gotten worse in the years since the official end of the Great Recession. Specialties Pediatric Article

Food Insecurity and Child Malnutrition in the United States

Emily, a 9-year-old with a cinnamon skin tone and a strikingly angular face dotted by a set of chocolate-colored eyes, sits inside an examination room at the local children's outreach clinic. She comes to the clinic once a month with her siblings to have routine labs drawn and to be seen by the program's sole pediatrician, Dr. Graham.

Emily lives with her mother, stepfather and two younger brothers in a cramped one-bedroom apartment located in the southeast section of a large central Californian city where nearly one-quarter of residents' household incomes fall below the federal poverty line. Her mother works mornings as a cashier at a gas station during the week and earns extra money as a cocktail waitress on weekend nights. From the middle of March until the end of October her stepfather mows yards in an affluent suburb for a local lawn service, and during the winter months he picks up odd day labor jobs to supplement the family's income. Emily's family does not qualify for many forms of public assistance since the annual household income of $38,000 exceeds poverty level guidelines for a five-member home. Her parents receive monthly WIC vouchers for her three-year-old brother that can be redeemed for specific grocery items such as eggs, cheese, milk and cereal. However, this form of assistance will cease soon after the boy reaches his fifth birthday.

Dr. Graham glances at Emily's lab results. The albumin, prealbumin and total protein are all low. The serum iron, ferritin, TIBC, B12, folate, and other labs are all low. With a height of 4'9" and a weight of 77 pounds, Emily is very underweight. The objective and subjective indications come together to paint a picture of malnutrition, a condition that Dr. Graham has been noticing more and more in children and elderly patients during this languid economic period.

The doctor inquires, "What do you usually eat in a normal day, Emily?"

The girl pauses for a moment. Her parents have instructed her to screen all responses carefully because of their fear of authorities removing the children from their custody if it is discovered that the household runs out of food several days before payday. She fibs, "I eat toast, eggs and fruit for breakfast, whatever the school gives out for lunch, and chicken, spinach and rolls for dinner."

Dr. Graham suspects the streetwise Emily of lying. After completing her examination of the three siblings, she gives her parents a pamphlet with the addresses of local churches that offer free meals on certain days of the week. She also thanks the parents for bringing the kids in regularly.

According to the Johns Hopkins Children's Center, malnutrition occurs when the body is deprived of the vitamins, minerals and other nutrients needed to sustain healthy tissue and organ function. A balanced diet is required in order to obtain these nutrients, but millions of children in the United States live in homes where food insecurity is a pervasive problem. Recent statistics indicate that 13 million children in this country are in households where access to an adequate quantity of food is restricted. The problem of food insecurity has only worsened in the jobless recovery that has followed the depths of the Great Recession.

Many working poor families in higher cost-of-living areas are disproportionately affected by food insecurity since annual earnings tend to be slightly above the federal poverty line, but increased costs for housing, food and utilities rapidly consume residents' net pay. In addition, numerous working poor families earn a little too much to qualify for forms of public assistance such as food stamps. The heads of these households often choose between paying rent and keeping the family sufficiently fed.


Malnutrition | Johns Hopkins Children's Center

Malnutrition Impairs U.S. Children’s Health, Behavior - LSU AgCenter


TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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Specializes in Pedi.

Uhhh... 77 lbs isn't underweight for a 9 yr old. 50th percentile for a 9 yr old female is around 60 lbs. A height of 4' 9" isn't really a typical height for a 9 yr old... that would put this child above the 95th percentile for height. BMI isn't that useful of a tool for children. She's on the growth curve.

That aside, the overall message of this article is true. Unhealthy foods are far cheaper than the healthy alternatives. Can't even count the number of times I've seen a young mother giving a baby soda in a bottle. You can buy a 2L store brand bottle of soda for under a dollar. Can't get any milk for that cheap.

Specializes in Pediatrics, Emergency, Trauma.

