Nearly a quarter of California households with children are affected by food insecurity (1) -- almost double the level prior to the COVID-19 pandemic. Given the lasting negative impacts this has on children’s health, addressing our growing food insecurity catastrophe is essential.

Defined by the USDA as limited or uncertain access to nutritionally adequate food, food insecurity is associated with several negative health outcomes in children, many of which are related to brain development. The most important and intense period of brain development occurs from conception to a child’s third birthday (2). If a pregnant mom and her baby are undernourished during this period, the baby misses out on key brain development that cannot be recouped later in life. This developmental loss is associated with increased family medical costs, challenges in child educational achievement, and lower lifetime wages (3, 4).

Fortunately, there are established nutritional programs that promote food security, support breastfeeding, and encourage appropriate transitional and toddler nutrition, all of which facilitate optimal brain development and growth during this critical period (5). It’s more important than ever that these vital programs be promoted and strengthened.

Women, Infants and Children

Women, Infants and Children (WIC) is a supplemental nutrition program for pregnant and postpartum women, infants, and children. It includes purchasing assistance for healthy food, breastfeeding support, and tailored nutrition counseling. WIC can help stave off the negative health impacts of food insecurity and also is associated with better birth outcomes and other important enhancements of brain development (6, 7).

WIC also helps families monitor children’s growth, development, and nutritional status. Since children who are food insecure have higher rates of iron deficiency anemia, which can negatively impact growth and development, it is important to monitor for anemia and increase consumption of iron-rich foods, like beans, whole grains, and leafy greens. WIC can help with this monitoring and support, but enrollment in WIC after delivery and especially after a baby’s first year, tends to drop off significantly (5). Less than half of eligible two-year-olds and only a quarter of eligible four-year-olds participate in the program (8). Pediatricians and family practice physicians should identify families eligible for WIC and encourage them to continue accessing the program even after their baby turns one.

During the COVID-19 pandemic, California WIC recipients received almost four times the usual vegetable and fruit cash-value benefit ($9 → $35). This helped mitigate food insecurity and increased families’ access to high quality foods that promote health. However, this benefit expired last month (9). We must urge Congress to renew this increased benefit.

Child and Adult Care Food Program

It is important to expose children to a wide variety of flavors, textures, and foods. Infants and toddlers are more likely to eat foods they see their peers and family members eating. Since children can spend up to 50 hours a week with someone other than their parents, childcare providers have an important role in shaping young children’s eating patterns and development.

The Child and Adult Care Food Program (CACFP) aims to improve the quality of food served for young children enrolled in daycare and early childhood education programs and increases children’s exposure to nutrition best practices. Unfortunately, since 2012, California funding for CACFP has been abysmal, causing many childcare centers and family childcare homes to drop out due to their inability to cover the costs. The COVID-19 pandemic has led to more than 50% of childcare providers running out of food.

Thanks to statewide advocacy, the 2021-2022 California budget includes $15 million for healthy meals served in childcare and early education programs (10, 11). Now, we must encourage childcare and early education programs to re-enroll in CACFP.

Advocating for federal and local programs for maternal, fetal, and neonatal nutrition, like WIC and CACFP, is critical to help ensure pregnant moms, children, and families thrive.

Dr. Emma Steinberg is a pediatrician and certified chef. She teaches culturally-informed culinary medicine to medical trainees, patients, and staff.  For the last six years, Dr. Steinberg has also worked with Bay Area community members, elected officials, schools, and health care providers to advise on and implement programs to reduce food insecurity and improve health equity. 

References

1. Schanzenbach, D and Tome, N. Visualizing Food Insecurity Food Insecurity: Weekly Food Insecurity Rates During COVID-19. https://www.ipr.northwestern.edu/state-food-insecurity.html. Last accessed 30 Sept 2021.
2. Fox SE, Levitt P, Nelson CA III. How the timing and quality of early experiences influence the development of brain architecture. Child Dev. 2010;81(1):28–40
3. Zambrano E, Ibáñez C, Martínez- Samayoa PM, Lomas-Soria C, Durand- Carbajal M, Rodríguez-González GL. Maternal obesity: lifelong metabolic outcomes for offspring from poor developmental trajectories during the perinatal period. Arch Med Res. 2016;47(1):1–12
4. Walker SP, Wachs TD, Gardner JM, et al; International Child Development Steering Group. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007;369(9556):145–157
5. Schwarzenberg SJ, Georgieff MK, and Committee on Nutrition. Advocacy for Improving Nutrition in the First 100 Days To Support Childhood Development and Adult Health. Pediatrics 2018; 141; 2. DOI: 10.1542/peds.2017-3716.
6. Black MM, Cutts DB, Frank DA, et al; Children’s Sentinel Nutritional Assessment Program Study Group. Special supplemental nutrition program for women, infants, and children participation and infants’ growth and health: a multisite surveillance study. Pediatrics. 2004;114(1):169–176
7. Breastfeeding and the use of Human Milk. American Academy of Pediatrics Policy Statement. March 2012.
8. National and State Level Estimates of Special Supplemental Nutrition Program For Women, Infants, And Children (WIC) Eligibles and Program Reach in 2016 (summary). https://fns-prod.azureedge.net/sites/default/files/resource-files/WICEligibles2016-Summary.pdf. Last accessed 23 Sept 2019.
9. Nelson, A. Without Congress’s Help, WIC Vegetable and Fruit Benefit Bump Will Soon Expire. Nourish California Blog. 5 Sept 2021. https://nourishca.org/fresh/blog-category/without-congresss-help-wic-vegetable-and-fruit-benefit-bump-will-soon-expire/. Last accessed 30 Sept 2021.
10. Homel Vitale, E. Access to Food in Early Care Continues to Decline. Nourish California Report. 11 Jan 2019. https://nourishca.org/publications/report/access-to-food-in-early-care-continues-to-decline/. Last accessed 30 Sept 2021.
11. Cannon, M. State Funding for Child Care Meals Finally Realized. Nourish California Impact Stories. 14 Jul 2021. https://nourishca.org/impact-stories/statefundingforchildcaremeals/. Last accessed 30 Sept 2021.