Data from the Early Childhood Longitudinal Study, Birth Cohort showed that mothers (with an infant) who were suffering from depression had a significantly increased risk of food insecurity.13 To better identify infants at risk of food insecurity, it would be beneficial to identify women suffering from depression during pregnancy or postpartum.13 These patients could then be referred to WIC and for SNAP benefits.
What you can do. The American Academy of Pediatrics recommends that physicians identify families that are food-insecure by conducting a validated14 2-question survey about food insecurity at every health-maintenance visit, as long as the child is a patient in the practice (TABLE 1).15 Physicians can then refer families that screen positively to local WIC and SNAP centers.
Ideally, physicians should be prepared to facilitate more active engagement by providing patients with the contact information of staff members working in such local programs. Staffing the practice with a patient-care manager can be an efficient way to navigate this process.
CASE Over the 6 weeks following Ms. D’s visit with you, she is admitted 5 times to the hospital in diabetic ketoacidosis, always with a significantly elevated blood glucose level. At each admission, she admits to “sometimes forgetting” to take insulin. Hospital staff members do not ask about her food intake. During each hospitalization, Ms. D is treated with insulin and intravenous fluids and discharged to home on her prior insulin regimen.
During a follow-up appointment with you and the clinic’s nurse–care manager, she talks about missing doses of insulin. She tells you that she has been getting food from the local food pantry, where available stocks are typically carbohydrate-based, including bread, rice, and cereal. She admits that she cannot afford other kinds of food—specifically, those that contain protein and monosaturated and polyunsaturated fats.
