A 5-year-old child and their parent come to your office for a well checkup. You observe the child as the nursing staff and medical assistant are completing the intake. The intake includes the child’s temperature, weight, height, and blood pressure. Upon visual assessment, the child appears to be doing well. In your chart review, you note that the parent has verbalized concerns about their child related to their reading abilities and asthma. You decide to screen for food insecurity in addition to the vital signs already obtained by your office staff. The gold standard in screening for food insecurity is:
EXPLANATION
There are 3 main screens that exist to identify families/children who lack adequate and sufficient access to food. The Hunger Vital SignTM (2 item screen) was developed in 2010 after being sampled among 30,098 families. The sensitivity was 97% and specificity was 83%. It asks ‘within the past 12 months we worried whether our food would run out before we got money to buy more and within the past 12 months the food we bought just did not last and we did not have money to get more.’ The Household Food Security Scale 18 item screen is considered the gold standard in screening for food insecurity. Families must answer 3/18 questions in the affirmative to be classified as food insecure. The final form is the short form version of the US Household Food security scale. The GAD7 (General Anxiety Disorder Screen) is a screen for anxiety disorder, not food insecurity. Some research has shown that kindergartners who experienced low food security during the preschool years had reduced reading scores, those with low food security at 2 years old had decreased reading performance and decreased math performance, while those who experienced low food security at 9 months old had decreased math scores. Those kindergartners with very low food security during the preschool years had decreased approaches to learning; those with very low food security at 2 years old had increased hyperactivity, conduct problems, and decreased learning and math; and those with very low food security at 9 months old had increased hyperactivity, conduct problems, and reduced reading scores.
REFERENCES
• Johnson AD and Markowitz AJ. Associations Between Household Insecurity In Early Childhood and Children’s Kindergarten Skills. Child Development 2018; 89 (2); e1-e17. DOI:10.1111/cdev.12764. Accessed March 21, 2021.
• Hager ER, Quigg AM, et al. Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics. 2010; 126;e26. DOI:10.1542/peds.2009-3146. Accessed February 21, 2021.
• Suarez L, Cholera R, et al. The Association between Food Insecurity Type and Health-Related Quality of Life in Adolescents and Young Adults in the National Health and Nutrition Examination Survey (NHANES). Pediatrics (2021) 147 (3_MeetingAbstract): 223–224. https://doi.org/10.1542/peds.147.3MA3.223
