America’s low-income families struggle to protect their children from multiple threats to their health and growth. Many research and advocacy groups explore the health and educational effects of food insecurity, but less is known about these effects on very young children. Children’s HealthWatch, a group of pediatric clinicians and public health researchers, has continuously collected data on the effects of food insecurity alone and in conjunction with other household hardships since 1998. The group’s peer reviewed research has shown that a number of economic risks at the household level, including food, housing and energy insecurity, tend to be correlated. These insecurities alone or in conjunction increase the risk that a young child will suffer various negative health consequences, including increases in lifetime hospitalizations, parental report of fair or poor health,1 or risk for developmental delays.2 Child food insecurity is an incremental risk indicator above and beyond the risk imposed by household-level food insecurity. The Children’sHealthwatch research also suggests public benefits programs modify some of these effects for families experiencing hardships. This empirical evidence is presented in a variety of public venues outside the usual scientific settings, such as congressional hearings, to support the needs of America’s most vulnerable population through policy change. Children’s HealthWatch research supports legislative solutions to food insecurity, including sustained funding for public programs and re-evaluation of the use of the Thrifty Food Plan as the basis of SNAP benefits calculations. Children’s HealthWatch is one of many models to support the American Academy of Pediatrics’ call to “stand up, speak up, and step up for children.”3 No isolated group or single intervention will solve child poverty or multiple hardships. However, working collaboratively each group has a role to play in supporting the health and well-being of young children and their families.

1. Cook JT, Frank DA, Berkowitz C, et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr. 2004;134:1432-1438.

2. Rose-Jacobs R, Black MM, Casey PH, et al. Household food insecurity: associations with at-risk infant and toddler development. Pediatrics. 2008;121:65-72.

3. AAP leader says to stand up, speak up, and step up for child health [news release]. Boston, MA: American Academy of Pediatrics; October 11, 2008. http://www2.aap.org/pressroom/nce/nce08childhealth.htm. Accessed January 1, 2012.

Key Take Away Points

  • Multiple household material hardships including food, housing, and energy insecurity impact child health, growth and development individually and in combination.
  • The youngest children in the “invisible” age group of 0-3 years are the poorest Americans and thus at high risk of experiencing material hardships and associated adverse outcomes.
  • Public benefits programs ameliorate but do not eliminate negative child and maternal outcomes in the face of material hardship.

