Like all pediatricians, Dr. Lori Smith keep tabs on many aspects of her patients’ health, but until recently the Westport-based doctor didn’t always consider whether the children she sees might be going hungry.
“It wasn’t something that was necessarily on our radar,” she said. While her practice treats some lower-income patients from nearby Norwalk and Bridgeport, most of the children Smith and her colleagues see come from relatively affluent families.
But Smith, who has been a pediatrician for more than 16 years, and her colleagues recently began screening all patients—regardless of their household income—for food insecurity, part of a new effort doctors and advocates hope will help prevent childhood hunger.
The American Academy of Pediatrics (AAP) in October recommended that pediatricians screen all patients for hunger at well visits. In a policy statement, the group advised pediatricians to add two questions to those they ask caregivers or children at well visits: Whether, in the past year, they worried about food running out before they had money to buy more; and whether, in the past year, food they bought did not last and they could not afford to get more.
Hunger affects various age groups in Connecticut but is especially prevalent among children; according to Chicago-based advocacy group Feeding America.
Feeding America’s “Map the Meal Gap 2015” study, which examined data from between 2009 and 2013, found that 13.6 percent of Connecticut’s overall population was food insecure but 19 percent of Connecticut children were. That means more than 152,000 children statewide were food insecure, according to the report.
While many Connecticut doctors who serve low-income communities have been screening for a while, the new push likely marks a shift for those who don’t cater to high-risk patients, according to Jillian Wood, executive director of the Connecticut AAP chapter.
Prior to the new recommendation, Connecticut pediatricians anecdotally seemed to ask mainly higher-risk patients about food insecurity, she said, whereas the new recommendation is for all families to be screened.
There is no data on how many families in the state currently are screened, since there is no particular billing code for it, Wood noted.
At Smith’s Westport practice, patients or caregivers are now asked directly about food insecurity, in addition to other questions assessing children’s health and safety.
“We did implement a new screening program,” she said. Screenings began several weeks ago in the wake of the AAP recommendation. “We haven’t used it enough to really get a ton of feedback.”
Screening at pediatrician visits is an important step in combating a prevalent problem in Connecticut and elsewhere, said Lucy Nolan, executive director at Hartford-based advocacy group End Hunger Connecticut.
“It acknowledges that [hunger] is an issue,” she said. “It creates a way for something to be done about it. To have the AAP go out and sort of take the lead on this, I think, is very helpful. If we ignore [the problem], it’s not going to go away.”
When pediatricians discover food insecurity in a household, the AAP recommends they connect the family to local resources that can help. Doing so, the group says, can help stave off an array of physical, emotional and behavioral consequences of hunger.
While it put the onus on pediatricians to act when they notice food insecurity, “it’s a very good idea to have it on the radar because you might not know these things unless you ask,” said Dr. Allyson Driggers, chief of pediatric ambulatory medicine at the Bridgeport campus of Yale-New Haven Children’s Hospital.
She and her staff work with a Greater Bridgeport population at high risk for food insecurity, she said.
“In a lot of ways, pediatricians are in a good spot because patients do see them on a regular basis, so they’re in a good spot to try to identify a lot of things and a lot of problems,” Driggers said.
Hunger can have various adverse effects on children, according to the AAP, including poorer health and a greater tendency toward depression and suicidal thoughts compared with food-secure children. Those who are hungry also are more likely to struggle in school and have behavioral issues, according to the group.
Pediatricians are well-positioned to ask families about food insecurity, since families trust them and doctors can ask sensitive questions in a non-judgmental way, said Dr. Marjorie Rosenthal, associate research scientist in the pediatrics department at Yale School of Medicine and a pediatrician at the Yale-New Haven Hospital, Primary Care Center in New Haven.
“We form strong bonds with families,” she said, and the doctors typically see children at a series of well-child visits.
At the Primary Care Center, pediatricians screen for hunger at certain well visits: when children are 2 months, 15 months, 30 months, 6 years, 10 years, 14 years and 18 years old. Doctors began formally screening last year, though they had been informally screening for much longer, she added.
“We see many people living in poverty,” Rosenthal said. “We already screen and we are committed to it. Starting the conversation is important. For the family who experiences food insecurity, that family needs to know that health care providers are trying to help.”
The AAP recommendation is a meaningful first step, said Paul Shipman, marketing and communications director at the Wallingford-based Connecticut Food Bank, which also has a warehouse in Fairfield.
“Good nutrition is important for the physical and mental health of children,” he said. “Children and their parents or guardians may be reluctant to self-identify as hungry. Giving pediatricians guidance on questions that can assess child hunger and connecting families to local resources are important steps in raising awareness of the problem and getting people the help they need.”