Food Insecurity, Health, and Development in Children Under Age Four Years.

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.

Nutritional and growth issues related to child neglect.

Child neglect and obesity are major public health problems that undermine children's health and contribute to lifelong disparities. Most of the past research has focused on relations between child neglect and failure to thrive. This article finds that evidence linking child neglect with obesity is mixed. In a recent meta-analysis, five of the eight studies reviewed did not find an increased risk of obesity among neglected children. The case study and three longitudinal studies that reported a relationship between neglect and obesity were conducted among young children, and used caregiver or teacher/clinician definitions of neglect, rather than referrals to state protective service agencies. Dysregulation of the neuroendocrine system associated with neglect has been implicated, but further research is needed to understand the mechanisms that may increase children's risk for obesity. Findings suggest that under some conditions neglect may increase the risk for excessive weight gain, and that high body mass index may be an indicator of possible neglect. By exploring both possibilities, clinicians can promote children's healthy growth and development and prevent subsequent health disparities.