Unhealthy foods are far cheaper than the healthy alternatives. Can't even count the number of times I've seen a young mother giving a baby soda in a bottle. You can buy a 2L store brand bottle of soda for under a dollar. Can't get any milk for that cheap.

That's the real issue in fight back against malnutrition, and even obesity; why are the healthiest foods sooo expensive; or some communities that have to travel distances to get food? If healthier choices were affordable, would there be such a public health epidemic?

Specializes in Pediatrics, Emergency, Trauma.

Unless you live in my area and have to think between a meal and bills; living pay check to paycheck style, then it is NOT a myth... It IS expensive: bread cost 3 dollars, milk 4 eggs 2 dollars; rent for a 1 bedroom is 1000/month in a well lit neighborhood; gas can be up to four dollars in the poorest neighborhoods. Some grocery stores do not have the best or the freshest food, making it more of a travel to get fresh foods. I have to travel outside of my area to buy fresh fruits and vegetables; or have to pay a "membership" yearly to get the gluten free products that I need and get more bang for my buck. It is expensive and my local news channel really out it into perspective that broken down, it is the high sodium simple carb foods that are cheaper than the "fresh" foods. I'm talking actuals...not national averages...REALITY.

The USDA need to look into the poorest areas; the areas with the ACTUAL loss of income, THEN they will sing a different tune. :blink:

Specializes in Pedi.

FWIW, I've never seen an ear of corn for $0.25 nor I have I ever seen a box of veggie burgers for $3. And, I agree with LadyFree28. I live in a major city. My neighborhood borders a very nice, well-to-do part of the city and, on the other side, a part of the city known for its high crime rate. The supermarket on the bad side has a terrible produce selection- I went there ONCE after I moved here 2 1/2 years ago and realized that there was not one good vegetable in the store. The supermarket I currently go to- on the better side of the neighborhood- is beautiful and has excellent produce selections. Both are between 1-2 miles from my house. Public transportation is not great in these residential neighborhoods and it would take 2 buses- that don't run often- to get from the bad supermarket to the nice one. There has been a movement in the city to get SNAP benefits accepted at Farmers' Markets but not all markets have the capacity to accommodate that. Most of my patients live in the city, in public housing, the projects, etc. Most of them have parents with very little education. Many of them also have parents who would prioritize buying a $10 pack of Marlboro reds/day over buying good food.

Specializes in Pediatrics, Emergency, Trauma.

Thanks Kel. My black bean veggie burgers at BJ's cost 7 bucks. ;)

Last time I saw an ear of corn .25; 1986 as a CHILD in CA...that's when a gallon of milk was .89... Came to the east coast 2 years later; similar costs...milk stayed steady until the 2000s, then the essentials went up for "inflation" and "gas costs", lol :cheeky:

I live in a pretty nice area, away from downtown yet the stores are iffy at best, unfortunately, forcing me to either travel outside of my neighborhood, or if I want the farmers market fruits and vegetables and other essentials, I have to go downtown, and pay 5 (would be 8 dollars round trip on bus/subway) dollars for a round trip ticket on the safe train to save money on 12 dollars parking inside a parking garage because my city's on-street parking situation SUCKS. Even public transportation has cut back where it isn't reliable either-at one time busses ran 10-15 minutes; now they run 20-30 minutes, hence the option or the "nicer" train rides with the "quiet cars" than the unsanitary subway UNLESS necessary. By car, I can get to places 15-30 minutes tops in the greater city area, so it's not a hassle, but when I did not have access to a vehicle, it could be up to two hours to get things done; never mind if you had other places to go, running back and forth home with tons of bags-not fun; especially when you WANT to have the food available in your own neighborhood. It can be downright ridiculous.

It's all actual economics that I have to do.

you don't need milk and you don't need bread. and lack of supply, is partially at least related to lack of demand.

In the summertime when we've got corn coming out of our ears, it is easy to find "4 ears for a dollar". Obviously other times of the year would be harder.

I buy veggie burgers - love the black bean ones - and they are around $3.00 a box.

