Food Insecurity in Children but Not in Their Mothers Is Associated with Altered Activities, School Absenteeism, and Stunting

Abstract

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.

The Measurement of Food Insecurity Among Children

“…There is evidence that children age 7 and older can accurately report their food security [3,9], but particularly younger children are less able to report the causes of their experiences. For instance, young children may not be able to distinguish whether a reduction in food quality stems from parental under-employment, crop failure, or increased demand on food resources from extended family or neighbours.…”

“…Child food insecurity is related to hunger and malnutrition, but it also includes experiences of worry, stigma, and shame related to food challenges. It is predictive of severe physiological outcomes such as stunting, but also of the more moderate nutritional deficiencies that precede those severe and sometimes irreversible outcomes [3]. Child food insecurity focuses attention on food, but also on other interconnected domains of children's daily lives, highlighting the role that food plays in children's choices between school and paid work, between their own well-being and their responsibilities to siblings and parents.…”

“…For the child-level approach (i.e., directly measuring child food insecurity) to work, information is needed that builds on and expands the existing qualitative [48,53] and quantitative research [3,8,16] that has been done in the United States and Venezuela. The required process for developing a base of knowledge about domains and potential indicators across countries has been successfully implemented previously to develop international measures and indicators of household food insecurity [41] and of family care [65].…”

“…This can be accomplished quickly and efficiently through focus group or individual interview strategies, added on to existing food-related projects. Fram et al [16] and Bernal et al [3] developed and validated questionnaires to assess child food insecurity asked directly to children that were based on previous qualitative research in the United States and Venezuela. Whether the domains of child experiences of food insecurity that were found in that qualitative research and the questionnaire items developed to assess them are applicable across cultures and contexts needs to be tested.…”

“…Child food insecurity is associated with a range of negative developmental consequences, including behaviour problems, poor health [4], disrupted social interactions, delayed early childhood language development [5], shamefulness [6], poor school performance, absenteeism at school [3,7], lower physical activity [8], altered daily activities [3], poor dietary intake [8], high intake of energy-dense foods [9], less healthy diets, and inadequate intake of micronutrients such as calcium, iron, and zinc [3]. Existing research demonstrates that child food insecurity is both consequential and common, but limitations in the range of countries, contexts, and time points for which data have been collected, and a lack consistency in what is being measured and how, has resulted in incomplete information for addressing child food insecurity, its causes and consequences.…”