Section I: Challenges of and Solutions to Prenatal Hunger
In 1969, the White House held a conference regarding food, nutrition and health, which issued recommendations for supplements to be given to high-risk pregnant women and their infants. That was one factor that lead to the formation of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
According to the USDA website, the mission of WIC is as follows: “WIC serves to safeguard the health of low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating including breastfeeding promotion and support, and referrals to health care”.
WIC was met with initial opposition from the USDA, as they claimed WIC would be redundant with the USDA Commodity Supplemental Food program. Despite the challenges WIC faced in its conception, positive results were recorded from those women and children who received supplements.
Children have seen improved growth, better hematological status and additional advantages to their overall health (Kennedy 1999). However, WIC is not without faults. In a study of WIC participants measuring diet quality, the mean score of 53.9/100 fell into the lower end of the “needs improvement” category.
That indicates subsidies provided by WIC are not so comprehensive as to sufficiently resolve the negative effects of low SES on diet quality (Abu-Saad et al 2010). The determination of the quality of the diet is an integrative assessment of nutritional intake compared to the recommendations for pregnancy established by the United States Department of Agriculture and the Institute of Medicine.
Through more research, it can be determined what junctures are most critical for intervention or attention. Based on findings from animal studies, fetal growth is highly affected by what nutrients are absent or lacking in the maternal diet. These deficiencies are often in essential micronutrients and protein sources during the peri-implantation stage and the stage of rapid placental development.
It means that rather than focusing on the maternal diet during pregnancy in isolation, it would be advantageous to consider the periconceptual and lactation periods as well.
It can be hard to form conclusions about the direct link between maternal and fetal nutrition, as it is “mediated by the mother's habitual dietary intake; her intermediary metabolism and endocrine status; partitioning of nutrients among storage, use, and circulation; the capacity of circulating transport proteins; and cardiovascular adaptations to pregnancy, which determine uterine blood flow."
Additionally, many of the women that might be suffering from hunger or lacking in nutrients during pregnancy might also be exposed to additional risk-factors associated with low SES, such as lead paint and pollution that can also detrimentally affect the development of the fetus and later health of the child.
Despite the complications of drawing direct conclusions regarding maternal nutrition and infant health, there are recommendations issued from the American Dietetic Association and the Dietary Reference Intakes (DRIs) from the Institute of Medicine. These recommendations can differ from woman to woman based upon age, body composition, level of physical activity and other person-specific factors.
One of the most critical dietary components of pregnancy is the energy intake based on kilocalories (1000 calories = 1 kilocalorie).
Energy is required for growth and maintenance of the fetus, the placenta, among other critical tissues. These new formations and the increased mass and respiratory work being performed by the maternal figure account for the rise in pregnant women’s basal metabolic rate (BMR, rate of energy exerted while resting in a relatively neutral state).
Thus, if an expecting mother is not taking in an appropriate and sizable amount of kilocalories, these processes will not be completed to full fruition, leaving the fetus at risk of being born at a dangerously low weight, IUGR (Intrauterine growth restriction) or to experience preterm birth.
Additionally, in order to have optimal conditions for their child’s birth and general health, mothers are suggested to take in high levels of protein, folate, iron and essential fatty-acids (Omega-3s, Omega-6s, etc). Mothers looking for a breakdown of how they can find these micronutrients in foods can find a visual representation of dietary recommendations on the pregnancy MyPlate chart on the Choose MyPlate government site.
Section II: Missing Micronutrients and Child Development
The first years of life for a child play a critical role in fostering key developmental advances while also setting the foundation for a healthy and balanced lifestyle (Biesalski 2016). A vital component of nutrition and development in the formative years of a child are micronutrients, which are essential small quantities of vitamin sources found in whole foods that affect brain development at both the prenatal and postnatal periods.
From birth to the first four months, newborns should only be ingesting breast milk or formula.
The next stages move from formula or breast milk, in addition to pureed fruits, vegetables, meats and iron-fortified cereals, to adding elements such as pureed legumes. Also, further along in their progression, introducing mashed vegetables and finger foods can occur. A major concern is iron deficiency or vitamin D deficiency for children.
Deficiencies in micronutrients for children can occur when micronutrient rich foods are not present in their daily diet.
A balanced diet for children can include animal-source foods or other protein alternatives, vegetables, fruits and grains. Animal-source foods are the only dietary sources of vitamins b12, retinol, bioavailable heme iron, bioavailable zinc and vitamin D (Allen 2014). A diet that incorporates animal-source foods provides children with the opportunity to intake riboflavin, vitamin E, iron, bioavailable zinc, calcium and choline.
However, vegan children can also take in these essential micronutrients from b12 supplement sources and can take in enough protein from legume sources such as lentils and beans. When a child is not receiving an adequate amount of these micronutrients, their brain development as well as overall physical health may decline. It was also found that severe and marginal vitamin A deficiency can increase the risk of morbidity and mortality in children.
If a child shows clinical signs of vitamin A deficiency, then they may experience delayed growth and stunting. After a meta-analysis of vitamin A intervention trials, there was a 23 percent decrease in all-cause mortality rate.