Author Biography

Katherine M Joyce is the Study Coordinator for the Boston site of Children’s HealthWatch. In this role, she manages IRB protocols, oversees data collection and assists in outreach efforts at the Boston site. Her current research interest concerns the use of the 2006 World Health Organization measurement standards in the United States. Prior to joining Children's HealthWatch, Ms. Joyce worked at The Medical Foundation’s Healthy Girls, Healthy Women! Initiative, employing and empowering young peer leaders to promote healthy eating and activity habits through local community based organizations. Amanda B. Breen, PhD, is the Research Coordinator for the Philadelphia site of Children's HealthWatch at the Center for Hunger-Free Communities, Drexel University School of Public Health. Currently, Dr. Breen is pursuing a Master's degree in Public Health at Drexel University. She received her BA in Psychology from Ithaca College and her PhD in Social Psychology from Temple University. Stephanie Ettinger de Cuba is the Research and Policy Director for Children’s HealthWatch. In this role, she is focused on managing the process of translation of data through analysis into policy-relevant research. Prior to joining Children's HealthWatch, Ms. Ettinger de Cuba worked at Project Bread—the Walk for Hunger, a statewide anti-hunger organization in Massachusetts. Ms. Ettinger de Cuba received her BA from the University of Michigan and her MPH in International Health from Boston University School of Public Health. Dr. John Cook is Associate Professor of Pediatrics at Boston University School of Medicine. Dr. Cook researches food, energy and housing insecurity, and their impacts on the health of young children and their mothers. Dr. Cook is Senior Research Scientist and Principal Investigator with Children’s HealthWatch. He has extensive experience in evaluation of community-based public health programs and consults with Feeding America, the national food bank network, chairing its Technical Advisory Group. Kathleen W. Barrett is the Study Coordinator for the Little Rock site of Children’s HealthWatch. She began her research career at the University of Arkansas for Medical Sciences as study coordinator for the Infant Health & Development Program, a multi-site, longitudinal four-phase study following low birthweight preterm infants through their 18th year of life. She has also coordinated other pediatric research projects, including Medical Home for special needs children, metabolic syndrome in obese adolescents, fat distribution associations with adiponectin in obese adolescent girls, a middle school obesity intervention, asthma management in Head Start children, and outcomes of traumatic injuries. Ms. Barrett received her BSE from the University of Nebraska and her MSE from the University of Central Arkansas. Grace Paik is Project Coordinator at the University of Maryland School of Medicine’s Growth and Nutrition Division in Pediatrics. Her educational background includes Bachelor of Science degrees in neurobiology/physiology and psychology from the University of Maryland, College Park. She coordinates the Baltimore site of Children’s HealthWatch, a multi-site research study that monitors the impact of economic conditions and public policies on the health and well-being of young children. Her primary research interests are early childhood poverty, early childhood development and behavior, maternal and child health and nutrition, and urban population health. Natasha Rishi was the Data Research Assistant for Children’s HealthWatch. Prior to joining Children’s HealthWatch, Ms. Rishi was awarded a fellowship by the HRSA Maternal and Child Health Bureau Training Grant that focused specifically on the nutrition and behavioral health status of school-aged children at Dorchester House Multi-Service center in Massachusetts. Ms. Rishi is now working at the Massachusetts Department of Public Health as a program analyst for the Massachusetts Infant Early Childhood Home Visiting Initiative, a provision of the Affordable Care Act. Ms. Rishi received her BS in Kinesiology from the University of Michigan and her MPH in Maternal and Child Health from the Boston University School of Public Health. Ashley Schiffmiller is the Program Coordinator for Children’s HealthWatch. In this role, Ms. Schiffmiller performs all administrative tasks for the Children’s HealthWatch center site. Ms. Schiffmiller started as a Northeastern co-op student in the Grow Clinic for Children at Boston Medical Center and Children’s HealthWatch in 2005. Prior to working for Children’s HealthWatch, Ms. Schiffmiller was an assistant teacher at a daycare and after-school program in Connecticut. She was also a residential counselor at a group home in Brookline, MA. Ms. Schiffmiller received her BS in Psychology from Northeastern University and hopes to get her Master’s and PhD in Child Psychology. Bianca Pullen is a graduate of the University of Chicago, having earned a Bachelor of Arts in Human Development with a focus on social and cultural aspects of medicine. Since August 2008, she has been working as clinic coordinator for the Grow Clinic at Boston Medical Center. Selected to participate in a highly competitive fellowship with the Congressional Hunger Center, Bianca advocated for communities in Boston and the Mississippi Delta facing both malnutrition and obesity. Dr. Deborah Frank graduated from Radcliffe College and Harvard Medical School. In response to a growing number of failure-to-thrive (FTT) families, she founded the Failure to Thrive Program at Boston City Hospital (now the Grow Clinic at Boston Medical Center). The program has served more than 2000 underweight children. A Professor of Pediatrics at Boston University School of Medicine. She is the founder and Principal Investigator of Children’s HealthWatch (www.childrenshealthwatch.org) (formerly Children’s Sentinel Nutritional Assessment Program [C-SNAP]). In 2010 Dr. Frank received the Massachusetts Health Council Outstanding Leadership Award and the Physician Advocacy Merit Award from the Institute on Medicine as a Profession at Columbia University. In 2011 she became the inaugural incumbent of a newly-established Pediatric Professorship in Child Health and Well Being at Boston University School of Medicine.


We are grateful to the families who participated in this study, and the staff in emergency departments and primary care centers that have permitted us to work with their patients. We thank current and past principal investigators Maureen Black, PhD; Timothy Heeren, MD; Diana Cutts, MD; Patrick Casey, MD; Alan Meyers, MD, MPH; Nieves Zaldivar, MD; Martha Wellman, MD; and Carol Berkowitz, MD; for their dedication to this project. We also thank all of the dedicated Children’s HealthWatch interviewers, site coordinators, data analysts, and financial administrators past and present; Ingrid Weiss, MS; Chenelle Christian and Tu Quan, MPH, for bibliographic assistance; Elizabeth March, MCP, as Executive Director emeritus; and Zhaoyan Yang, MA, and Sharon Coleman, MS, for their data management and analysis support. Children's HealthWatch's work on behalf of underserved young children would not be possible without the generous support of private foundations and individual donors. Past and current donors include: Annie E. Casey Foundation, Anthony Spinazzola Foundation, Candle Foundation, Citizens Energy Corporation, Claneil Foundation, Daniel Pitino Foundation, Eos Foundation, Feeding America (formerly America's Second Harvest), Fireman Foundation, Gold Foundation, Gryphon Fund, Beatrice Fox Auerbach Foundation Fund at the Hartford Foundation for Public Giving, Joint Center for Political and Economic Studies Health Policy Institute, The Krupp Family Foundation, Larson Family Foundation, Leaves of Grass Fund, The John D. and Catherine T. MacArthur Foundation, MAZON: A Jewish Response to Hunger, National Fuel Funds Network, New Hampshire Charitable Foundation, Pew Charitable Trusts, Project Bread—The Walk For Hunger, Sandpiper Philanthropic Foundation, Thomas Wilson Sanitarium for Children of Baltimore City, United States Department of Agriculture, Vitamin Litigation Funding, private donors and major funding from the W.K. Kellogg Foundation.