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

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


Specializes in Pediatrics, Emergency, Trauma.
the biggest thing we can do is to get persons to NOT have children they have no way to support/feed. public health education. etc Yes, I understand that a fair number are in this position d/t the economy, but how many have had more children in the last 4 years, adding to their problems?[/quote']

The birth rate HAD decreased:

We have bigger fish to fry than thinking the birth rate being a cause...pun intended.

Specializes in ICU, LTACH, Internal Medicine.
Do you work 2 full time jobs? Many of these people do. I grew up poor, and food insecure, often times, from around 8 years old on, the person cooking was me. I am far from a rarity, in fact, I'd say my upbringing was pretty standard for a child of the working poor.

8 year-old girl cooking is pretty standard for most of the world beyond The Great Seven, poor and middle class alike. As my grandma used to say, "a girl must sift her first flour before she starts to walk, and knead her first bread before she learns her first prayer". This is still the way of bringing girls up in many, many countries.

I was working two jobs before why doing it all, and will have job and full time school in a few years... maybe I'll settle for buying some more basics instead of making them from scratch, but not for more. Unfortunately, I have several special diets to manage including my own, and 80% of what is sold in typical supermarket is prohibited.

What working person has time to cook down beans?

What working person has time to cook down beans?

Crock pot. ;)

Specializes in medical surgical.

You can cook beans in a crock pot and it is very good.

Specializes in Pediatrics, Emergency, Trauma.
You can cook beans in a crock pot and it is very good.

We're talking about people who have food insecurity, meaning, economic insecurity. Depending on the area and COLA, a decision on buying a crock pot may not be an option if there is no money left after bills and essentials...if one has only five dollars left, which crock pot should they choose, albeit an emergency or needing to fix something, or a for medicine, gas???

Most crock pots are not even 10 dollars in a dollar store or a discount store :no:...

So, which one should they choose? :blink:

I didn't get a crock pot until I was less food insecure, and had more income; I COULD NOT afford a crock pot when I was food insecure, and economic insecure. :no:

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
We're talking about people who have food insecurity, meaning, economic insecurity.
Very salient point. Many food-insecure people do not have (or cannot afford) appropriate cooking facilities such as crock pots, microwaves, grills, stoves, ovens, etc.

In most places there are food banks and churches willing to help, if families don't qualify for food stamps. But most of them should, if they're really low income (although the program is getting cut all the time). I guess I have a slightly cynical view, that lower income people (and those less educated) do not make it a high priority to buy fruits and vegetables. Instant mac and cheese is easier, cheaper, and most kids will eat it without complaining. I think the point some are making here is that if people REALLY wanted to eat healthy, most of them could find a way to do so. I don't doubt that it's more challenging in some communities than others. But as other posters have mentioned, the dried beans are cheap, as are bananas, brown rice, carrots, and wheat bread. For those folks who fall between the cracks and don't have enough to eat, I am very sorry and would be happy to cook for them. :-) But I think in the U.S. that's quite rare, thankfully.

Specializes in Oncology; medical specialty website.
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.

I live in a very agricultural area of the country, where you can drive down the road and get fresh produce at Amish roadside stands. I have never seen corn that cheap, and corn is plentiful in season. There's a wonderful farmers' market in the city as well where you can get straight from the farm produce, but still, it's not all that cheap. Citrus is still very expensive...$1.00 for an orange!

​Unless there's a parent who knows what to do with inexpensive products, they really don't do that much for a family. You have to have someone who can cook and has the time to cook. If you have a family with only one parent who also has to work, that can be a challenge.

I would love to upvote Spidey's mom comment. We need so education in how to cook balanced meals. From dried beans, frozen vegis, and eggs are cheap. If the girl like she said she did it would be a non issue. We need to hold classes that teach how to use dried beans , make bread and tortillas. basic make food from ingredents classes. I took home ec in school it was worthless (this was in the 80's) we didn't learn basics that could be built on we learned to make pizzas from canned biscuits.

Thank you Commuter for bringing a very important subject to light! I have tried to read through most comments so forgive if this was addressed but does anyone know when people receive SNAP do they offer any nutritional classes of information on how to budget or shop for nutritious food? And how about the WIC program? I am a firm believer in educating people. It is to easy to pass judgment on people who have their carts filled with junk food and assume they want to eat that way.

I grew up in the 70s in a working poor and welfare poor neighborhood and everyone cooked, for the most part and we were all skinny kids. I am not sure where the breakdown occurred in nutrition for families; economy, more parents away from the home working?.

I agree, pointing fingers helps nothing. Let's think of solutions instead!

I wish at grocery stores where it would be needed that there would be a nutritionist able to hand out information and do cooking demonstrations;) wishful thinking huh???

Some communities do a community garden.

No child or the elderly, or anyone for that matter!, should go hungry here in breaks my heart:'(

This is what I am talking about; I live actually in the city. Being in home health in several neighborhoods, I am all too familiar with the lack or sub-par grocery stores, as well as when a good grocery store does to a community. :yes:

I live in a medium sized city in the upper south, and one grocery tried to make a go of it downtown on MLK Blvd. The produce did not sell, and the shoplifting losses had the doors closed for good in about a year. Sadly, the mini-mart a block over is still doing a great business in lottery tickets, cigarettes, and alcohol....oh, and pizza and subs.