Zinc is a micronutrient, which is vital for DNA and protein synthesis and if a child is zinc deficient, then they may be at risk for “growth failure and delayed secondary sexual maturation.” Infants born before 37 weeks, or “preterm” infants are shown to reap benefits in growth and overall development from zinc administration.
While the data surrounding zinc’s role in human brain function is inconclusive, based on experimentation on animals such as mice, rats and rhesus monkeys, it can be speculated that zinc deficiency gestation can impair learning while also reducing memory and attention in their offspring.
Missing or inadequate sources of micronutrients in a child’s diet contributes to a cyclical pattern of disadvantage for students, as they may have difficulty focusing in class when hungry or may be absent more frequently when sick. As defined by the USDA, food insecurity has two different levels: low food security, which reports of reduced quality, variety or desirability of diet, and little or no indication of reduced food intake compared to low food security, which reports of multiple indications of disrupted eating patterns and reduced food intake.
There are two other levels of food security that the USDA examines: “high food security which is when there are no reported indications of food-access problems or limitations and marginal food security when there are one or two reported indications — typically of anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake.”
Households are evaluated according to the 18 questions in the Core Food Security Module (CFSM). According to a report from the journal of health economics in 2009, "children in households with food insecurity are more likely to have poor health, psychosocial problems, frequent stomachaches and headaches, increased odds of being hospitalized, greater propensities to have seen a psychologist, behavior problems, worse developmental outcomes, more chronic illnesses, impaired functioning, impaired mental proficiency, and higher levels of iron deficiency with anemia. Perhaps paradoxically, food insecurity has also been associated with higher propensities to be obese".
Research following school age children that suffer from food insecurity has shown an association between the food access status and suspension from school, difficulty with having relationships with other children, etc.
It was also found that the more severe and prolonged cases of food insecurity tend to predict greater incidents of behavioral issues, internalizing where the child is sad and feels ashamed of their situation, and externalizing where the child acts out in aggressive or inappropriate means of retaliation.
There was also a link found between low-income households with hungry children being sent into special education programs. Food insecurity was tied to poor scores in math achievement, as well as grade repetition.
Section III: Food Insecurity, Parenting Habits and Health Risks
Poverty and poor nutrition are closely linked, and the connection is multidimensional. Not only is a child who lives in poverty more at risk to be exposed to stress, lack of education, chaos, unsupportive parenting and a pattern of low level education in their family, but they are also at risk of going hungry or being fed foods that have poor nutritional value.
It can pose a grave threat to the hippocampal and amygdala development, which is important for emotion, language and memory. Food insecurity during pregnancy is associated with higher risks of some birth defects.
Households that are food insecure are at higher risk for children to suffer from increased levels of aggression and anxiety, higher probabilities of dysthymia and other mental health issues, higher probabilities of asthma and more instances of oral health problems.
Furthermore, there is recent evidence linking mothers in food insecure households with elevated depressive symptoms.
In a study of parent-child interactions for children at infancy, preschool age and older, it was found that maternal depression was associated with greater hostile and coercive parenting behaviors, especially at infancy age. Additionally, parents experiencing depressive symptoms are less likely to engage in cognitively stimulating activities with their children, potentially are at a higher tendency to provide fewer play materials to their children and are more likely to have a child that develops an insecure attachment.
When compared to non food-insecure children, the diets of food-insecure children are high in fat, refined sugars and sodium and low in fruits, vegetables and fiber. The lack of whole foods can lead to high carbohydrate intake and decreased levels of vitamin, omega-3, fatty acids and iron (Melchior 2012). Children suffering from food insecurity are twice as likely to show consistent hyperactivity or inattention than children who are not food insecure (Melchior 2012).
The issue of hidden hunger is nothing new in the United States, but, it is not an easy problem to go about solving. Many of those children who go hungry while in school do not show visible signs or often, they will not ask for help because they have learned to be silent out of shame from their parents.
Another dimension to the nutritional crisis is the prevalence of fast food chains in low-income neighborhoods. Hunger is more prevalent in low-income populations and therefore, many low-income parents are looking for cheap and easy options to feed their children. In the population, both parents may be working and find fast food to be a convenient solution to their breakfast worries despite the implications these processed and high fat foods might have for their children.
It means that some children that might not be eating enough, might also only be eating fast and processed foods that are void of any nutritional benefits and riddled with disease causing sugars. Some might perceive the clear link between obesity and hunger as counter intuitive or a paradox, as when one thinks about food insecurity, they think of children starving.
While one part of the situation is hunger that leaves children underweight, there is also a fraction of children facing obesity. These children being fed mainly cheap calorie-dense food from corner stores consistently are likely to be at-risk for negative health outcomes related to high levels of fat and sugar, such as obesity and diabetes.
When a child takes in excess calories that are not needed for the amount of physical activity that the child exerts, they can over time become obese. In a recent study, the University of Illinois at Chicago and the University of Arizona found that children in low-income areas are more likely to be targeted in fast food advertising campaigns than children from wealthier communities.
Fast food chains often receive business due to the convenience of their service, which for working parents is ideal when they are on-the-go. Furthermore, these corporations push into lower-income areas to turn profits by marketing options such as a “dollar menu” to tempt nearby residents that are looking to save money on a daily basis.