Children's experiences of food insecurity (FI) may be conceptually distinct and different from those of adults. Previous study of children's experiences of FI has relied primarily on their parents' perspective. This study explored, described, and conceptualized experiences of FI in children attending 5 public schools in peri-urban areas of the Miranda State, Venezuela, South America using a naturalistic approach. Children aged 10-17 y were studied through focus groups (n = 42) and individual interviews (n = 13). Interviews were recorded, transcribed, and analyzed using grounded theory. Children were cognitively aware of FI, worry in their parents, and causes both external and internal to their households. Children were also emotionally aware of FI, with feelings of concern, anguish, and sadness, and manifestations such as crying. Children reported being physically hungry, experiencing reduced quantity and quality of food intake, having smaller meals, and recognizing thinness and fainting as consequences. Children's responses to FI included reduction of quality and quantity of food, child labor, sacrifice in food consumption, food from waste, support from extended family members, and strategies for purchasing, acquiring, preparing, and cooking food. Children were not always protected, especially when the head of the family was unemployed, had drug-alcohol problems, or was extremely poor. Protection could come from parents to children and from older children to parents and younger children. Children should have certain access to food that is dignified, timely, efficient, and adequate in harmonious social conditions to prevent and resolve situations that compromise their physical, cognitive, and socio-emotional well-being.

Household food insecurity has substantial detrimental effects on children, but little is known about the mechanisms through which these effects occur. This study investigated some possible mechanisms by examining associations of food insecurity reported by children and mothers with daily activities, school absenteeism, and stunting. We conducted a cross-sectional study in a nonprobabilistic sample of 131 mother-child pairs from a poor peri-urban area in Miranda State, Venezuela. We assessed food insecurity in children by using an instrument developed through a naturalistic approach that had 10 items for food insecurity and 9 items for management strategies. To obtain mothers' reports of food insecurity, a previously validated 12-item instrument was used. Children's daily activities, school absenteeism, and stunting were measured. Chi-square tests for contingency tables and logistic and multiple regression analyses were used to test associations of food insecurity with outcomes. There was no association between mothers' reports of food-insecurity and any child outcome. Children's reports of food insecurity were associated with higher odds of doing passive home chores (OR: 1.17; 95% CI: 1.02, 1.32), cooking at home (OR: 1.21; 95% CI: 1.05, 1,38), taking care of siblings (OR: 1.15; 95% CI: 1.01, 1.31), and doing labor (OR: 1.22; 95% CI: 1.04, 1.42) and lower odds of playing video games (OR: 0.86; 95% CI: 0.76, 0.98) (all P < 0.03). Children's reports of management strategies were associated with 5 of 7 work activities measured. Labor in food-insecure children was the main activity that explained school absenteeism. Food insecurity reported by children can be assessed by pediatricians, school personnel, and other practitioners by using a simple instrument to identify food-insecure children and to respond to mitigate their food insecurity and its consequences.

Coexistence of food insecurity and obesity is expected given that both are consequences of economic and social disadvantage. Food insecurity and obesity are positively associated in adult women but not men. There is some evidence of association in adolescents, but mixed results for children. Distinct from adults, children experience cognitive, emotional, and physical awareness of food insecurity and take responsibility for it by participating in adult strategies, initiating their own strategies, and taking action to obtain additional food or money for food. Food insecurity is detrimental for children, being associated with behavior problems, disrupted social interactions, compromised school performance and attendance, poor dietary intake and physical activity, altered daily activities, and poor health. Some of these outcomes increase the risk of developing obesity. From life course, cumulative inequality, and developmental perspectives, child food insecurity may have long-term effects, including on risk of obesity. Pediatricians can help identify and respond to children who are food-insecure and at risk of obesity.

The shame that children experience associated with food insecurity, and actions that they take to alleviate it, is not known. We aimed to examine the associations among food insecurity in children, their management strategies to alleviate it, and the shame arising when their lack of food is known by others. We conducted a cross‐sectional study, with a non‐probabilistic sample of 404 children from a poor area in Caracas, Venezuela. We assessed food insecurity in children using two instruments developed through a naturalistic approach that had 10 items for food insecurity and 11 items for management strategies. We asked children if they felt shame when they are out of food. Food insecurity in children was associated with shame of others knowing they were out of food (γ=0.37, p<0.01). Nine out of 11 management strategies were significantly associated (p<0.05) with feeling of shame of being out of food. Girls from 13‐17 years were most likely to report shame when they also reported lack of food, had the refrigerator empty, wanted to eat more but could not, or had to eat the same food every day (p<0.01). Understanding the interrelations between shame and food insecurity is important to understand the detrimental effects of food insecurity on children and to improve delivery of socially acceptable programs and policies aimed at increases access to food for children in vulnerable populations.

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