I have a hard time with believing that every piece of produce in a grocery store is bad. I worked in a small store when I was younger and yes, the manager did keep out some produce way past it's time but there was still produce that could be used. Also, there are canned and frozen veggies to chose from.

Personally, I always buy what is on sale. Yesterday I found a good sale on a good brand of veggies and bought a bunch of cans. I'm not a fan of canned veggies and prefer fresh but I can use them in soups or casseroles.

I still think, with proper education, people could buy healthier food and it wouldn't cost more than junk food.

From the USAToday link:

"The price of potato chips is nearly twice as expensive as the price of carrots by portion size," she says.

Overall, the economists found:•When considering portion size, the ranking from least to most expensive is: grains, dairy, vegetables, fruit, protein and less healthy foods. Protein and less healthy foods are very close in cost.•Grains, such as bread, oatmeal, pasta and rice, are the cheapest foods no matter how you measure by portion, weight or calories.•Protein, such as meat, chicken and fish, is the most expensive food by portion size, but there are low-cost proteins such as beans and eggs.•When looking at price per portion, fruits and vegetables are lower in price overall than unhealthy foods. "Like every food group, there are cheap veggies and fruits, and pricey ones," Carlson says. "Cheap unhealthy foods and more expensive ones."

I'll betcha that a bag of Lay's Potato chips in any store is still more than the price of carrots if you go by portion size. Fresh carrots are pretty darn cheap if you stay away from the baby carrots and even those aren't bad.

I don't live in a fancy city with Trader Joes and Costco nearby. Our stores gouge us a bit due to being up in the mountains (same with the gas stations). But, there are always sales going on and I consistently only buy stuff on sale. In every category, there are sales. You have to be a savvy buyer. It isn't hard.

I still believe that it is a myth that good nutritious food is more costly than junk food.

Specializes in PACU, pre/postoperative, ortho.

That's what's great about my small rural community. Many people have gardens & some sell at corner stands during summer. There's so much in a good year that people give it away. A neighbor down the street was going house to house giving fresh corn away this summer because it was more than they could use. Lots of people hunt deer but can't use all the meat.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I still believe that it is a myth that good nutritious food is more costly than junk food.
Your aforementioned example shows the buying power of $10. Having grown up in a household that was 'food insecure,' I can show anyone how to stretch $10 with anything other than a couple of bags of the frozen foods that were shown in the image.

1. Pack of 10 hot dogs. . . . . . . .$0.99

2. Pack of 8 hot dog buns. . . . . .$0.99

3. Ramen noodles (6 pack) . . . . .$0.99

4. Russet potatoes (10 lb sack). .$2.99

5. Medium eggs (1 dozen) . . . . . $1.19

6. Head of lettuce. . . . . . . . . . .$1.19

7. Generic salad dressing . . . . . .$0.99

8. Apples (1 pound). . . . . . . . . .$0.88


GRAND TOTAL . . . . . . . . . . . . $10.21

Starchy foods and certain processed food items tend to be cheaper than their healthier counterparts. My aforementioned food budget, while not healthy or balanced by any stretch of the imagination, could last a family of four one week if portioned very carefully.

Specializes in ICU, LTACH, Internal Medicine.

Store-brand 5 pound/bag of vitamin-enriched white flour costs around $1.99 where I live. Same of whole-wheat costs $2.49. Yeast is $ 0.99/pack of three. Salt is almost free. These plus some water, and you'll get more than enough fiber, vitamins-B group, and protein-enriched, home-baked sourdough bread for a family of five for a whole week for less than $7 total, including electricity and water. 10 lbs. bag of chicken leg quarters goes for $6 in Walmart nationwide. Bag of dried beans (equals up to 8 15 oz. cans) costs between $1 and $2 there.

I can understand that people may not have money on gourmet or special healthy foods, but their "inability" to get basics like above and cook them is, IMH(onest)O is pretty close to being plain lazy and not willing to learn cooking beyond pushing "defrost" button on microwave. If I can do it all while working full time, they sure could do it too.