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Stanford Medicine

Nutrition, Pediatrics, Public Health

Who’s hungry? You can’t tell by looking

child for hunger post2How can you tell if a child is hungry? Well, looks alone don’t tell the story.

That’s the message of a new photo exhibit on child hunger, which opened May 22 at San Francisco City Hall. The exhibit includes 20 photos of Bay Area children, who all appear to be healthy and well-fed. But half of them qualify as “food insecure,” meaning they and their families often go without enough to eat. In fact, one of four children in California lacks adequate food and may suffer the ache of hunger, what pediatrician Lucy Crain, MD, MPH, and her colleagues are calling a “silent epidemic.”

“I think people don’t want to focus on the prevalence of hunger and poverty. But we have to get it out in the open and acknowledge that it’s there. There shouldn’t be one child that goes to bed hungry for lack of food,” said Crain, who is an adjunct clinical professor of pediatrics at Stanford. Crain helped organize the exhibit, part of a larger campaign of the Child Health Advocacy Committee of the Northern California Chapter of the American Academy of Pediatrics to end childhood hunger.

The campaign was begun in response to the recent recession, when committee members all were reporting increased rates of hunger among their patients, said Lisa Chamberlain, MD, MPH, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford and founder of the advocacy group. Then in 2013, Congress threatened to eliminate the Supplemental Nutrition Assistance Program, which includes food stamps, on which millions of families depend. Congress did decrease the program benefits, with the result that more families and children are hungry and food banks are scrambling to keep up with demand, said Crain, who recently retired from her practice at Lucile Packard Children’s Hospital Stanford, where she treated children with disabilities.

child for hunger postAt one meeting, the pediatrician activists were struck by the fact that it is hard to tell which patients were hungry, noting, “You just can’t tell by looking – it’s all around us.” They decided to draw attention to the problem among legislators and the public at large and increase awareness among pediatricians and other health care professionals, who often fail to screen children for hunger issues. Children who lack adequate food, particularly those younger than age 3, may have developmental problems and are more likely to be in poor health as they grow up, studies show.

To illustrate the problem, the group enlisted the help of San Francisco documentary photographer Karen Ande, who has won awards for her work in photographing children in Africa (Karen happens to be a friend of mine who collaborated with me on a book on AIDS in Africa). She volunteered her time for the project, in which she shot photos of 20 children at a health fair and in neighborhoods in San Francisco. The project team screened the same children for hunger issues using the two most reliable questions from a survey developed by the U.S. Department of Agriculture. Half of the children were found to be food insecure.

“The real power of these photos is that you can’t tell by looking who screened positive for food insecurity and who did not,” said Crain, who is also a clinical professor emerita at UCSF.

The advocacy group is recommending to the American Academy of Pediatrics that its guidelines include screening for food insecurity as part of routine child health visits. If pediatricians know a family has inadequate food, they can refer parents to local resources, such as food banks and food pantries, or encourage them to apply for CalFresh, the state’s food stamp, supplemental nutrition program, Crain said.

As part of its campaign, the group also is preparing posters to be delivered to 2,000 Northern California pediatricians, as well as a BART display of the children’s photos. Collaborators in the project include the Food Security Task Force of the San Francisco Department of Public Health, the San Francisco Food Bank, WIC, CalFresh and the San Francisco Unified School District, all working to help achieve San Francisco Mayor Ed Lee’s goal of eliminating widespread hunger in the city by 2020.

Previously: Could a palm oil tax lower the death rate from cardiovascular disease in India?Lucile Packard joins forces with Ravenswood School District to feed families during the summer breakDoctors tackling child hunger during the summer and Annual federal statistics on children’s well-being released

Photos by Karen Ande

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