Children with chronic conditions may face higher risk of food insecurity, study suggests

Food insecurity is more common among children with a chronic medical condition than those without one, a new study suggests.

The prevalence of food insecurity remained higher in this group even after adjusting for key family and household characteristics, like income, education, and employment status, as described in the Michigan Medicine-led research published in JAMA Network Open.

“Our study suggests that children with chronic conditions should be prioritized in efforts to reduce the harms of food insecurity,” said lead author Nina Hill, M.D., a postdoctoral research fellow in the Susan B. Meister Child Health Evaluation and Research Center (CHEAR) and the National Clinician Scholars Program at University of Michigan.

Hill and colleagues analyzed nationally representative survey data from 2019 to 2023, which included 34,188 U.S. children ages 2–17.

The analysis compared food insecurity rates among children with and without seven chronic conditions included in the annual survey, including asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, developmental delay, intellectual disability, learning disability, and prediabetes/diabetes.

The study also identified a stepwise increase in food insecurity risk: the more chronic conditions a child had, the higher the likelihood their household experienced food insecurity.

Pandemic-era gains were short lived

The authors also analyzed trends in food insecurity over time and found that food insecurity rates improved for both children with and without chronic conditions around 2021.

This is likely in response to COVID-19 pandemic-related policies like the expanded child tax credit and increased Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Assistance Program for Women Infants and Children (WIC) benefits. However, the data showed that when these policies expired, gains were subsequently lost in 2022 and 2023.

While the study establishes an association between chronic conditions and food insecurity among children, it raises questions about the direction of this relationship.

Authors say more research is needed to understand whether food insecurity contributes to the development or worsening of chronic conditions. Alternatively, it is possible that families of children with chronic conditions experience economic instability due to missed work and increased caregiving responsibilities, ultimately resulting in food insecurity.

Food insecurity common in households with children

In the study, food insecurity affected approximately 10% of U.S. households with children ages 2–17. Health consequences of food insecurity for children include increased risks for asthma, anemia, developmental delays, and poor mental health.

The study’s authors say the findings highlight the need to screen for food insecurity in pediatric care, especially among children with chronic conditions, and to connect families to available resources.

They point to programs like SNAP and WIC that may reduce food insecurity and mitigate its adverse health effects.

Health systems and health insurers are also increasingly implementing programs to assist food insecure patients through prescriptions for produce and medically tailored groceries and meals.

Several state Medicaid programs have piloted programs to address health-related social needs as well, the most common of which is food insecurity.

“Our findings highlight how critical it is to protect and strengthen national policies to address food insecurity in children,” Hill said. “Now more than ever, our patients need access to effective nutrition support programs.”

The study was co-authored by Kao-Ping Chua, M.D., Ph.D. a pediatrician and researcher at University of Michigan Health C.S. Mott Children’s Hospital and the director of the CHEAR Center.